02070013 INO
CITY ofsDPvSot DIVISION PERMIT CONTRACTOR:INFORMATION:
BUILDING ADDRESS
PAULA AVE MICHAEL YINN / TSENG PAO FEN ,PERMIT NO
YINN / TSENG PAO FEN 22368, SANTA PAULA AVE T
a
APPLICAboyrT�2002
PHONE: SANITARY NO. 11 L/ CONTROL NO.
O a0 oz ARCHITEC(ENGINEER: BUILDING PERMIT INFO
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u z LICENSED CONTRACTOR'S DECLARATION D
soI brrmr cram,mat 1:Im Rrennm nnaer pravixinna arenagter 9¢nmmenring ell'bV b")/02/2 0 02
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=C wi Section 7UWlaf Division 3af the Busiea,,..J Proo,wes Cae.md my license PLANCKRE P FEE P
;xE inmrmlrnreennaerrert. ORIGINAL $02020031
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Data Coated",
u. ARCHITECT'S DECLARATION
�'-"°g I understand my glom shall ate used as puhlir rtcnNx
1 o c
Licensed Pra(exmmnm
c(ay
OWNER m BUILDER DECLARATION
I hereby a(ann that 1 out exempt from the fe si o s Co License Law o for the
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followingreasona(Section]1131.5.Boninessand Professions Code:Any city or county
which requires a genii r t construct,alcor mprme,de nota. or repair any structure
ipdo lo its issuance,also requires the applicant for such permit file a signed statement
oat. he sedpum amt the Division3 eConwnnesLittnulfTors Coal
S Ft. Floor Area„ Valuation
(commeail exe..Sec.on](XNl)of DivisionJol the Bu;nesq arW Profe ,ons Code) 6 yt� •t l� q' 1t �1 n i i�
or that he s eaempi thciefrom nYtd the basis for the alleged a%emptiun.Any violaiom 300'5' 0'67 :60"'
arca more m
blind
.
d .th1.5by anyapplicantfarupermitsWjems tie applicammacivil pcnalry
ath five Honored annam($srlo). APN Number . Occupancy Type
°1,an owner of the property,or my employees with wages as their sole compensation, 101 - FOUNDATION
-will-do the work',"una-the amcture'is not intended or offered for sale(Sec.7044. 1 2 - PIERS
'Business aad Pmfaoions Cale:The Contractor's IJecnu Law does not apply to im Required Inspections
owner of progeny Who builds or improves theme ,and who does such work himself 103 - UFER
or throeph his awn eirq nycen.Provided that such itnprovententa are not intended or
offeree for sale.If.however,the building or improvement is rola within one year of '1 O4 - REBAR
completion,the comer-builder will ban the burden of proving that he did no,build or
improve for purpose ofaale.). 105 - ANCHOR BOLTS
., ... . ..- .. .___. .-- —. 106- - SEWER & WATER.. - ._..
°S,ata owner n o ec p(Sao.1014.exclusively it Poisonous
Co cenuina Cm aon iscon
icaria, aepresent(applyser.7toanoBasilicas eroomaertywhonacaor n:)mprvesthereon, 202 - UNDERFLOOR PLUMBING
u«weLaw n«.mforsuc mrjcts wth propacomywnn wadesei pursuanttothe .203_ UNDERFLOOR MECHANICAL
:..
and who contacts for with a cemmcmris).lic<nsdd -toot..
such projects pursuam m the
01Cimmexe LicenseLaw.Sar. - 204 UNDERFLOOR' FRAME
°lam ex///cm tunJer Sar. B&PCfm thea reason
own _ Date �' -X_. � t: 205 - UNDERFLOOR INSULATION
S MPFIRbgION ECLARATION 301 - ROUGH PLUMBING
• Iherebyalr ofocrjuryone athe follow mgdeclarations: 302 - TUB & OR SHOWER
° 1 have and will maintain a Cenifirole of Consent to self-insuu for Workers 303 - ROUGH MECHANICAL
Compensation. as pmasded for by Section 37W or the Labor Code, far the 304 - ROUGH ELECTRICAL
xu
_ performance of the work for which this permit is isal
°1 have and will maintain Worker's Ccm,mmion Insurance,as required by Section 305 FRAME
37M of the Labor Case:for aa
s performance of tie work for whim this permit is 306 - HOLDOWNS
issued My Wmkcr'a Compenution Insurance entertained Policy number are_: '
CERTIFICATION OF E%.Ifty NON FROM, 307 ,- ',INSULATION
Lamer' 9 r'' y t `'Xn "I
' woRReasl',: ' t F ••a 308'; 11$HBETROCK '-;c'
COMPENSATION.INSURANCE 09� EXTERIOR -LATH'
-' •"Otis secdon need not be camplaed if the pmanit is for me hundred dollars 310 `-v INTERIOR LATH •'
(sllal I ' _ 311.:.-. SCRATCH COAT .
I wt ry hat i�a -n}t .. anhq wmrk tar wn to m, pe 't 'ironed 1 313 - ROOF NAI'L:,I:' .. - •:s',�' ,
ihall n .employ,y hyper of y manner an as to become subject i theWorkers --
CampensI ' I w;x , oma.ume_��2501 - FINAL ELECTRICAL ENERGY
AFpplc t
�ppl"ICf T11 PLI A11711 ofof Lod. ircfEenpt.........Wild 502 - FINAL PLUMBING ENERGY .-
1 catsubject o the k,' C=a p ' ns of the Labor Ca y must
O Forthwith cply a hp ,. ape it hat]Wd e kw _ 503_ - FINAL MECHANICAL ENERGY
'corvs7RucTIory LENDING ncFNcv 504FINAL -BUILDING -ENERGY -
�� •1 .:I
1 by affirm that there is a consteurtion lending agency for the performance
� � ora okr mm�alipmifatxaeasr3o97cw.cr 505 - FINAL ELECTRICAL
z506' GAS TEST
Leda xAaa e. ' 507 - FINAL PLUMBING '
V � 1 unify that I have reed alis application and nam..urne above infoen eha is
Ci u tobuild I ague tr comply with all city and county ordinances and sure laws enter
upon 508 - FINAL MECHANICAL J
O•.p tobuildingconicatedor;pertyfrim,ectimcrepresentatives of this city.o ether upon 509 - FINAL GRADE I/
�,r,g] tie abovee)igionrdproer mder rifyadiohei,hon
a We)asrtetouse.endermicynntlwhihmayintheCity ofcrueniuoaglast 510 - FINAL PLANNING
Vi' liabilities,judgments,cons and expenses which may in any way¢erne agneas.said
tJ- City in ennsequn,<e of the graining of thls permit""'" '
APPLICANT UNDERSTANDS AND WILL COMPLYW PH L N-POINT 514 NA WORKS
t. SOUR GUI:ATIONS: ' - o _ „_ Issued by: Date'
g e fAppl canVL t t - .-Dort " Re-700fS
HAZARD 5 MA ERIALS DISCLOSURE -' 3-
Will ae rapid cant or future Wilding axvpa t star or handle harmdous material Type of Roof
as def a by the C penin Mumc ppp���Code Chapter 9 12.and al Health and Safety
Cod Sena 255121u1 ;J l: k -( 1 ' 1 '• ',_ t* " ,. •.) _.
('/(y\6"° All roofs shall be inspected prior to-any roofing materia] being installed.
worn nNtpa t nine hang < part seequipment oraewiceswatch If a roof is installed without first obtainingan ins ection; I agree-to remove
i emit haze doses n,r cmite man os coed by the Bay Arca An Quality Management P
Diann^ ki all new materials for inspection. Applicant understands and will comply with
°Y """ _ all non-point source regulations: .
Id a tithe hazallo,s.mater ola ugmremeWl under Chapter 6.95 of the
Ca ifem,u Health&Safety Cale,Sections 25505,25533 and 25530.1 understand that
if tie building cars not currently have a tenant,that it is my responsibility to notify the '
occupant of the-requirements which most be met prior to issuance of a Certificate of
Occvpa ' -
�. Lignature of Applicant Date
o near anaariaea esem r All roof coverings to be Class "B"or better'