02040130 (2) cI oe curE
BUILDING DIVISION INFORMATION:
xun.nc vtSION stoN PERMIT
BUILDING ADDRESS: PERMIT NO.
10708 S TANTAU AVE 02040130
•wNER;NAME: APPLICATION SUB DATE
ALFRED Sc MONICA WONG 04/23/2002
PHONE: SANITARY NO. CONTROL NO.
^ Z ARCHITECDE-NOINEER: BUILDING PERMIT INFO
m O BLDG ELECT PLUMB MECH
u
N Z., LJ 1—I U
O y z LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chuprer,9(commencing Job Description
'_C� isithSection]WO)of Division 3afthe8osvee./andNet, m.Cade dmI DEMO
mor-I is LIa1 1f i and crfrc r
u< Cc< e s Li.a
O y U SIL
[�/ Cmn a ATI �
I 3 u .J+�S 7L Si[R�j"iac UE AT161P�7/✓:,On 1 v a.rood m s shall be uco
sed as public patches,
ia, o
i O O Licenced Professional
a.
X a LL OWNER-BUILDER DECLARATION
1 batch, from aha,I um exempt from the Counufm v License Law for the
L?} following recon.(Section 7031.5,Bu,iness and Professions Coe:Any city or county $8000
IFP whicl reclaimsp , „ he,' P demolish, ep ny structure _
N'.
322
poo w, 'ss 1 u q m th pprc ,f , hpchmiu n 'gnW.taremem .. _. __ _
'hat he is licensed E r tto the,provisions oftheC tmcmh License Law chapter9 Valuation
ne
m°mntng wlnt Suatiun 9(100)of Division 3 ofah Business d Professionso
Ce) {- t: .�i,T+3'i7,D 3'✓V,�`.S».)O.0\].�o 1.,LI i.�f•� :
or that he is exempt treeefrom and the basis for the alleged c6aft ut.Any violation
of Section 7031.5 by any npplican,for a permit subjects the applicant to a civil perulty-
of not more ran five hundred doffars(S5W). NO IYS'l�D INSPEC IONS Occupancy Type
❑I,as owner,of he properly,or my employees with wages as theirsole ronpcmuilm.
will dome work.and the structure is no,intended or offered for sale(Sec:70LI.
Business and Professions Codc:The Contractor's License Law Jae,not apply to an Required Inspections -
owner of pmpeny Who builds or improves thereon.and who does such work himself
or through his own employs,,provided that such improvementssolam not intended
is
offared Tor sale.If fibwevec,he buildin '- tusold:vilhin one 7- �-
completion,the owner-builds will have the burden of proving that he did not buil)or
impnwe fish ryrpoxc of sale,),
[11,its owner of the proem,am Business
controlling with licensed cnmmmers rs ... . ..
_ onnmd the does
(Sec.]tilt Business and Professions Coda)mTheph ves doatur's
License Law d«s not apply man owner of property who builds or improves thereon,
and who contracts for such projec¢with a.commcmr(s)IiccnseJ.puauam.m.the
Contractor's License Law. _ --_------ -- —_- _ -�
❑I am exempt under Sec .B&PC his reams .):Vit:�".' 4
Owner Data
... - WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of pnjuryione of the following declarations:
❑ 1 have and will maintain a Cenificate of Consent to self-insure for Worker's
Compensationas provided for by Section 37W of the Labor Coe, for the
_ p ;crformancc or he work for which his permit is issued.
❑1 have and will maintain Worker's Contptnsation Insurance,as required by Section
37W of the Labor Coda,for the ptrtormance of he work for which this permit is
cT mpC ,yV y por apye co er and PalicY number ore .. f s
CLRTIFICATIDN OP,E%EM 1 N F UMW WORKERS" IA r n•.%, s'
•` 'COMPENSATION INSURANCE
mus section need not he completed if he panni,is for one hundred do]).. "
i
(SI MI)or less.) .
1cemfy,hat in the perform c ofheworCfor.hmhthispc 't s smed'1 jr
hall not employ by peson in any manner so as,o become subject to the Workers t` `
Compensation La's of Cartoon..Date'
--Applicant.
NOTICE TO APPLICANT:If.stair making this Cenilicmc of Exe,ni you sM1ould
become subject,o the Workers Compensation provisions of the Lahr Coe,you must
Q O fonhwith comply with such provisions or this permit shall be deemed rooked.
'F rutCONSTRUCTION LENDING affirAGENCY,
thereby affirm that there mi
i,a comminution lending.gone,bathe performance
of he work for which his permit is issued(See.3060,Civ.C.)
Q
Lender's Name
-.. ._._. ,r.. ..........
Ltiii Address -
f.,) Q 1 ccrify hm 1 have read this application and state to a,he above infommdon is
Q V �whet,.1.,.am comply with all cit and county ordinances and state laws belating
to building mnsuuc,ion.and hereby authorize mirmsendroses of this city to enter upon
rgra the ab°vemctamared Ravi for institution purposes.
gy, (We)agree to save,indemnify and keep harmless the City of Canaria.against
JO banili,ies,judg qs.costs and expenses wh p may in any way accrue against said
C.).z City in const crick of the granting of chit.
APPLICA"t1f DERSTANDS AN If MVPLYWITHALLNONPd " I Date
S OR CU "0' by:
A a t /
g Will he a *am or future buildingoccu am sort or handle havmduus mat Type Re-roofs
HAZA US MATERIA CLOSURE e
material Type of.Roof
as dcfnw by the Cupenm M icipal Cd Chapter9.12 a d the Health end Safety
Coe Sea oa 25531(a) 1t
All roofs shall be inspected prior to_any.roofing_material being installed.
Will m pN lr rcbuilding wpan uscequipment o devices hien If a roof is installed without first obtaining an inspection, I agree tfi remove
imat hazardous air tonummants dcfned by
he Bay Area Air Qaluy Management _._.
Dln Yr - all new materials for inspection. Applicant understands and will comply with
CY "° all non-point source regulations:
1 M1ave cad the hamrd us materials require Heats under Chapter 6,91 of the
Califomi6 a,h&Safety Coc,Sections 15505.25533 and 2553 .1undo tend that
if the Hui gJce>nm turtcndy haven
I.hat it is my res ,ability, otify the
deco" of the m9uirtmenis which t be ran pimr,p j�pu n' f - -
/7/� Signature of Applicant Date
-` ? aamodaea age D t All roof coverings to be Class"B" or better
.._. .., „
., .. ;L.�.:. . ._.. .. . - ... - - OFFICE - - - - --