01120100 CI BUILDINGUDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19055 PENDERGAST AVE JUDY WANG 01120100
,djfiWNER'S NAME: APPLICATION SUB DATE
UDY WANG 19055 PENDERGAST AVE 12/28/2001
NONE: SANITARY NO. CONTROL NO.
Nif ARCHITECT/ENGINEER: BUILDING PERMIT INTO
m O BLDG ELECT PLUMB MECH
LJ GI L-1 I—]
LICENSED CONTRACTOR'S DECLARATION
5�z I hereby Rtrm that I am licensed under provisions ofChapter 9 g Job Description
i m-e Y a pand
(commencing
_t; withSeainnlDum)ofee,. on3ofthcBusinessandPrfessionsCoe,anJmylicense ADDITION OF 456 SQ. FT.
is in full force end effret.
°gDC(1 GARAGE 462 SQ . FT.
�a License ems, use.x
Data Co. sem,
ARCHITECT'SDECLARATION
3 J]6 .t9Rnt sells shall
be u s public records
iv3}F
i p O Licensed Papre sin /J
o OWNER5B ECLARATIII
onsC
='m ercby,
tfrom that 1 am exempt from the Cmttmctor',License Law for the
(:?< following rcazon.(Seen.]031.3.Business and Professions Code:Any city or county
O wh ch q s pcmnu t c n.wa Iter,improv,demolish or rcpmr any stmnurc
n3m .pno ce,oho rcquue-thrittiocant toe Contractors
toicense aw(Chapter9 - - cc:9 .. " -- - - -
t
rlutn t smedpnAtentrgma g isionsoftneCommnonLuenuLow(Chapur9 S Et:1FloorArey.-,a ,. aluation
(camme c 9 lh scow ]000) f Division 3 of the 0 mess qnd Profegstons code) t'%)`R t 9r,t��.'f
or that he Is exempt therefrom and the basis for the aI IzW en miryion.Any violation
-of Section 7031.5-byany applicant fora permit subjcna the applicant to a civil penalty3.7
of not more than five handnal dollar,($500). A umber Occupancy Type
O L as owner afthe pronarry.or an,employee with wages mtheir sole compensation,
.111 do the wok and the stracuture Is"net intended a,offered for sale(Sec '1044,' - -
10-
'Businessand Professions CodeThe Contractor's License Law does not apply to on 1 Q+',2 '�s Q rhncI�071owner of p opcny Who build in mp es thereon and ho does such work h mself ���,or th gh ht own employers proided that such rap ovemc is m tmcnded or 10AJ Roffsed forsole Tr how a the building p tiss Id itA n one yeof 1 4 ARcompletion the owner-ben mer will have the burden of proving that hed d not hu Ider
for Purpose of wleJ. . .._ 1 ,._. BO �T _ ___ .__ _ _ _:nowncr a the pmpeny m cxdusively contrveting witA licenud comtadors to 1 - L+,' & In] ri' •Iconstruct the project(See 7044,Business and Professions Cade)The Contractor',License Law does not apply to an owner of property who wild,or improves thereon, 202 - UNDERFLOOR
,nod who cmdocu her such pmjeus with.a commensals).licensed puuuam.to.We ___ .-
Cmunt,t°r,ucenseLaw. . -" $03'--UNDERFLOOR-MECHANICAli
0 l amexempt under Sec.'' " ' ,B&P C for this rcomn 204 - UNDERFLOOR' 'FRAME'
Owner' " Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
lhercby affiant ander Penalty otpeijnry one of the(snowing declarations: 301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
0 I have and will smoiain a Cenmcaieof Consent to ulbinmm for worker'a 303 - ROUGH MECHANICAL
C°mpensutim. asProvidedfor by Section 3700 of the Labor Code, for the
performance of worktor ._;nmisprmitiaiamod. 304 - ROUGH ELECTRICAL
01 have end will'minum knorker's Compenwiion'Insurnnce,hs required by Section 305 - FRAME
37W'of the Labor Code,for the performance of the work'for'which this pelmh is 306 - HOLDOWNS
iksodd My W k Ys C mpena tipn Into are ca ier and Pul y w e
C:6 yQ, a Pau<yN 30,7.jy,o INSULATION; - ' at'.r,
_.,,CERTIFICATION OF EXEMPTION FROMIWORKERS'� (' j .,� r(. ll
COMPENS_ATIO_N INSURANCE:"`°"•+ ' 308 aSHEETROCK''
(5100)or lesc)iisn treed not be co '-"-._....,.._ m �n•.. ..._. _._-__
_., 3.0.9..i„_.;;EXTERIOR”"LATH._ _---'----- _ -----------
r.
"4Thilsec mpicoed it the permit is for one hundred dollar, C'�; p.r:i•
310 - INTERIOR LATH .
'`rtl Ic nP Yw�Yn y ohhc work(or which thspc ris'ismed l' .. 311:'.- SCRATCH,,-COAT - .
shell riotemploy
m I an rson n an manna so as r becorne sub3cct to the Wo k m 313 - ROOF NAIL''
PPS y pM rinse e - 501- FINAL- ELECTRICAL-ENERGY
- - - .-Compensation
om nsation La s of Cal f mr are
A 1
Can',
NOTICETOAPPLICANTIfaf..on ingl isCnnCate o(Ese pbon you should rr
become, b)ecn Ne WorkersCompe sat npro eonsottheLabor Rc yWormi 502 - FINAL PLUMBING ENERGY
OO mnnnhcmply till enpott orthspermtehnllbedemed ked, .503.. -_.FINAL- MECHANICAL._ENERGY
FFF2lll 4 �- t CONSTRUCTION LENDING AGENCY
F=� ':' the by Nf6n that the adwsvpcton lendn egehejm me pearomiance 504 - FINAL BUILDING ;ENERGY,','
w-> of the work forhich tms'permlt. issued Sed.3097��.c) ,. _ ._•r�_._;,,,. -,. _ . ,,. . 505 . .FINAL ELECTRICAL—'
rs., z -"IAnderarvmn .: 506 - GAS TEST
.^� Lender Add
.V-OIcesty that lh ,re ad this epyliwt nand state Nat the above informaion ix 507 - FINAL PLUMBING
0 w,F 0arectol agree to comply with all city and count,me inances ad son,laws relating 508 - FINAL MECHANICAL
C.7 to building construction,and hereby aurhorize represenradves of this city m enter upon
W the above-romicned property far inspection Purpose;.. 509 - FINAL GRADE
y (W) gne.'ve sae d nify and kip hxrmlesnhe City ofCai,nRoo aIgainst -
I hal,I t a m..e,,cost,e d xpcnses which may in any ay accrue against said 5 1 0 F I NA PL I NG
V onsegenco'Lflheg ming of Nis ppeermit -
LICANTUWERSTAND N6E ILL COMPLYk'ttF1ALLNONp01N'(r` 14 N IC WORKS
URCE GULATIONS Issued b5y: Date
ignamle y Ie pejoMOumaat ERIAL$Oi9CLO a Re-COOT$
PP p
SURE
1 Ne eppitcent or famous ben Id ng aaupent store or handle heuNous memdal -Type of Roof -...
as def or b the C p p and the Health d Safety
Code Dye.-c25j321a! t]No T e ya .w - + 1.. Fs}lt t.'.Yu t.t,
shall be Inspected
All roofs .pnor to any roofing matenal being,installed.
Will the applicant orfumrcbu'Idingocc p t ucqup t or devices whch If a roof is installed'without first obtaining an inspection',I agree toiremove
,tor hazardoo
us u conummants as defined by the Bay Arca Air Quality Mmen
anaget
District? ' all new materials for inspection__ Applicant understands and will comply with
°Ye` °No all non=point source regulations,, .,,, "
fl'i't 1 ha a ead'the hamrdous mmerials regaircments`under Chapter 6.93.-6f the
Czlifomta Health&Sofa y Code;Sectidtu 25505,25533 and 25534.1-una,anand thin
Wilt Wild not currently haveatenant that t smy rcsponabd ry ro notify rhe - - - - "' - - "_ -"
or nt of Ip rcqu hich usilbe et p r to isso a of a Ccnifents of '
o` °`y (lam ' Signature of Applicant Date
r, -~ caner or authorizede -
(I All roof coverings to be Class"B"or better
r
u
OFFICE