02060190 (2) CI BU DI I
BUILDING DIIVIISNO
IONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
7667 BERLAND CT 02060190
OWNER'S NAME: APPLICATION SUBDA E
CHRISTYONO MULJADI 06/272002
noPHONE: SANITARY NO. CONTROL NO.
00 ARCHITECT/ENGW[[R: BUILDING PERMIT INFO
(wi BLDG ELECT PLUMB MECH
M a i r=7 =-i L_J _:__I
Z H= LICENSED CONTRACTOR'S DECLARATION Job De n &'ot3 +
0 Z ln 0 1 hereby affirm,hat I am licensed under provisions of Chapter 9(commencing P- +""-s I
pHFae with Section 70D0)ofDivision,3oftheBuslneaaandProreaamn.Code.andmylicense KITCHEN REMODEL.
isinfom=and ellen. SEP 2 2002
'�0 a License Class Lie.x
0 i 0 Dae Commnor
b.LL a�+ ARCHRECrS DECLARATION
F_O 1 understand my plans shall be used as public records
BUBLC9 ,W
iV ca O Lmenud Professional
>o OWNERBUILDERDECLARATION
`-' L naso offmm that 1 1 exempt from the Contmcmro a License law for,he
followF Zx a which ire mason.(Semon]onstr Business dna Professions h,or Any city or county $40000
F O Poor t requires a permit re comedo,alter,improve,demolish,or repair any tamnum.
i��..Poor to nr. parnrequiresthasions o for Contractorsuch Perrout is signedChmmcm
that hq.slicensed p manit n previsions of the Cnnuaunrs L' La (Chapter 4 Valuation
(cote ]o,and basis
ooftheBuxilcxatdProf nyviCodq •3,6 �0 , ,,:As. U! i
or that he Is exempt therefrom end the basis for the alleged emmpnt to Any l violation
-of Smimt 7031.5 by any M1 cont for u permit subjects,he applicant ro a civil penalty „�,�,�
of not more than five hundred dollars(S50B). 101AENr'At�TIftVTJATION ^ Occupancy Type
❑I,as owner of the prupeny.ur my employees with wages as their sole compensation, 102 - PIERS
-will thework:alms Codeewrc'is hotintendedLi ense eredLaw toe sale no,(Sedapply
]DLf,
IBueidcof dna .y Who
Code The Comm�or's License Law does not apply ro an 103 - UFER Required Inspections- •- '
owthr of progeny Who Wilds or ovidedes unworn.suchiand who dale such work himself
or through his own employees,provided that such imp is sold me not intended or 10 4_- _REBAR _ ;
oRcmd for tele:If.however.the building or improvcmcnt is fold\within one year of -- _-..._.
dordpini°n,the ownerWnaerwiuna�emeWmenarpro�ingmatneaianarWimor 1:05 — ANCHOR BOLTS .. i=.�.•:F a•. ... . . . .
p f Pare, r ' ." 106 - SEWER & WATER
- - --
nn p pcny m l fy fig 'tni<-.'a nt trs�o- -'202-" "UNDERFLOOR" PLUMBING -
zi
nn t th p of a(S 70M B . a P f :CnJ:)TheC t nor s
iee 1 a m artily to nrp property n builds . mreon 203 - UNDERFLOOR MECHANICAL
_ ..and wh mans.f such.projects wile. renm(s) dosed punuam.to h
te
aunt .a..n
w. .t — — --2'04- _ UNDERFLOOR
1 min exempt..it r " /'' "�f -'.B&P C for his reaaan 205 - UNDERFLOOR':'INSULATION
ow^er Dae p/'Z'T/U? - 301 - ROUGH PLUMBING
,I "WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
_Y. 'hereby°m"m tot analiyarp<;uryddeormefollowing aeclamdona:- 303 — ROUGH MECHANICAL
❑ I nave and will maintain is Cenificae of'Comcm to sel&insum for Worker's
` Compensation. u provided-for by Section 3700 of the Labor Code, far the 304 - ROUGH ELECTRICAL
- - petfotmance of me work fo,wnich mis peon is iswed. 305 — FRAME
❑I hale dna will mainmin Worker's Compenvtion Insurance,as requiml by Section
306 - HOLDOWNS
37W of the Labor Code,for the performance of the work for which this permit is 307 - INSULATION
issued My Worker's Compensation Insurance carricrand Policy number e:
raft yN , --`-"-308'--_- SHEE_T_ROCK -
CLRTIFICATIONOFE%EMPIONFRQMWORKER l-
COMPENSATIONINSURANCr �s^r1309c
310 1-°"EXTERIOR? LATH • i '`� ' 1
-; .I-NTERIOR....LATH - _ . .
(Th a ton need not W completed if the permit is for one hundred dollars
(aiWl ripaa.) 311 SCRATCH COAT '
Trentfy that in the,pert e r the wore for which this pe m l -...news -----3 1-3-- ROOF -NALL ..,-. .,... -_ -- -. _._.._ . _. ---.:..
shall t e ply any K -in arymanner co as ecame m bject the Workers 501 - FINAL ELECTR I CALn`ENERGY
Compensation laws or Coliform. Date
. APPlicaat .. - I I -- .._- - -
502.-.___._FINAL_.PLUMBING .ENERGY-. ._
NOTICETDAPPLheWor:If,aMrpenlungmrCerdnsofthLaboficme of rodeyoumY'd 503 - FINAL MECHANICAL 'ENERGY
Z becmma cOF6c t m the Workers Compcnutmn provisiona of the labor Calc,you must
fnnhwith comply with tech provisions or xis permit shall b.deem - ,_ . _._. __ _-_. .504._- FINAL -BUILDING-ENERGY
_
COMP TftUCT10N LENDING AGENCY" "
gag= ) P< .._.
F- 'I kforwhich'his .reis,<n^swntonlemaln agency dormuncee 505 - FINAL ELECTRICAL -'
C j
rte kr which'his m,'t aissued(S San Civ.c.) „-. 506 - GAS TEST _
....Lends N _.. .. -- " _...
_. . .-..."507 - FINAL PLUMBING
� �
Lender's- odd ax
i&�dfrmail•Tail;e�aimsappbcalnnandniammntm=anoacmrorm.,tlnnix 508 — FINAL MECHANICALL
rj+;,e`", cormoirl agree to comply with all city and county ordinances and state I relating 509 — FINAL GRADE
to building construction,and hereby authorize representatives afinis city to error upon
y � the a4 dprpe f p Pp 510 - FINAL PLANNING
P. (W)itime t ate mdemsify andkeep haml ithc CnY fC pnn gainzt
liabilities,jag t. cost .d expenses which y' any way cone ataigat dam 514 - FINAL UBWC WORKS
i J Z City in consequence of th=gmnimg of,hii pcimit. -
-
APPLICANrUNDERSTANDS-ND xV FO\IP LY WITH ALL -PO
Sol
Sol' CE GU
RELATIONS' . .•• ION
1\7 Issued by: Date
St t rc of Appl'anUC tract - b r
Data _ Re-roofsHARDOUSMATERIAL$DISCLOSURE
Will sur h nth anam 1 - r �
_
-""
x -„ -2adelbythCupMpalCChapter9.12 and thHealth dSafety YPe ooo - - '-
,
C
1 (al` d nt•s3dds Sect 25
❑\e ON -p2
All.roofs shall be inspected prior to any roofing_material,being.installed. .
Will theapplicant future building p t egt'p t rat .which
u n I nm t as defined by thex n� Q Tty M magem , If a roof Is installed without first obtaining an inspection;I agree to remove
�KI”" all new materials for inspection. Applicant understands and will comply with
❑va ONa-: - -- P . PP- P Y
all non-point source regulations. . "-- - -
1 have ad the"azadouz materials mquiremene,under Chapter 6.95 of the
California Health&Safety Cade,Sections 25505,25533 and 25531,1 understated that
if the building does not currently have itewm.that it is myresponsibilay m nmifythe
occupant of the requircme ¢xjtich must W met prior m ismance of a Certificate of
D«upaney.
Z Signature of Applicant _Date
is T or out
zea agent Dam All roof coverings to be Class "B"or better
_ _..
OFFICE-