02080097 OF
CI BUILD NG DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
Y6TNgjDD9sMERSET DR TROJAN REMODELING & DESIGN INCO2080097
nM CHUNG 681 ELDEN DR APPLIG6[`Q75TV71) 002
PHONE: (408) 371-9179 SANITARY NO. / L CONTROL NO.
n&O ARCHITEC)ENGINEER: a BUILDING PERMIT INFO
E ❑❑ BLDG ELECT PLUMB MECH
Lao 1--_ 1' G-1 IJ
�a�
Z y= LICENSED CONTRACT'OR'S DECLARATIONDescription
MiO
OZ— ction7W)o1 hereby fthuion3I am ofcnscdunder inessaovisiofsof Chapter 9 sionsCde.andmmecense CHANGE OUT SHOWEhg
F,�,L. with Section TOOB)ef Division of Ne Business an Professions Code.and my license
�y txmrml free derv« E08 Z .I ^ 9yrD
6 Liccnu Cl Lic.x '"§'4 e. "
C a U Dm Contra
3 tv ARCHITECT'S DECLAR ON e qq
1 un morrid my plans shall o used as publi records 111 I 1 ZOOL
ZEN l
a c,o Licensed Paofc,sional
OWNER-BUILDER DECLARATION
1 hereby,Ram that I am exempt from the Convector's License Law fm the �' ®O V�r3 5(]O
(:? following t<nson.ISenion]031.5.Business and Professions Code:Any city or county t
o which ma permit t t t Iter reprove,sent or repairany suushoo
t t I :the I tfor such 'u filesigned statement - - - -----
o. P^ 4 pPonso �� g
maths licensed Randomt7"the loo of (Chapter 3'6t9g7(F.0�'IdotQ"Q'ea- p ♦♦'J' C4 Valuation
or mm mmng with Section orif and t e basis o t the Bgntte.. ad oii.Any
Cade) ('i}• y,•a 6 t N S s:a{ S:} i ya: l
or Natio 7 31.5 bt thertrom end the basis fora,the alleged exemption.Any vipi
-of not mo]031.3 iv any applicant fora permit subj«ts Ne opplicanno a civil veto),}
of not mor<man rye hundred donors(ssl>u). 106 APNS`fiYIV$1$t & WATER Occupancy Type
❑I.as owner ofthe pmpmtx or my employees with wages as their sole compensation. 202 - UNDERFLOOR PLUMB ING
—will(to she wink,and the'suvnure is not imetged'orofand for sale(Sm.Tau. -301 - ROUGH PLTWNAns ections
Business and Professions Code:The Contractor's License Law does not apply to an P t
owner of proven}Who wad.,or impmves,h omm,and who does such weak himself 302 - TUB & OR S OWER j
or through his own employees.provided that such improvements arc not intended or
offered for aale:IL however.the Building or mprovement i7sold within unc year of 502, FINAL; -PLUMBING'-ENERGY
completion.the owric-bddder will have the burden of proving that he did not build or 506 - GAS TEST
improve for pur ase of ailed.
,
...._....-_- -.. -. _ .. .cr ,._...__. -. -507-- FI-NAL--PLUMBING - - - - ------
consumer
L as owner once property,em Business}conracdng with licensed c Contracts to i f! v'
_-
License
the project(Sec.7044,ownBuser o and erry who
Cede)Th<Convenor's .t ..
License taw does oat apply to m owner of a.conay who Wilda or seimvmvea.nbaetho
f" .ond.wa License L such projects with a.comm�ags)licenud.pursvnn,.,o toe..._.
01Contractorexe ptundelaw.
❑lam exempt under Sec .B&PCforthis. n 't ell
O!wrm Date'
WORKER'S COMPENSATION DECLARATION
1 hereby arfinn under penalty of crjury one of the following declarations:
❑ 1 have'and will maintain a Certificate of Consent to scl6iman,for Workers
Compensation, as provide) for by Section 37M of the labor Cede, for the
_ perfmmance of the work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as tequimC by Section
3700 of the labor Cale,for Be performance of the work for which thik permit is
ix. ❑.My W rkcrs C Pc. t n Insurance tuner end PT y _w ere:, - a _ -- _ _ ,
1.h t
� " ',CERTIFlCATION OF E%EM FRDM.WORKERs a i' Is l cs s ` t fI
COMPENSA
.' finis section need not In completed if the permit is for one hundred dollars - H• f•, ,, -
(1I00)or less.)
s1 n fy there Ih pr( cc of the work for wM1 hth pe 't Aiswed.i. - �•.. •— •, �-"Y.���•� .•.�•�—. .. 1 „• _. ; .. . . ..
nullnot employ any Perron to any manner in as to bermaso sublea to the Workers -
Compensation L,aw.a of California.Date
.Applicant
tTO APPLICANT:If,after making this Cenificmc of Exemption,you should
z Qbecome subject to the Workers Compensation provisions of the Labor Cale,you m
forthwith comply with such provisions or this .it shall on deemed revoked.
Fe.Ni e" CONSTRUCTION LENDING AGENCY ',
a 1 hereby affirm that there is'a construction lending agency for the pedomtinee
> of the work far which this permit is issued(sec.3010.Civ.C.j. _.,._..._ .... .. _ ._. _ ... ._._... .. . .. _ . .
Q ..Under',Name.. ...,....__ . ........... .. .... .........,.,._.,._,.. __.... . .. __. .. _.._. __..
Z Undcr'x Address . -
f..) 0 I certify Nm 1 have real this application and stem tws Ne arose infoametion is
recf.I agree to comply with all city and county ordinances and nate laws relating
Q'V m wilding construction.and hereby authorize representatimsof Nis city locnt«upon
6 ,he abnvcmentioned Piopeny for inspection puryonen.
(we) ma msave,indemnify a"keep harmless the City of Cupeninb against
(/I liabilities,judgments,costs and expenses which may in any way memo against said
V Z Ciry in conuqu a of the gmming of Nis Permit. v�
.^ APPLICANT N ERSTANDSANDWILLCOMPLYWRH'ALLNON-P INT Issuedb Date
SOURCE RI G'.FTtOR ys
igonm caMContmnoa 4 Re-roofs
- HAZARDOUS MATERIALS DISCLOSUR
lint pPli<antorf wiewilJng«c p t maeo handle hamnlous national Type of Roof ._ .. --•" .:-.
.as definedby,the Cupcnhm Municipal Cade Chapter912 d sheHalth and Safety ,,..,I J•' s
'Cod Section 355RW)' - -t s .. �'i k".p s 9y. sat •;(T C la
❑ate, ATI roofs shall be inspected prior.to.any-.roofing matenal.being installed,
Will the,applicant Franc Witilangoccupant use mp t or eevi<exwhich If a roof is installed without first obtaining an inspection, I agree'to.remove
emit brizardous aire t ants as deflardby the Ray Arco Air Quality Management
District? . lam<� all new materials for inspection. Applicant understands and will comply with,
- : all non-point source regulations...I .,l -
El Yea
I have read the wmoloto material,requircma enunder Chapter 695 of the
California Hmlth&Safety Code SFctlonsi55o5.25533and35534.1 unJersmndtha -
ifthewildim
am"mently have a tenant,that it is- y responsibility m notify the
nimpr f the re uirements which must be met prior to issuance of a Coil of
Occup ncy. Signature of Applicant . Date
/9 0Z _
weer gen, ,ate All roof coverings to be Class `•B" or better
._ ._ ...., -_ ... ... .. . . -- 'OFFICE--. ..- . _ _ .. .. .. ..