02090161 CIBUILDING UPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10640 STOKES AV RUTLEDGE EDWARD J AND DENI E 02090161
OWNER'S NAME: APPLICATION SUB DATE
RUTLEDGE EDWARD J AND DENICE 09/23/2002
PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
qiF BLDG ELECT PLUMB MECH
LJ I--- CI
LICENSED CONTRACT'OR'S DECLARATION
1F-6
Z O 111 z 1 hereby Rmi that I am licensed under f Chapter 9(commencin Job Descriptiopp
cy_o pdPmn=. g REPLACE FURNACE & ADD A/C
P_ru wish Scnion] 1dDivision JoflM Busiltes dProfnsi.m Cak,arW my li<eaze
Y f J is in full Or< d<T(ecl.
z 6 License C Lie.
are Com
nai 3 a I-n ARCHITECT'S D RATION
tai, g I ndersland my plans shell be used pried iemrds
wd 6 p O Licensed Professional
Its
OWNER-BUILDER DECLARATION
�` T hereby alarm shat 1 em exempt from the Conlracsar's Lice.law for the
h?a following reason.(Section 7031.5.Business and Professions Code:Any city or county $1000
Y R❑ which aqui res a permit to construct,alter,improve,demolish,or repair any stmt
iia prior to its"samove.also requires Ne applicant fur suchpewl 10 rile a signed statement. _. ._. .
Wt¢q s I'censed Wes�nl so Thi hlondmis aide,Com..ca's License law(Cloqu r 9
(c°mre, n,with,Som ]WO)ofDivision3oftheBusmc. WProfessi...Cock) 0"'N t32�&y�M� orolQeaj, YY a' ! ,, Valuation
or that he is csempl the7efrom and she basis fer the alleged demgion.Any vrolaunv - - v< ! + as tisk S I l}
of Section 7031.5 by any applicads for a permit subjects the applicant o a civil penally
;of nor male dram five hundred doll.(S500). 3 01 APNftU)l { PLUMB I N Q Occupancy Type
❑I,sowner of the property,or my employees with wages re their sole compensation, 303 ROUGH MECCHANIL L
will do nes..'work:and the stmaode T e is not tracto's Licentended seBared for
essale o (see:t(ga; 3 04 — ROUGH ELpj yi FNG45Q C[IOnS'' '''I"
Bu n i he work.an o th Cade The Contractor's License Law dors not apply m an -"
owner of property Who Wilds or improves thereon and who does such work himself 505 - F I NAL ELECTRICAL
or through his own employees.provided that such Improvements art rot intended.r .--—-
"-.Rend for sate IChowevcr,the Wildin 1 is mid within one-eor of --- _ '..I— --'------------'---�------ -
'cdmplclion,the owncr-huilder will have me burden of proving that he did not)wild or 507 -��--FINAli-��PLUMBING-- i >n,;t, A
impro.erapu,swa.f.ale.). 508 — FINAL MECHANICAL
colas wrier ofthe p(Sevnyam businessadPradin8w+to Iicenuh Connect
consumer the does
project face. too Business and Professions Calca The Connector's _ 1 _
License taw docs nal apply m an owner of property who Wilds or improves thereon.
_.._ ......_._..........
—_......___.—._...__..—.
F.nua t r L ccn Y ..
❑1 c PI ,,d r5 's "` B&PCfonhis reazon ;n'1 .':`-..IVC:C.
MPEN(At16NDLCLARATTON '
.. i r
IherebY offw d pen ltY of Ml rya rf,rhe foil ng declamsinns: 0002
❑ 1 have end will'maintain a Cerifcam of Conuni'ro self-insure for Worker's OCTl• C
C.mpenanceof ore ark provided which this
Section 37W of the faWr-Code, for the
prf°mxn< lhewnrkfa`whi<hlnispwiri`i..udl„ 13UILDING
❑I have and will mal lam Worker's CuinPenmtio i'loommu ce,as required by Section
3700 of the L,Mr Code f the peff°rmans,of the work'f°i which this permit is
rss d:My Worker.Compensnt on Insurm¢e ita^ler it Pofcy number�11 a¢ _
Cam 1 ClN f 1( 1{,•. 'lP.1 cY
M1"It;CERTIFICATION OF EXEMPTION FROM WORKERS'I �I tSti n..
" -COMPENSATION INSURANCE'""a" " "'
rat (Th s sect iso need wm
n.i bepliaeil f the Permit is for one hundred dollars 1"
ISI W)or lcsz.l ,
. . i r. - n. .... ....�,... ,.
Icnmyths in theperf iro.4;;f
l .for wh hlh. pc r"sissued.-I il ' .IH '
shall nal einpluy nny,ps, rflo any mune nrh<cnm,subject Io the Wmkers
C. p[ LI 'IJIW.Of (IOmIe in •r ,� -
'Apel e
INOTIC 'APP A is Ceraticam of Exemption you should x' . 's: ` I
halm so jec °the Wsaker.Catn,cnsnli in provisions of the Labor Cade,you must
Q 0 fonhwith comply'wilh such provisions or this permit shall W deemed revoked.
-_ _ __.- _—. -z'Icna`7 hr' ^ I'sICONSTRUCTION LENDING AGENCY `,. I htmby'1Trm that there is.cort,arasuitef lemadingi gracyfor tnperfnnrce
birthtrick for hi hm Le.dar',Name it.perm) issued(Sc 3(P)]'C C) ""
._.
'-Z Lcndcr'i Address" •.
' 1 1, ..... . . ... ...•.... .. .. it-..1:
1
ominifythatlh read this application esstatet that the h information isn 1 agreet comply wids city and countyordinances and store I ting
Q�ul Wilding construction:and hembY dumxrtpm 'tirvc fth city to enter upon
to We ri ni redp pcny f pees p ryoes
k N I
g cid as indent peaxilk ph Wa rbcCity isC p nisi.g"rad
C6 liabd t o j dg nIs cost si c m,of
both,may�n any y gainst said G
C:7 Z Ciry n conu9 ce f 1 com,of N perm t.
SO RICEREGUD NSuOSA\O WILL COMPLYP'ITHALL\ON- f`1Tn ISSuedby; Date
1. IS ..r a I: Re-roofs
HAZA MUS DISCLOSUREE I,
Wllth applie t futureWilding oecupant store or haraBe� ..u mxte al Type of-Roof.
as defined by the Cu,scroom Muoicipai Code.Chapter 9.12,and me Health andairy - „; 'I ' 101
QCodc SectionQYe '25532(x) - a I 1 :�.'l< i 'li :sY'Z A.1& A e�:l iso'.- I: .. .
^' " : Lr A ;_ , _ . ` All roofs shall be inspected prior to.any_roofing material being installed.—__led.—_-
Will the applicant Forum building oec p s use eq teats t a a.which If a roof is installed without first obtaining an inspection;=)agree.to remove
cout hasmadmis air contaminants as debndbythe Day AmaAir Quality Managent
D 1 t all new materials for inspection., Applicant understands and will,comply-with
°''. all non-point source regulations. . z'-r1 .
,, I have read theh ord- 'inaten T. requirements under Chapter 693 oLihe
Calif rn Health A,Safe,,Cod 5 dmrax 25505 25533 and 25534 1 understand that
-ifrhe buildingdoes mocurrcml have amam.rhar is is m - bilis nnollf she- - - - - - _ - - - - - - - - - - -
Y yrexp.nsi Y Y
occu dam of Ihc.rc rWmenls - riot to is. C'of a CeniGcam of
vw p muss W mel p
Oceu ane ' '
Signature of Applicant . . _-_ - -.- _ _- Date
:
-� o ua eJ agent T Dam a All roof coverings to be Class."B" or better
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..OFFICE -.- _.-..._. . .. .. ....._. _. _.... ......_.. ..-.