02090068 (2) CI BUILDIi^s o VIiSiONRNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
_ LAMPMAN RICHARD H AND CATHY 735 INDUSTRIAL RD 09/11 /2002
�
.
HONE: SANITARY NO. CONTROL NO.'
(650) 593-9001
-z ARCHITEC(ENGINEER: a BUILDING PERMIT INFO
m Q BLDG ELECT PLUMB MECH
U
:On z LICENSED CONTRACTOR'S DECLARATION
` I nertby arerm mal I an Banaea anger prosssmns orcnamer 9leommencing Job Description
cwt Lq with Secllon70011 fDivomr3 of the Business anJ Professions CWe.o dmy license
cxf� is la to, �ifee. 5S'lakl�l DEMO r
c tic s a Linn-Clas. Lic.x
%O a U Dae Com
%LL u.y ARCHITECr'S DEC 10N
2 ON understand my plans shall be used as public records
] O OLicensed Profe rman l
ex OWNER-BUILDER DECLARATION'
y I hereby affirm that 1 am exempt from the Commcmr'x License law(m the
C?< following reason.(Section 7031.5.construct.
Business andProfessions
improve.
de io demolish,
Cede:Any city or county
S O which rcyuircs a permit ra c insvua,akar,improve,h permit t or repair any structure 2 0 0 0 0
v.3 m poor l Is y rc.Ih applicant bn such permit fleasigned.t mment
mit he al mnxdp iauonuolhe pr
.
(commencing
e g wish h TIDO)of Division
ivision 3othof
the Business and
usinessand nP-t rroWf a cruodnspCode)
s ,1 ` ric
5 Ft.Floor-Area
. a1.!;
Valuation
or 0.9 hreesem tZhui and he burs for the011e W cxcm troy Aruviolation 356034`t-0'0
of isoe hIsgrii,itdio rotapermuxnj«sme
of not more than rive hundred dollars
ascot APN Number Occupancy Type
❑I,as ownerof the properY or my employees with%ages as their sole compensation, NO ASSIGNED INSPECT ONS
'will dome work:and the structure is notIntendedor b!Tercd for sale(Sec.7041:"
Ba4mesl`aad professions Code:The Contractor.License Law does not apply to an Required Inspections' :'`�
owner of property who Wilds or improves thereon.and who as such work himself
rough his own employees.provided mat saeh improvmhimselfe
ems oro not intended or
m ... . ..._... . _.. .....____ -._. _....."_. ,I _ _
ffcmd'f If,h bebuilding . 1,old lin a
. . p y
ne f
-.
ompbi n owne l h will have thebuNen f proving that h bu did not Id or
repro-for p,u rpose f wlee))
s ❑Latowneroffliepro,orry.am exclusively r i g 'tali cn.W e tact t
construct thep )ct(S ]tB dProfessions
f. oae)The Cotinnt O t,. <' t : .-I
LicenseLa does not apply too a o .n owner f property whoIdimproves the
" ..and who
o nwcts fo h projectswith on .ons Ccontortions)1'c<vxd P vans m the .._. .._.. .. . _- ';,200
Cotractors License la ])
❑I am a pt oder S '' ' `e&P C f this reason „ ''r,;` �On ' r..
``•f V`
id
'WORKER'S COMPENSATION DECLARATION
�" I hertbY vRrm order pcnahy of perluryrone of me following dularationx:
r- . ..
aI hove'iiitl will provided
o Cby-Secti of consent'to uLabor for Worker's
mpensmion, as provided forby-Sectiao PlNl of the Labor Code, for the
pedarmanabf the work!or which this permit is icmed.
❑1 have and will me nt w ke Compe at on hiamince.as rtquimd by Section
3700 of the'Libor Code,for the perfomtincef the uorV for which this permit is
issued.My Workers C pen' on t 1 era a.c- nd Pill u
Came pal
CERTIFICATION
OF FROM WORKERS
COM
•' COMPENSATION INSURANCE"'"I as
r
'`-''y (Thdsscuxt6oad'not harmpletW if he permu is for one hundred dollars -slsU l' t--'1 —_ --'-- .j_ O ('t ll" _--"-"-
(SIOOI or lcasJ `
1 1 mpl mai In the pert ante"of th< ark r 'rich iris pein t rs Workers'
1 - -
Cona t ployvnypfmo Yate so ase nnonu sub)eenothc Workers .Ze:'.H Iai !IAIk`C`iV i'••'.'U. •.0
Comicant on Liws of Califomio.Dae' "
Appl
+NOTICE TO APPLICANT If,after making this Certificate ofE pt -'"-
n,Yousholtl, .__..._ ._.. __ .
C) 0recome �bject to theta k 'Compenwt provisions of theLaborCode.you must
forthwith comply with such provisions or this permit shall h dearmed rooked.
t•' W "e'`v I beatb"n(COh STRUCTION LENDING AGENCY "' -
�, 1 h for aPrtn thin th - n4wa d nB aEe Y f is perfoon.nce ... L'
workwhich th s pc t "3 ucE(S 3(MJ] Cv.C) -
'yia '-Lender Name.+-v - --`_ ��;.t . _ _._- _._._ _.. ... ___— . .__.
laoec 'Add - - I:
I n fy th t l h a cad th' ppl c t nand st m mat Ih bo nformetron is
corms ve agrc t comply th II city and c ty o J' c J tam laws relating
ta"Ran, t t r dM1 rcby aath a pre trues fthsc ty reenter upon
the above e)aa".cd propenY for inspection puryoxs.-F. S I W<) grea to sax dem 'fy and A p harm) the C tY of C pen no egama V
rA lub'a es Judgments,co a ad penes h ch y n eny y accrue egaman said
,V'M City
ouqu rice of th g t gottars pe it -
APyLICANTDNDER$fpNDS'AND WILL COMPLY l41TH ALL N'P�JLNT
sGMIwF.RJ.Guf;ATloss:T . � - ;, S 4�oZ Issued by; Dale
Sigtnciato,of
APpl¢ant/Coouacher..4•:-.;..'... - r, Dae Re-000f$
" HAZARDOUS MATERIALS DISCLOSURE ' !' "'
r „ W II me opPl cam or r t rc bu'Idng p nt sin hamlle hamra6as material Type of Roof ,-. ._
as d f ed by th Cupcn M c l Cod Chapt 9 13 and th H Ith and S fcry
Code S❑ecY 255JII) N 1 Ilt:2 d r i ra'f - !1. 1 ap fly l' at
''s t' r _All.roofs.shall be mspected.pnor to,any.ioofing.mateiial being installed.
... NII theapplicant fur Ido& c pa t t de s which - ---
mjthmrd a a t rs eir"W by m e yA =gin Quality M -gement, If a roof is installed'without first obtaining an inspection Izagree to remove
Distinct. all new materials for inspection, Applicant understands and will com I with
OY -,- No P-.Y.-
' all non-point source regu]anons.
t hastilrcadlM1e It ..a a inial rtga emcnts and Chapter 6.95 d the
ifts.mit Hzal Znotfelyoode ave.ns25505 _itis 1rello J1-llundersrendthe
;retie buI donnotnvercntl hh'ams, me,bar itlsm rc ibil. torimif the`
vccup t f tae . tic t h ch must , met p r toy so ce"f Cen,d of,
Oce ) , , i - •. .
71. ature
Si nl
y�d( ---g. of A PPicant
. Date._ .
_._
-oy n< p to =ce.e= nate, All roof coverings to be Class B 4 better
r e;
."OFFICE-""-