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02080016 (2) OF CI BUILDINGUDIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS. PERMIT NO. 10281 N BLANEY AV 02080016 OWNER'S NAME: APPLICATION SUB DATE An CONLY DONALD E AND JO A 08/06/2002 PHONE: SANITARY NO. CONTROL NO. to to tc ARCHITEC'UENGINEER: BUILDING PERMIT INFO be w{O BLDGELECT PLUMB MECH El a C= r--I L_LJ I--1 O1 LICENSED CONTRACTOR'S DECLARATION Job Description O z=o I hereby affirm Nal I em liernud under provisions of Chapter 9(commencing rest. wiyth�9Section 7")of Division 3ofmc Buyd Professions Code.and my license RE P I PE Yms9 FB NA L�l� sev 1-OLLOU ✓\ ARCHITECT"$DECto TION ,/ AUG 19 2002 se sn g I understand my plans shall he used as hire records dE!y T "p0 LicenxdProf<ssiorul BUILDING o,o Oat I am exempt from DECLARATION u�=' 1 hereby affirm that 1 am exempt from the Goons, o License taw co ms F a following mason(Semon 7031.5,Business and Professions Cade:Any city or county $2000 F F c which requires a permit m construct,alter,improve,demolish,or repair any structure 3 _priono its ixsmncc,also requires the appliwm for sucM1 pemu,,o Ble o signed summate. Wahl intingwdh SRtii�to me pm Division do Business usineLievue Lawns Carl Valuation (c that he ingwi!h Sation.7inanof dlne basisoof the teallejldemand braProfessions Cadet f_ [fsyi'P'31C7f3:5O1C/-.i;C1`CI•k•;jns,_a}l`i,jf >�. of mai Ire is exempt Iany apli and the basis for the subjects they a pliant to Any l Pennon. t -of Sertien4071:$by any applicant for a permit subjects Ina applicant To a civil penalty ,of no,mote than five hundred dollars($500). 202AP_Nt4Ml§eYFLOOR PL MB' TNG' Occupancy Type ❑1,as owner of the property.or on,employ.,with wages m their sole ampere.ion. I will-do me work:of and Professions stm:The is nm Contractor sintended or aofferedLaw for sale(Sec )bed; '---- - -' - - Bane, and P oyes,ons endo The Contmcmr s License taw docs not apply m an 502 - FINAL PIIBIItq�ideN�Is �Y owner of property Who builds or improves memnn and ve e s such work himself 507 — FINAL PLUMBING t or through his own employers.provided Nat such improvements within not intended m or see - m WildingtimprovementfProv s sola wuh n note year of ) •improve for the owner-builder will have me hurdrn of proving But he did not Wild or -" improve for purpose of sale.). ' 171 of the property,7 am Business sly Tracing wird Imrnud mnuacmrs m construct n a project(Sec ]bed,Bums,and Profess ore Code,)The vthereon,Commission's Lid who taw does not apply,o of own.th property who builds or improves thereon, L _Coil ittees Livens lonsuch,projers wim.a.conuacmrts).li<ensed pursuant m.,he.Committees am axe pt under S ❑lam exempt unJerSc • B&PCfor.this reams WORKER'S C .. - - " OMPENSATION DECLARATION I hereby M.undtar pe alt,of ponj rY me of the fall wir,declaraions:.. ❑ 1 have urd will inturtim'a Ceni(cat f Cause.1 to self-itume self-itfor Worker's Compensation. as provided f by Section 77M of the tab Code, for the perfearr,unce'of the work for which this permit is issued. ❑1 base and will meimaln Workers Comprnsation Insurance,as squired by Steelton 97M of the Labor Cush,for the performance of the'wbrk for which mis'atmiu is limed My W lo 's Companuiders Insurance carrier and Pol ry.mrmber arc: �'�1" Co Poi I,TCE FICATfON OF EXEZ, FROM WORKERS 't �`0� l ,t. .� ' itI i�fl�.'•'r.IP I'').viil,ll COMPENSATION INSURANCE a.g E ' (This eecnod need not be completed d the pemTiT is for me hundred dollars ($1001 or less.) , I 'I cimilothat i a perms nhM1 work for which this pe , issueda ,' t , t ',t,11?tl shall i rept Los" person m any man r as,o become subject to the Workers' l '" 'Wripers' _ ro Applcantt1 Lodi fCalifornia.i 9 - NOTICETOAr'MUANTIt. ❑ making th Contractile Crr t bfExemption.-you u Id o uhf uo the W kf Confirmation Provisions theWho Code you inm 0frth Th c py with hp 'i ,o re permit hll W decried revoked. Z .._ .. _ ... . .. . ......—. .. .. . .. .._...._ _ ._.... mCONSTRUCTION LENDING AGENCY an - �,' I laucrk fm iffirmWhdCh that dicFm conmNCT n leading0agency f the performance •oath work for wNah Tit spcl ti ,issued(S .tW],Cv:C) L D ..Lo de 5N'me ._...a.. -.t':'_,r _ ;.. ..a. _..-.. .. ..._._._ .-__._.._ ..... .... ..... .. U O . . I certify that I hbout this city application and tT, ban he information is agree W F eo a 1 g T comply with 11 i,y a d count ordinances e anddstate I laws relating � V theta ld g construction.andrtyfmaavm ertp move fm cry, m upon IM1c bo ani nil art f }.W e property Y Peet on Pa.. _ [.., IY (%r) geioser e d rena and ketpwhich hamay in Jia CroyofC pea againm rn Cit Ii judgments, a and pe u h ch --n any Y e geiat said V Z AiryconsequenceDER the granting D m pc t - - r AP t'IrERJ UNDERSTANDS nS'ANO WILL CObIPLY WITH ALL J-O`1T 1,L '�6r���lhs l r ' `_1„ Issued by: Date axil fn dl mpCupv RMmc pili ndRIChSDISoe or Jm<N Health Re LOOTS Igo tum YA I caulCo t t D Ie, RE Wllih t,Capam Mfuturt Wilipso injCo e,Chapt store or h d and Earl Type.of .,......_..__„,___..._ / ....... Y. p serf ty I '"""` •• Cotl OY 12557,1)11 YI I r...t Cc j1t I_m r 1i F i i�_snVt All roofs shall be respected pnoi to.any.roofing material be' g Installed mums anii,ca , oilfimb im.,oc,,Pon, q Ipart de.i.,which If a roof Is installed wi[bout first obtainingan ins echos 1 a ee t6 remove 1 have read le'haurdwsmaterialsrequirements under Chapter b age [ p Di' ' n all new materials for inspection, Applicant understands and will comply with rpYes 9u n p .. . _ . . .._.. . m, ucot Tasdefned byre Bay Area AuQ Quality all non point source regulations r' I 95 of me CaliforniaeWlHeal,,&Safety Coda have Sections 25505 t itis and s,pr l un to atif maT, ftnebuildingdpesnot ernems dv have a,enant,Natnrsmy mspom,btuty,er nnmry mc' - _.._- .. -_ ._ ... _ ... ._ _. _ .. .. ............ . . .. Kb—part of the requirements which mum he met primo issuance ofd Certifies of r_ a cy' .. . . .. Signature of Applicant Date T� _ _.. �mI'sq.q erg or p to All roof coverings to be Class B"or better . .- ---.... 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