02020049 (2) CI BUILDING
UILDF GDIVISION
PERTNO
IPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
RT.RrTRIC 0202 049
OWNER'S NAME: APPLICATION SUB DATE
ONG RANDY T AND EVA S 1250 BIRCHWOOD DR 02/13/2002
( 'HONE: SANITARY NO. CONTROL NO.
(408) 734-4282
O O ARCHITECTMNGINEER: BUILDING PERMIT INFO
a BLDG ELECT PLUMB MECH
i zLiLICENSED CONTRACTOR
oi, nnON
DNo Ihereby aRmilttIamIicroodderpiocofCha =r
9lmmmercing Job Description
ithnirc0)ofDivision3oftheBusin �andPafcssionsCodc.and mylicnx CIRCUIT BREAKER FOR ROOMyI Flom nal JY rea uc
_ Lica O
y 3 u. -klgm S DD'z
a O / ARCHITECT'S DEC TION
,5 I understand my plans:ball be used as public records
xas
n a er O
Licensed Professional
a OWNER-BUILDER DECLARATION
uai 1 hereby orfmi,nal 1 a Business
from the Contractor's License Lou,for the
v m exempt
5=C following reachrens a(Semon 7cm,am Bonito and improve.
de ore h.or Any city or county
zt xhch requires $2.700
c.ie m P W_irc the applicant for such pc.it nine a signed smmment. •1.7..IF �, S
q permit t a after. mpmve eemolisn or rcpan any strvaum k
no m y a c d
man it«.gapean )o �i. naormetheBucmrsL.itPronwon,Cer9 Ft, Floor�At% Valuation
-1' n<se exempt
70IX1) fD tan3of the Busineuandmi.Any stational
tionl 1 1" qq b•t'I' "�a
^f mal io .e 31.5 b therefrom andfee.para far me ani¢ed dempu°d Any emmaen 3 S 6 O 6'0^3 O )-0�0 -t--�-
-of Section 703L5 iv pry•hundred
d m for a permit subjecu rhe applimm to a civil penally-
°rnmmorcmamfxeWnaredennarslssofl. APN Number .. , . Occupancy Type
❑1.asownerofthepmpany.ormyampl^yea,wnnwagraastheirstilecompersabm,. 304 _ ROUGH ELECTRI A'L
will'do'the voids:and the structure is our intended or offered for sale(Sm:7W4, - -- ---- --
Business and Professions Code:The Contractor's License Law docs not apply to an Ctlons ",
owner of propeey Who Wilds or improves thereon,and who docs such work himself 505 - FINAL E
or Infrared
fM1 his own employes,provided that men impra_emen¢am not intendedcar or 1
,ort e IIL er the Wilding p emmv Ia within no, )cm of 'l
completion, hetn herb Id illhmem burden of pr�vingthat h did not build pr -
mprnv=ror pu,pnae or:ale).
Q!,- --- '-- ---._._ .. -- .. _. n
aa^wnerprjecp(Sm.7,am ivelyc Po4callsomCa licensed The Contractor's
onmomro W�ftav��
acetum the does
n (Sm. to a,ownr Business and Re,who b Code:)improves
ves tin,eon. ■ t
License law does not apply roan owner th progeny who builds or improves thereon, "
.and Coloel s t case h p n3<ns with a comm<mr(p licensed,p oath to the s
❑lam exempt undr5 c' B&PCfor his mason . APR 24 2002 -
- - - Owner' .. .. Data
_ WORKER'S COMPENSATION DECLARATION
BUILDING
i I hereby effort under penalty of perjury one of the following declarations:-
7 1 hadc and will maintain a Cenificae of Conant to self-insure for Worker's
in motion, u provided for by Section 3700 of the Labor Code, for me
p<rfomsance of me work for which this pertnit is iuucd.,
❑1 have and will maintain Worker'.a Compensation Insurance,as required by Section
37W of,the Labor Cod' for the performance of rhe work,for h h this perm r's
r
issued.My rk 'i Compensation Insurance came,..it Pol W
m 0. �2�3L/ e -
el "1'CERT FlCACOMPEN EXE PTNS ROM WORKER{Slt„ L..S.-/�Z g `Z• C.
gel- 7'st xh;r '`itr'Y 4,q. .1''.r!•t r
'C
COMPENSATION INSURANCE •.,-:, __.._._--...__- . .____-. _�_. ...__- ..__.
r . . .:;:'�1
I3100)olc )csion nectl nos Wcompleed iRhdmi
pert is for rare hundred dollars t-
'� ,\ r •' s.' ��—:'^ i„
I nfy thnperformance fwork for which h th' portas el t-
shell 1 employ any
<ry r : 6y m ,an 10 bccom object the Workers
Compc'. ion taws ul C f " 1 Da¢
A
NOTICE TO CANT If,offer looking'his C si(cote the
Exemption.n You should -Workers Comt e, IoW Cod must -
OQ fonh tnc 1 with suchprovisionspermit hllhd d revoked, '
yabar .- .. ___ ....... _. ...._. - _ - .. _
r .cc me ub a the CONSTRUCTION LENDING AGENCY
C 7 Ina' drum Charm eis.e .t fon lending aje cyf the perform ntt r -
r bf me inkfor which thispermn,:round(Ser:3W7.Cie C:)
-I<ndeia Nam' ..". •- ..•._ .. 4. .a•::. :.o_ ._._ _ _ _..__ _. ..
I<nder's Address • - 1 1
V.O , I ecnify thin I have read this application and state that the above information is -
correct.1 agree to comply with all city and countyordinances and state laws relating s`
0:V to building mnmrvnion:and hereby aumomr,mprescriurives ofmis city to enter upon
�.;W 11 me abase-mcmioned,property for impacrom purposes.,.
�.A, (We)agree to save;indemnify and keep hmmlcis the City of Cuperium agaimr
rn liabilities,judgments,cost and expenses which may in any way acme against said
V:� City nc sequence or thegrantingof this p n '' '
'APPLICANT" t ebERST,N S 'D WILL COMPLY WITH ALL NON-POINT
oto UD N _ ZT3—oZ Issued by: Date
S natuicol pp m/Co rachr ., .•. . .,.. :5.,s /
a d f neo by me Cupcn no Municipal Code.Chamr 9 12.and the Health and I Reproofs
tin. a g pant vivo UREI
,} rata a l t rrmrcn Itl naalen ta t 1 Typeof.Roof.. ..
p RDOUS MATERIALS DISCLOS
Code
Second 255321e)7 rP Saf ry l a 1 7 l , �t ay T
A fn5 S
All roofs shall be mspected,pnor to any roofing,material being installed, _ _
rum itc to f sorebu'Idngbythe musecgop tli ge - s" icn If a roof is installed,without first obtaining an'-ins inspection,I agreetto remove
smith rd m at 'defneab)rh ByA A Quality gc ant g P
``t 'oy all new materials for inspection. Applicant It and will comply with
{ , �':� alltion-point'"source regu] ations. ..
t I h e'aad the amadous romenats req iamems,orderChapin 695 of the
Cal fom,n Hcels.'&Safety Code.Seasons 25505,25533 and 2553 h I ter 695 o mm
Rth b Itl age of cu t1Yh co, n t m t r yrcpo hll t unify mc" - "'- - - - - ..
cemP rod th qua r hch mus.. etP so sssua ra Cenfict
,. Oce Pa eY -. . ..
Signature o_fApplicant \\ Date
x� 2 l3
vim* n, annrt nag nr All roof coverings to be Class `B" or better
` e.... . ._...� . . f OFFICE