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02040008 CI BUILDINGmyON RTPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 6212 SHADYGROVE DR 02040008 OWNER'S NAME: APPLICATION SUB DATE ESTHED YANG 04/02/2002 PHONE: SANITARY NO. CONTROL NO. ez ARCHITECf/ENGINER: BUILDING PLIVol r INPO F.z 0 C BLDG ELECT PLUMB MECH r d w L=1 r_U C:_l y¢c w2 LICENSED CONTRACTOR'S DECLARATION Job Description z=o I,ma70.Ram that I am licensed under previsions of Chapter 9(commencing p „C,� witns<ea°InoomlorDroLion3nnheaut�nlx.anaPmresxmnaCode.altdmyfi<emse CLEAR OUT ACCESS SEWER. imyn ' Tautea ana erre< liC c m0 i u 4Ts Lic.. 4 fie C.aamcor e . mn i 3 u G AHCHITECI"S DEC ATION u O a 1 dcrnun� vh a aIWILx used ns limit records Limnscd Pndessinna� - m w OIUILDER DECLARATION 1 hereby.(lien the,atI ma1. .Burin s�n the Can tmes Cos License Law,for the which moreason.(ern 7U31.5.Business improve. Professions Code:Any city orruunry $850 I x O which rcquirts n perms to construe.ober,improve,demolish,ar repot(.ny structure V Pfarm lift oaten the fthc suchFrmr s.fit signcdstmememther a3°O "pr'ortoe issmt al.nrequires the a..in mfor suchpecou, filen m{a pSe a -p Ormnso screw lChepmr9 S �,,<,Dpr�a Valuation (commencing xnh Semiont]n of Division3n 'he Business and Pmr<..ions Coo<) `Oti.'� �3rr�4Ff:( C4"'.::-W:9�'ti�. 'E ;ilk. ei that he is exempt theiefmin end the basis for the alllgetl exemption.Any violation - - of Stttion]031.5 by any applicaa fur a permit rid of the apphoam e.a civil penalry- 'of no(mine man five hundred dollars($500). 10(5PN '9� & WATER .'.'oro. Occupancy Type ❑I,as owner or the pmpeny,or my employees with wages as their sole compensation. -will do the work,and the structure is not intended of'ofered for sale(Sec.000.1, Business and Professions Core:The Contractor's License Law does not apply to an 301 - ROUGH P204*ifMspections'' owner of property Who Wilds or improves thereon,and who docs such work himself ofthrough his own employees.prow ided that suchimprovementsarenot imelwer or 302 - TUB & OR SHOWER. brt<aa Rtr xw�'Ir.nbwxv<r.me remain -'--- o.orad wdnm ons - r . .. .... ......'__-_-_ '.— .--.-.-.-.- --.-_ - geburdeovcnien aro 502 - FINAL PLUMBING ENERGY " •tL'r t iompinion,the owncr�huildcr will have the burden of proving that he did not build or ' mprovemrpurpoaenfsale.). 506 - GAS TEST _..._. -y or gw;' - - --507-----FINAL--PLUMBING.......--- ... -'-7-L !1__, - - - ... - ❑1,m r or the pmpeny,am exclusive tmcun th licensed conwetom m - b ! :. comtme the project(Sec.700.1,Business and Professions Code:)no Contract.,, License Law dues not up,ly to as°caner of p,.,.y who builds or improves thereon, :. L ._and who.comects for-such projects with a.contmetor(s)licensed pursuant to Ne. _ _ ___ _ _ Comracwrs License Iaw.. F'INgLE ❑lam exempt under$tt. .B&P C for ibis reason I('.. - -t 1d'L ownce Date ' NPR 0 3 2002 WORKER'S COMPENSATION DECLARATION I hcrtby affirm under penalty of perjury ono of the following declarations: ❑ I have .ad will maintain a Cenificne of Cause., to sel6intare for Worker's BUILDING Comp<mmion, as provided dor by Section 3700 of the Labor Code, for the p<rri mta ice of the weak for which this permit m issued. ❑1 have and will maintain Wooker's Compensation Inamence,ss required by Section 3700 of the Labor Cale,for the performance of the work'for which this permit is issued:My Worler's'Compensation lnmmnce carrier and Policy number are: mor: policCERTIFICATION OF EXEMPTION FROM WORKERS"if: � � �'•e '• I ,�a �.t.l t l.�t F1'3ti+..I f. '.4,x`,'1: '' 'I, 1 COMPENSATION INSURANCE ' .O .. --._.........._.. __— (This sacnodneed net be completed film perms,s for one hundred dollars , I , (Simpler less.) n I may rh t rh pert oma of the work for whichm pe 1 L.ueJ 1 shall t cm 1 /my\:y,' [ s toy)��co b c u th W°A rs Cmmpe Ile aWi ef�.'.Jf .L11enM{� �✓ U ) . Apple M�(�f r .NOTI E APPLICANT if she aking the Cenrficate or Exemption.you should I nc2wne'si,njca tothe Faker's C, tpcnsaiioi,provisions ofthe Labe,Cole.You most Q R forthwith comply with such provisions or this permit shall be deemed rtveka. E-4 t •t CONSTRUCTION LENDING AGENCY - 1 he by ffrro to, h s onunecti leading.gen y r the performance t > '1 W,> bribe work frh'ch the pidanit is issued'(Sc3097•Cis.C.) ;D,z Lenders Address, V Q s y,I codify that I have mad this application and state that the above information is tat;E.. c'oden.l agree m comply verb.II city ad ,,.a,,.airman.,and stale laws misting to building consminion,ana hereby iodation mpesenudves of this city to enter upon the move-mentioned propmy for inspection purposes. - F (W'e)agmen sox;mdemnify and keep harmlesi the Chi of Cuperiirio.gainst F' h liabilities,judgments,costs and expenses which may in any way acerae ago nst said U z City in co sequence of g t of this permiC APPLIC 'ONDE A A DWI oh1PLYN'IYFfALCNONPOINT' Issued by: r Date SOl C ULA - y' Si time.IfI elmou �[grey/(by��d�in"g>ERIALSmit6ie�hSiMlc �NoL� Re-roofs PP '•. SURE pp, aamasbraiceel Type of Roof - _ - asdeandbytb Cre M 'p1Cod Chapter 912 no th H 1th dSarmy ;, .I c -.• - -' _ _-v,`I code season 25s32(a) t �r •"t 1 f !' , "fi : 17 Yes ` z a "'+ _ All roofs sliall,be inspected'prior_I any-roofing material being.installed.. , - _ .. Will the applicant f building occupant equipment devices which If a roof is installed without first obtaining an inspection;'I agree tdremove emir-hazardous air contaminants as defined by the Bay Area Air Qat iy Management Dutdet7 'I' all new materials for inspection. Applicant.understands and will comply with _ '� - :­;Y - all non-point source regulations. . -•ai.:• 1 ti vc rcad the brizardistis'mameabi requirements under Chapter 695 of the California Health&Safety Cads.Seenimax 25505:25533 and 25534.1 umdcrstand that f eb Id gdoes of officialyh is t f th ayys ti h h must be m If p to Issue c of a Ced Bcata'of /V\f we •' � •�L Signature of Applicant Date w m,agenr' Date All roof coverings to be Class "W' or better st. "r.'aa . : . 1 .-OFFICE - - _.- . . .. . .. .