00100018 cr'UIoF G DIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADURESS: PERMIT NG.
OWNER'S Nl1ME: APPLICATION SUR DA'I'S
JAMESii-25 UPLANP WAY CHRISTIE ELEC RIC INC00100018
WE, - SANITARY NO. CONI ROI,NO,
S9 XWORTHY AV 10/03/2000 -
w O O AHCIII'1'r:C'I'/I? G-PM T PI REL. � RUILIIINO PERMIT'INFO
y. BLDG 17I.ECI' PLUMO MECH
lg'�E —8566
Z SN G LICENSED COMiRACruR'S DECLARATION Job Description
O Z_ I hcrehy affirm that 1 am licensed under Provision.of Chapter 9(commencing
F v,Faa with Section 91XX))nf Uivi.ion3 ifthc loo,me.sund Promwione Ctda,sndnhv license
in in full fora unit If
K s U Done sc Ca� �UV Lic.p 7 �
i<C u Dam S DECLo< rS
3 n.� ARCHITECT'S UECLARAIIUN
A Iunderstand my plans shall be used as public retards REPLACE 200 AMP PANEL/GFI IN BACKYARD/
u O I,ioonsM Professional
UWNERTUILDER DECLARATION
= I hereby affirm that 1 a lIron the Conlrwror'.License Law for the
fallowing reason.(Section 7031.5,Boone, ,and Prfax,i is Code:Any oily lir county
"F❑ wh cl relplims a Perot ttor" II h repair any trachea '
al a pr, t I a l h applicant I pe 't 111 g 1.- t mem
a. oha fic is 1 d,ua, It Ahep :,. l Ine( tona on,Liven,,Law(Chapter 9 Sq. Ft. Floor Area Valuation
Il, g In Secl 9(X)())aImolai: Sot the lh,'as II tssunaCode) p V
lir hal hr N cxcmp,therefrom and the bases for the alleged exemption.Any violation / Z
of Section 911.915 by any mppliminl for n omall ampou the applicnnl In a cieil penalty
of nm more than five hundred dollams S51Xn. A PN Number Dccupancy Type
❑1,as owner of he property,m my employees wilt wages as their sola marremmion.
will do the work,and the amcmm is but imcnded lir ofced for.sale(Sea.Into
nn.ines,and professions Cade:The Contract.,x License Law does ant apply m an — Required Inspections
owner of property Who Wilds or improve,chemo.and who does:uch work himself
hough be,own<mploy«e.provided that weir impmvnnans arc not intended or L_36:618�023.
offered for sake.If,howovr,the Wilding of improvement is sold within one year of
completion,the owne.W ildef will have lire burden of proving that he did not Wild or
improve foe purpose afsalot 304 — ROUGH ELECTRICAL
D 1,as owner of the propery,am exclusively contmning with licensed comments to
construe the
far,at,, and Pone.inn.Codr)The Celmmor. 501: — FINAL ELECTRICAL ENERGY
n pm w ohuuds lir int thereon.
rod vvhn conlmtt%r project,with a cnPropmeemn.o recused pau:tram ,,he 505 — FINAL ELECTR I CAI_
h
ou"
(rater or'x hittnw nes.
D I an,exempt no de,See .a K P C for his mean
owmr Data kzrz
WORKER'S CUNPF.NSAI'I(lN DECLARATION
I hereby ollihm undo a Calty of penury ane tort $it llmving decimations: /O/
t 1 hove and will maintain f Cby Sixc of consort a,xLaborre for Workers • Q
)pen r"'a us provided for by Sminn J91X1 of the Labor Cde, for he lin/
performance of the work for which this p.it is i...ad.
have slid will maintain Worker's Cnmpenwtion Immortal ae reyuited by Saliian O
3]1X1 of the Labor Code,far the pertmandoa of the work for which this permit is /^
orad,My Worker',CCompcmalionnInsumncc carrier and Policy mmnher are:
Crnrricr:"Ifolic,No.:
CLR IIdCATION(D EXEMPTION FROM WORKERS'
CIIMPENSATiON INSURANCIi ,
rI his rection need an be mmplecM II the Perot,is butane hundred mio',
(8100)or lese.l '
I serif,than in the performance of the work fin which this permit is ismcd,I
shall not employ any pc,.a in any manner at,seem become subject un the Worker'
Compensation Laws of Cslif nvia.Data ,
Applicant -
NarICE'rO APPLICANT:If,after making this Certificate of F.aemgion,sena should
hcomsubject m Rcf's the 'urkCompensation provisions of the Labor Code,you mus,
Q OWoman,forhwi,h comply with such proi jmns or this permit shall be deemed invoked.
F ^ CONSTRUCI'[ON LENDI NO AGENCY
Ci > 1 heathy affirm the,here is u ra.,roued.n lending agency for the perfom ence
W
oldie work In,which this perea it is Issued(Sm.VO,Civ.C.)
L Q LrnJer's Name .
D Z Lender'.AJdree,
U Q 1 ccnlfy Chid I base read his npplEcmiou and sure hul he above infooploo n is
4. P correct.1 agree o,comply with all city and comity onfintmsev and state laws relating
Q U :r Wilding Sommetion,and hembynmhorve mprecnmivesm this any to enter rpm
} rW he ahov-locnWneJ prmxry for inspection purpose.
E' L (We,agree to,ave indmonify and kccp hamdcwdue Cityot Capcnino again
Z1 liabilities,judgment,,mus and capenws which may in any way varve aguhtsh said
U Z City in uvnuyucntt of h�� V fillAPPLICANT UNDERSWITH ALL NQN- OI r Issued by: Q- i�✓7 I DateSOURCE REGULATIOUOJ
Signature ofApplicant/ Date Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE
Will he applicant or future Wilding(wcupout store or handle limitations material Type of Roof
is defined by the Cnpenino municipal Cade.Chapter 9.12,and he Health and Safety
Code,Section 25532m)'I
D Yee All roofs shall be inspected prior to any roofing material being installed.
Wdldm htpprcam or mom bnddimgas,tp::m am t,pdprmanor dr,me whit, [fa roof is installed without first obtaining an inspection, I agree to remove
nfu Ihnntrdnus air comnndn;an,or,dallneal by the Ory Arca Air 12uali,Mo lin, n o"a
Diatie'r �� all new materials for inspection. Applicant understands and will comply with
DY" all non-point source regulations.
1 have road he hazardous materials requirements trader Chapter 6.95 of the
Culimmia Iivalfh.Y Satny CWe.Sections 255115.25531 unit 15534.I unJeaand Ihet
tithe Wilding does not emmmly have a tenant,that it is my responsibility to notify the
xcupam of t rc s which est W ma prior u,issuance of a ce fit: t
�
OccupancyoU Signature of Applicant Date
G—erinarfhnriin .see Dome All roof coverings to be Class "B" or better
OFFICE