02020109 OF
CITY
I BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10741 N WOLFE RD (HILTON) 02020109
INNER S NAME: APPLICATION SUB DATE
PETER PAU 02/27/2002
j PHONE: SANITARY NO. CONTROL NO.
10'-10.
0' O O ARCHITF.Cr/ENGINEER: BUILDING PERMIT INFO
E w— BLDG ELECT PLUMB MECH
S i LICENSED CONTRACTOR'S DECLARATION
I hereby 0 ion that 1 am licensed under provisions of Chapter 9(commencing Job Description
„Ea, with Section 70W)ofDf, irn3mine BasinexsandProfession,Code.and in,Imre HOTEL FLAG POLE .
is in fall sera and erc<n. 3 )
ce w< Licnrse Cho, Lie.b l
O 6 J Dale °r
5
:1[-0 ARCHITECTSS DELL DECLARATION ��
"—y'O 1 undcnland my plana mall be u,cd a,puhlic 2<nld� \\j
i590 9
X5p O Li<enud Professional
tie OWNER-BUILDER m the CoATIOS
s '—`'H 1,ruby.(Tien on I ora nemPt from the Cessions a License Low for the
t& firfovvwhich r g rtas°a.Nearmin 7031.5. t,aiien andimpr vee d ciao exwr:Any oily sl e°amy $1300
al S en which requires a Permit re cram<l.alien improve.drnmll.rn. filets
repair any swment
6.3 ox _prone to its ixsuance.also«quirezthe upplicam for such penniuo Blea tlgned sutemrnt..
wtneixrateacinar"solinmePro.,,ion.ordkcomraemnucenxhw(ehapler9 . ).� r. a-,.., a ,,a . Valuation
(rommcncing with Senion,70W)of Division 3Ofthe euiinesp arN Professions Code) r;;-:;.. , ::3 g45 :'2f6 ,.:,�Ia,l�s
or that he is exempt therchan and the basis for Inc alleged esempnon.Any vi°Imion
of Section 703 LS by any ap,brion for a permit subjects the applicant too civil penalty A �yy�'�l
or not mom than five hundred dollars III 10PPN P'UONDATION '•' Occupancy Type
01,as owner of the pmipxd,or my employees with wages as their sale compensation,
will d"the work,and the sln¢mm is n01 intendal or cited for silo(Scc.7034,
Business and Professions Code:The Contractor's License Low docs not apply to an 104 — REBAR Required Inspections' "
Ow net of property who build,or improves thereon,and who does such work himself
or through his own employees,provided that such improvemrnn am not intended or __ 105 — .ANCHOR..BOLTS-
ulrined for sale.If,however,the building or impno mort is sold within one yen:of '
completion,the raider-buiMer will have the hurden of proving Ihm he did ran bund or 3 0 4 — ROUGH ELECTRICAL"'
CAL
w -
improve for pumnxofsale.). 505 — FINAL ELECTRICAL
p31,as owner of the pm,urty,am exclusively contracting with licenxd emmracmrs ur514- -- - FINAL - _
consumer the project(Sec.7044.Business and Profession,Code:)The Contractor's
— FINAL PUBLIC WORKS
License Law does not apply to an no net of Properly who build,or improves themoo,
and who co ndent,for such pmjens with a commnals)licensed pursuant to the
.. . .....
_ Conoace Licenx law. ,
❑lame lander Stt. ,A&PCfonhis reason
1�WORKIiR'S COMI'r:NS�TidN D[CLARATI(3N
I hereby affirm under penalty of perjury one of the following detlaralions:
❑ I have and will maintain a Cenlf,cale of Consent to self insure for Worker's
s` Compensation, as provided for by Scninn 37W of the Lobar Code, for the
performance of,hc work for which This permit is issued.
01 have and will maintain Woder's Compensation Insurance,as required by Section
37W of the labor Cole,for the performance of the work for which this permil,is
issued.My Workers Compensation Insurance carrier and Policy number arc:
..
Policy N.,
Cartier' CERTIFICATION OF EXEMPTION FROMWORKERS'! Cl�N13; .•, .t.isi ' ",5
, . L. . a.NIti, _ . .
COMPENSATION INSURANCE " .'_� peep
Mia section need not Ise completed if the permit is for one hundred dollars "
fSIW)nr las..
1 certify matin the irnnnanar°f the work for which this pandit issued,I
stall employ any personn in"thy mtlnner m as m become subject in be Workers'
Cnmnt on law,Of California.Dale
Applicant
NOTICE TOAPPLICANT.Worke L after,vrlag this Cenincamo of Labor Code,
.,,rind s -become subject m the Worker s Cikimcv srl his provisions. haof the Labor Code,you must
Q O forthwith comply with each provision,Or his Permit shall h domed revoked.
CONSTRUCTION LENDING AGENCY '
a'} I hereby affirm that them is a commandon lending agency for the performance
r nl the woe fpr wM1ich mos permit is iz.iucd(Sec.3077,Civ.C:)
Q
L<nder'x Nam< -
Undei s Address '
Qt z
V Q I eernfy that I have read this application and state that the above information is
i•'onecl.1 agree to comply with all city and county ordinances and,lala laws rdating
Q C.) m building connrvaioKand thereby hall rrpmseratives of this city mentor upon
} [s7 the above-mentioned pmpeny for inspection purposes.
LL (We)agree toxve,indemnify and keep harmless the City of Cupemn.against
fn liabilities,judgments.at.as and expenses which may in any way accrue against.said
U Ci(in con
seq5u�en1ce o dogmnungofthisprdant. - q /
,r APUACERGGCfvIT TANDSAND COMPLY WITH ALLNO Issued by: ( Date v
\\\��`��1 2127
Signmum of Ap,heunt/Couracmr - r le t Re-roofs
MATERIALS,DISCLOSURE 1.
"411 tha tipplicurn or metre bidding occupant glace a horde harardoas material. Type of ROOF .. ... .. .. _.. .. .. '-
as d Cedc Chapter 9.12.and the Health and Safety
-
Cod f Semon 25532m) o Muruci rn . l ,'v I t f;
Y Dc P
�YeP f "°' All roofs shall be inSpected.prior to any,too Ing.material being.installed.
Will the applicant orfuture building medpmsuse e,dipmentordevices which If a roof is installed without first obtaining an�inspection, I agree to remove
emit hdrard°us air cnnmminams as defined by the Bar Area Air Quality Management
Domct7 all new materials for inspection.. Applicant understands and will comply with
oyes - �a n all non-point regulations.
.'1 have mad the havrelou aanals requirimena'under Chapter 6.95 of the
California Headh&Safety Code•mSections 25505.25533 and 13534.1 undemdidthm _lithe building does not currently have a Imam.mm it is my responsibiliry to notify the '-
Dec� quiremenks,'butch artist be'mn prior l0'imuunce of o C nificme of
"`Y' Signature of Applicant Date
2 2 a
owner craumorized tiger, Dale . All roof coverings to be Class "B"or better
OFFICE