00090119 CITY iw +ONO
NPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: \ PERMI r NO.
21103 PATRIOT WY 00090119
OWNER'S NAME. APPLICATION SUR DATE
YANG, MINNA 09/19/2000
PHONE: -873— g9kY6 SANITARY NO. CON'IROI.NO.
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BUILDING PERMIT INFO Q AHCHI'l1iCl'/IiRGINIiI!R: BLDG ELECT PLUMB MliCli
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faaa f t 1=' h L- l -
IF-��i 'LICENSED CON'IRAMOR S DECLARNFION ,IOb Description
OO C I herchyut6mnhm I am licensed under proviAom of Chapter 9(commencing, p
wf to wish Section 70gual Div un Sof the limine-and l'nrlunn:.nn GJu,.unloly lie
<y�< i. nall iv,Cla ad effect,
ADD BATH/SHWR COM , BATH REMODEL
s rc s¢ lice m Clue. Lie.a
F O i(/ Use Cmmmaur
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ARC HI allfo foaled
DECVlir records I anit.rstanll may pl:ms Imam rte used as pnMm rceonls
w to p O LicuneA Pmlcanional
'ON'NIiR-Ii UILDF.H DECLARATION
n �I
W'9—` I M1crtby uffinn Thal I an cen:pl Irnrn Inc Comruumr'n 1dn7ne Iatw fnr the
C Z 2 following mason.IScclion 10175,Iiu.ine..mp we.all Ai .Ill Any any
..Tammy O
s o which reati- quires u,ernn a consweL mins.inhpnnv.Jmnnlish,or repair any xfmnu.:
i
3- prior t.lin 11-cace.aE.rcquircm the applicant for such pericitm file a signed statement
that he is livrnxd pur.uanno the Purvis....of the Cneralur',Littre Uw(Chapter 9 Sq. Ft. Floor Area Valuation
ot,oculocia,w;Ih S,,1417(mbit Or m 3uflhe limimas and profession,Cade)
or that he in exempt therefrom and the beasim for the alleged exemption.Any violation
of Section 7031.5 by any applicant or a perntit eobject,theappli,a ll m a civil pii
of not more than me hundred dollar.($5101. APN Number Occupancy Type
0l.as ow net offe property,or illy employees with wages as their mile clear,staxatimp. 32653 54 00
will do the work,and the wriii i,net intended in nclerical for sale(Sec.7044,
Runimc,amt ilncbs.icr.Codcr The Corm ctoc s License Law Joos nor apply to an Required Inspections
Ill lof proper,Who builds I r rani thereon.and who does such rod himaelf
mugla Ids own enolonyee,.op;i,.ided that such impmwmueots are not intended or 101 — FOUNDATION
offered for sale.If.however,the building or improvement is.sold within ore>car of ..
Impletion,(he owner milder will the burden Ill that held not build of 102 — PIERS
impm.erorpamoeufsale.), 1.03 — UFER
0 1,asowncrof the,ralery,ata excursively contracting with licensed contractorsIn 1.04 — REBAR .
caramct thee project(See 9044.Business and Pmlesvons Cosi ale Comrai _
l.WenscLuedrw.not apply to an owner of Prnpeny who builds or improves theeor' 105. — ANCHOR BOLTS
and whfill amtmcts r such proems with a contmetortm)licensed Pursuant ,,ibe `-
Commcmrs Ji cu,el.aw. 1.06 — SEWER 8• WATER
C,I atm emnhpl under Sec. .B&P C for this recon
ownor Dam , 202 — UNDERFLOOR PLUMBING
WORKER'S CnMPIiNSATION DECLARATION 22.03 — UNDERFLOOR MECHANICAL
I hereby about under Penalty al Perjury one of die fouowmg declarations: 204 — UNDERFLOOR FRAME
❑ I have and will mainml. a Comfi.am of Consent to nalf-rsure for worker's 205 — UNDERFLOOR INSULATION
C.... cn,alion, nI IrtuviJel ILr by ScOG 3700 of the Lahor Code, for lbe
perfbmhanceel the work for which this permit looped. 301 — ROUGH- PLUMBING
01 have;and will maintain Worker's Compensation promise,as reduced by Section 302 — TUB &• OR SHOWER
370g)of the LaMI Cod..En the grmmnmee of rho work fnr which this permit is
issued My Worker's Conpen.mfon In-r:mce cater and Policy member are: 303 — ROUGH MECHANICAL '
carrier: Policyfln: 304 — ROUGH ELECTRICAL
CERTIFICATION 017 EXEMPTION FROM WORKERS' ,05 — FRAME
{a CUMPENSnl'ION b
INSURANCE
Tl III,sect...area mol be coo oplelm if melsonlit lm sur oil.lmni dollars 306 — HOLDOWNS
f kug0orle,.) - 307 — INSULATION
I eertity that in Ile perfmmiance of the wild for which this penmit is issued,1
shall not employ any person in any manner%a as m becomo.subject m the Wider: 308 — SHEET ROCK
C.om"calmilah laws of C.1111-6:1L D'rte 309 — EXTERIOR LATH
Applicant
NCH ICH To APPLICANT:IL allot making his CerJOcae on:as mlrion,4,..0 should •310 — INTERIOR LATH
become mmhjcer a theworkers Compensation pruvismm of the LaMn code.you must
ZO lodwitn comply wuh mace Proyimi:hram or las per:hitt shall no deemod revoked' 31.1 — SCRATCH COAT
f" r^
CONS'FRUCTION LENDING AGENCY 313 — ROOF NAIL
a , 1 hereby anima lbm there is n conamirin I lending agency f he permmeance
of the work fnr whichthis pemm is issued(Sec.3097,Civ.C.) 501 — FINAL ELECTRICAL ENERGY
°mac lLeader's Addirs,mder'sN:lne 502 — FINAL PLUMBING ENERGY
U O I certify that l have readmis application and sae mill the above inPommtimn is 503 — •FINAL MECHANICAL ENERGY
fi E. '.meet.I agroo ah comply with all city and courtly nnlmani and none laws relating .
O U wM:ildingconstnmtion,and betch)authorizerepresenatives ofthis city menter ul"'^ 504 — FINAL BUILDING ENERGY
ta
heMm
weardioned properly Ino aware"..psirls s.
y wo)ngr t..auvc.inal emadyand keep hanmles.the ChymrCoperhioagain, 505 — FINAL ELECTRICAL
V4, liabilities,judgments,costs and expenses which may in any way acme against said
V Z City in canscqucrcc ill the g,i uing of this Permit. —
'� APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Date AS TEST Date �� r
SOW=.Rt�/(aj`,ATIONS. �/ y' NG
'gollkppliunl;ahnr Date L Re-roofs 508 — FINAL MECHANICAL
HAZARDOUS MATERIALS DISCLOSURE
Will we applicant or future fallen,cccupamlone handloIsamilawmaterial Type of Roof 509 — -FINAL 'GRADE
c,accred ri
by the Cup,rill Mucip;d Crde.Chapter 9.12,and the Health and Safety
c«Ie.5�tmn25532od? 510 — FINAL PLANNING
"!°J5i o All roofs shall be1s4ected prlCtrj t,,p•an`y�f.,afeiWNIN Ging installed.
Willmoarplie:m,I,,lnture wi:tgoeampamaeequip:mmrll.doyiee.wmclh If a roof is installed without first o mining an inspection, agree to remove
mail baenrdoue air contaminnnn n J fined by the Bay Arta Air Quality Management
. District? all new materials for inspection. Applicant understands and will comply with
0''e, L all non-point source regulations.
I have read the lava dOo,m:ncrials requirc ictus tinder Chapter 695 of the
California Health&Say Code.Section,25505.25533 and 25534.1 understand that ,/'
iffichuildingdisex", cufetmnJyhuvcmm�unLthan it is my rcnpmsitsillrymnotify rhe /O '� — 0/
acceptant of the requirements which must he met prior to issuance of a Cenificie of
xao Iw
Signature f A plicant Dale
r t yob-of
0...ro .
r..l,&i, art Date All roof coverings to be Class "B" or better
OFFICE