01030119 CITY OF CUI'EO CONTRACTOR INFORMATION:
BUILDING DIVISION
su'" PERMIT
BUILDINGADDRESS: _ 1'F:RMI'1'NO. 01,030119
23700 PALOMA CT V-15
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OWNER'S NAME: APPLICATION SUB DA'IC
03/21 /2001
I]ONE: SANITARY No CONTROL NO.
M00ARC]111'ECT/ENGINHFR: / HU ILIANGPERMITINPO
C ❑ HI-0LY Y.LECI' I'LI1MH ME CH
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LICHNSEDCONTRACTOR'Sandr, DECLARATION lob Description
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Z�,C I berchy afhrm that 1 em licenxd under pnwinionx nl ChaPrer 9(cumnvncing
F'4 14 with Section 70(M)nf D,s6n Sof the Basinsco and Ford n.into Codl any license
in full Io rve vat ell'
;%In Lie.k _ REMODEL BATHROOM AND REMODEL INTERIOR
C' G Date pp�11 (}11 cnntraemr _ _
nlfCllll[CI'S DELA ATI )N Ceti�'
I undcraand my,)1a,,lulu be used a,public recorC
d,
w O O Liccmcr Rnle..in,wl '
I%fo OIFAIiR0U11.In DECLARATION ALED
o,W= I M1ereby allirm tha am cxempf train the Q,mranor's License Law lirt the
s-a a follwing remnn.ISa,inn]n3 L5,tlusincsz and R,dcssion.CWc AnY city fir tummy
C
F m wh ch I permit t , , Iter. p I fish p Y t 'tare
pr on f eL y ,1 m,1ic If M1Pa fit 11 'g Lr cit
d3— m.,n I Ipuaa tt ,Iup n, ran c tt , ,.L to pmr9 Sy. Ft. Floor Area tuul Valuation
tcammenntng with Secfinn TXX))of Division l of,hc Busmecs and Prolcnsions Cale)
or that he i,exmnpt Ihco,t'rom and the basis for the allegol exemption.Any violation 7
of Scctinn 903 L9 M1y any applicant fix n pem,il suhjccts thu u,),)locum w u elvl)penally
of nor none than Fivehundred dollaaa5al). APN Number ING Occupancy ype
Ll 1.asnwar,ol fioprnpel,aruuy employee,with wages as Ocir.nmcnmpenannal, a', e 00
will Jo the work,and the sfaca¢is nal intended or uttered Ibr sale(Sec.71151.
Business and Rafessiotis Calc:Tie Contrucmr',License Law d«,not apply a an Required Inspections
w r fit prulvny Who builds fir Improves thereon,and who doe,such work himself
oror his own eiaployce..prvyiden fit.,snob hnprove rem,are oaf intended, 101 — FOUNDATION
offiml fa sale.If,hnwevc,the building fir improvement is old within one year of
completion,the ownerhuilder%ill have the burden of proving that he did not builder 102 — PIERS ,
impi'ovr liar Piii Ix,m oi,ule.l.
❑1.as owner of the propcn,an exclusively contracting with licenses]contractor m 103 — UFE R
,...le,the project Ne,:.]toy Nantes,sad Irofe.Ga ...
it.Code:) Can .tar, 1.04 — REBAR
Licniu'c Law does nm apply u,an owner of property who bailds or nopeaves thereon,
and who conleaets for such p.,jects with a conamca,(O licensed pursuant a the 1.05 — ANCHOR BOLTS
Coaaaar',Licence Law.
❑las,en,an ,jade,See, .B xr pc far this resat 106 — SEWER & WATER
Owner Date 202 — UNDERFLOOR PLUMBING
WORKER'S COMFENSAnON DECLARATION
203 — UNDERFLOOR MECHANICAL
Ihercby aflimt under penahy of per;ay ane ar etc faunwiag declarnaans: _ 204 — UNDERFLOOR FRAME
❑ I have ant will rantain a CeriifCele.t Consent a,selfinsure for Worker'v
Coittpvnaaon, a, provided lin by Swum Jltr) of me Labor Code, for the 205 — UNDERFLOOR INSULATION
perramtaneeonneworkfarwhichhisKonalisi...ed. 301 — ROUGH PLUMBING
❑I bnve and will maintain Worker's Conlpen,allon Insunince,n,rvyuired by Scctinn
T/ta of the Labor core.for the Niforaance of the work for whim his hermit i, 302 — TUB & OR SHOWER
n,"ed," k``y Corn,et,anu '.ace
carri"_ � P 303 ROUGH MECHANICAL
di
304 ROUGH ELECTRICAL
CER IIBCATION OF EXEMPTION FROM WORKERS*
contepENSATION INSURANCE 305 — FRAME
(rd,ectinnneed not be our,hrd if the lkrtnil is lin one hundred dollars 306 — HOLDOWNS
151(X))or Icss.)
1 mm'dy but in he arli,aatuct,of the wort for,life[,this ncnh i,i...M.1 307 - INSULATION
.hall not employ any,)Kwan in any manner or a,to become subject to the Wooer: 308 — SHEETROCH
Car inpenalio,i law,of CuBforniu.nae
A,h,aa 309 — EXTERIOR LATH
Not ICE TO APPLICAN E If,after.,akia,this Certilicae of Exemption,you should
L bea,ma e subject the Workee,C,,.ens.ti^a pro aomMa m
of the L, Code.oa ti.t 310 — INTERIOR LATH
p loon.i,hcainP1,wid, whproyianm,orthis,vounsh.nbedetailedrevoked.
311 SCRATCH COAT
F ^ CONSTRUCOON LENDING AGENCY
'
C 7 I hereby jinn that there i,a construction lending agency for me paformnaa —
313 ROOF NAIL
althe work Ibr which this per nil is Isvuvd(Su.309].Civ,C.)
y `p Under,Naae 501 — FINAL ELECTRICAL ENERGY
z Leale,',x Adam.` 502 — FINAL PLUMBING ENERGY
U 1 ecoify rev,I hayc read hi..hl,reaaan a"datum that the shave inforinatiat 1.
s — comet.I agree to comply%drh all city and county ordinance,and state laws relating 503 — FINAL MECHANICAL ENERGY
oU ,,IAlam,cnnstriaion.and hereby authorize ec,rc,enotivesofthis city toenter tion504 — FINAL BUILDING ENERGY
r U] the'I'a',namalaned prolxny Wraro,—'a pe rpa.m.
t.a M. (ixe)agrrc,o.ave.ialcaniry and keep haade,the city of Capcma,it, is'
(a liabilities,iud,ment —
x,cozy and cxpenws which ins)in any way wcrve against sail 505 FINAL ELECTRICAL 3` m r
U Cily in couvvvacnce lit he gnnrl.,oldr,,)con,
it SOURC INDEISTS SAN W— COI YWITSALLNgN�POtNT y, 506 — GAS TEST
•sourscP Lys )Ns 1 Issued b Date
PIP
S"nal„re,I pp1'inaiihcouln"I'ir mai Re-roofs —
uA6 RDOUSMAIER1ALSDISCLOgeR1; 508 FINAL MECHRNICRL
Will the applicant or future building a"cu,.t slon,ar handle hvNm
uuus aerhtl Type of Roof 509 — KINAL GRADE
as delined by nae Cnrcnmu Ma nicipia Cale.Chapter 9.12.and me Icalth and Safety 7��
Cale.Section 2553Nu)” �A f QLi �WW ma
❑Ye. "° All roofs shall be't ected rf(CC�iI�' n 1 m8 rial being installed.
Will ifie appuenitl or m„ire[n,iu,Iia„ia.,ilniin oris ey,dl,mtent a,myi.en.niah Ifaroof is insmlle�lw4ithoutIT. 1i lfkSrpeNtragree to remove
nit haeurdau,air conaminxms a,d,lbe d by the It.,Are.Air Quality Mana,nncn,
n,micn all new materials for inspection. Applicant understands and will comply with
11 yes C1 No all non-point source regulations.
I hayc read me hamrdnus ma¢risl,requircm,,nts under Chapter 605 of the
Caloornia llealth h Safety Code.Sections 25505,25533 and 25534.1 understand than
i1 the bailiir,sae.sol......idly nava”h,rena,that h may re.pon..bdity I.....lily flu,
cupaa of the reyuinmcnts which ratio be fact rinno Issuance of a ccoreae of
Octo't_ -y', t I Signature of Applicant Date
iwa o n,adaal aagent Dee All roof coverings to be Class "B”or better
\ \J OFFICE