02030003-COUNTY CITY
I of c DrnSIONSINOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
13325 STEVENS CANYON CHRISTIE ELECTRIC INC 02030003
OWNER'S NAME: APPLICATION SUB DATE
PETER CONSIGNY 231 O ' CONNER DR 03/01/2002
I PHONE: (800) 779-4956 SANITARY NO. CONTROL NO.
Y C O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
E w- BLDG ELECT PLUMB MECH
be i.0
y i LICENSED CONTRAC TOWS DECLARATION
z_ 1 herchy offiren(hal l ore licensed under pmvial°ns of Chapter 9(commencing Job Description
I-u�i with Sectinn]1f1)1°fDivision 3of the Busin�sjmd P...JeWem Cdaandmyliceme CHANGE OUT 100 AMP SUB PANNEL.
c m I is
Lived,
full anJ eR[1 Jx �O
0 License s U Lic.p
i 3 are Contra
RCHI'1'BCI"S DECL
-"°g 1 unde,ut nd my porn,,l dl be u.m as p It record,
2i
oeo O License)Prolvaional
- OWNER-BUILDER DECLARATION
1 hereby affirm Ihm 1 am esempt front the Contthe...i License Law for the
t z< muuwing rcas°n.(Section 7031.5.Belnes and Prdhssima ewe:Any city nr emimy $2000
s v which requires a permit to cnnamet,alter,improve,demmian,m repair any structure
ld32 ..poor to its issurconam.also miguestn ppf t for suchPer 'u file a signed statement
chat he N,ficcruelp want to the proOf the Contractors License La (Chapter 9 Valuation
(emnincovin,with Seemn.7000)OfD J f the aiciresi dPyyf< tons Code) �.11�• t ic3'r.J.l'].Ib U.lr,/°.:V,V C�.t n:l�l.t.i�`;:
or that nes onih,l Iheref n t and the basis fonhc alleged ricuppoka.A y v°Lxi ret
of Section 7031:5 by any applicant for a perm,subjects the applicanno a civil penalty
of not more lwmftve huncircd dollars(s500). 10 3AIBN liyAlf . . Occupancy Type
❑L as owucr of the properly,or my employee v ith wages as their sole compensation,
will do the work.and the structure is not intended or offered for wee(Sec.7011 - -- -
Business'and'ProfessionsCash:The Courtroom',License Law does.nt.pplyto.n 505 — FINAL EEffi.nI0J0dl4Stions " :r'
owner of property Who builds or improves thereon,and who does such work himself
Or thousb his own employees,provided that such improvements are not in¢nded or I
bffcrcd'fdr-s61Z.IL however.Ih<buildin lis sol)within one of " "'_. ._ _ _..____. .__.__. ..__._. _ ._ . . ._-__._------
completion.
_._.. _ ...._...__.._........... . .
ger nden of pro
completion,the o'n d milder will have the wrath of proving that he did not build or'
improve for purpose of sale.). ,
._. .of the. -It
.._ . . ....Iowa . .. .... .. ... . .._ ._ - _..__ _.._ _ .._.__. ... ...._. ...!__.. _ _ .
❑Las rponec propcnRam cusinissa mmmctingwitCWenude Contrtorslo ..',.1. rI'•
Liccove the reject(See.70is.Business and Professions Cwe:)The Contractor's
License Law does nut apply to an owner of property who builds nr improves thereon.
" -and who contracts mr.such projects with o.convachds)licensed pursu.id m me' A■ ED_.. ......_. .__. _. ._.._....._. . _
C nlmclors License Law. - - _ F� V 4.
❑l am exempt under See. ' .,B&P C Build,mason is)
Owner . . DomMAR® 2002
WORKER'S COMPENSATION DECLARATION
1 hereby offrtm under penalty of perjury one of the following declarations:
O 1 have and will maintain a Ccnificate of Consent m self-insure for Wa kcr's BUILDING
Compensation, as provided for by Section 3700 of the Labor Code, for the
per@nm eae of the work for which this permit is issued.
❑1 hove end will maintain Worker's COmpenwtian Insurance,as mql by Session
37M of the Labor Coale,for the performance of the work for which this peen 1 is
issued.M miser',CO lluji' i n insurance - er,annum�`I
Cart - 'Polk •.r •. s is�'•�•((
. ,CETT CATION OF I ION FR N'OR S' - A .• + � ;?. . .a* Jaira:. s3. s•J.1.
COMPGNSATION INSURANCE
Yrhii'4alnn need not be nornpleted if me reonil is for one hundred dollars
(SI W)or less.)
I certify Ilial in the performance the work for which Ili owed, (v „
shall not employ any person n any manner an as m bccomme subject
n to the Workers "
of Caifornia.Date
-Applicant
'
Ccnsaion Luwe
NOTICE TO APPLICAN3)IL after making this Certificate of Exemption.you should "
become subject the Worker's Compsnwlion provmmd'of the Labor Cwe•you must
.r
Q O fenhwith comply with such provisions or this former shall be deemed revoked. '.
._ ., .. _.. .. .. .. _ __. _. _.. _ ... .. _. ._.. ..
H � ^CONSTRUCTION LENDING AGENCY '
a.' '`I hereby affirm that there is a constmction lending agency for the performance
of Ili ..k'fa, h'h this Permit is issued(Sec.3097.Civ.C.)
Z U.ch Address• ., it.. .•
U.c I certify twl 1 hove read This application and start that the above information is
4W F•' ''6hcn.I agree to eomply,with all city and county ordinances and stale laws relating
0,U rebuilding construction;and hereby oulhorrep
izi resentatives of this city to enter upon
y ry the above-mentioned property for inspection purposes. .
F„ y (We)ago.to save.bullfy and keep hamdea:the City of Cupemno against
LI) liabilities,judgments.costs and expenses which may in any why acme against acid '7 n
U Z
Cit inconseguenceoftbegranting ofdris roods. ^ 7 ll
Pp TANDS'AND WILL CO .Y WITHALLNO`POI { /
R b.' Issued by: Date
Dal Re-roofs
HAZARDOUS MATERIALS DISCLOSURE `
wlllne pprea 1 or future wildingacceptfOnto orn dI hazardousmateral ,. Type of Roof .. .. ... _ . .
as defined by Ili Chloride,Municipal Code.Chapter 9.12.and Ili Health and Safely
Cw Section 25532(x) y, r, a i ( is
f %'F' S t.9 :t i •+:
DY' t'S '�l"° t 1' All roofs shall be inspected prior to any roofing material being mstalleQ.— _ ..
will the mu chat or,fumm budding Occup a equipment or devices xhicn If a roof is installed without first obtaining an inspection,'I agree to remove
cmnM1 d tat,contaminants as dented by the Bay Area Air Quality Management
Di.tocl? all new materials for inspection. Applicant understands and will comply.with
�No all non-point source regulations.
1 have read the hazardous ma¢riti requirements under Chapmr 6.95 of the
Cahomia Health&Safny,Cwe,Sections 25505,25533 and 23531.l understand that
if enc nuilding docs not currcplly haveamnam,that it is my responsibility to notify flit, -
&currant of 7eguircmenls which must be atter r 1O;i4 c
ssuawc of a enihu of
Signature of ApplicantDate _
u ooze agcm' _ le
All roof coverings to be Class "B" or better
n
`i „
OFFICE