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01060107 (2) CITYBUILDING DIVIISSIIONNO PERMIT CONTRACTOR INFORMATION: r��T r .t' BUILDING ADDRESS J/v SO I �Q I lryC PERMIT NO. 10423 S DE ANZA BLVD 5@U Awl'I O:n;1O "— GN 01060107 OWNER'S NAME: 373 L /` &K PK< DkAPPLICATION SUB DATE ,,.CALI EDWARD S TRUSTEE 51t B±VT 06/19/2001 r PHONE, SANITARY NO. CONTROL NO. (408) 339 @40'0-97d -3373 :]o z0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO be BLDG ELECT PLUMB MECH Hai CJ I ' I L_J LI zi LICENSED CONTRACTOR'S DECLARATION DECLARATION Job Description 0 a`= 1 hereby uffrm+ha I am ImenseJ under provisions of haper 9 ommencin py(_u wiNSeaion70001ofDivision3otsheBusinasandProfess ns Code, dmylicen REPLACE SEWER. m Is In full forceand z d a LicenseLic.p X 0 a N Dam - cnnmwmr uniAI CHITECf'S DECLAR 1 d U'an x xM1.11 be used as public ccar d , s a an a O O °'ca b Licensed Pro(esziowl , OWNER-BUILDER DECLARATION C1. 1 hereby affect this 1 am exempt from the Contractor's License Law for the F z'a Inlmwing re,^nn.(Section 7031.5.B i,ine,.and Probsxiorx Code:Any city or warty $3000 f xF o which requires a permit to construct.altar.improve. structuredemolish,or repair any structure x- .prior t it 1x ' to also rc,moo.dbcppl' f .- hp n file a. J-uummm, �- 'hlLt bc rc licearcidp'n ttothPro% ons of the Contractors Licenvt1-s (Chal,wr9 f1 1 ° 1:'. . - -Valuation (co ening with Sxio 70001 f Division 3 of the Business d Professors Cody ' ^\. '� 35�k%ll'V! , t k i �� or mm he is comp,ihcrcfrom and the basis fine the allkg<J exemption.Any violmion I -of Section 7031.5 by any applicant for a permit subjects she applicant to a civil Penalty of nm more than five hundred dollars(8500), 3 0 5APN DI f;"',• :• , Occupancy Type 01,as owner or the property,or 1ny employees with wages as mel,sole compen.vlim. i will tl 'he work,and the sw t re'Is not intended' offered for sal IS lou' -- -- 'Biciiiiiis amVPinfes,mart,Cm The cot t L Ln.ane, ma applyt 601 ROOF TEARtgpVg'Inslieetions ' owner ofpro,orty Who builds or improves thereon, d who does such work himself or hiccough h's mart employees,provided m t cn improvements on,not intended ca, 602 — ROOF PLYWOOD NAIL ,offeredr I 'IrM1 1n b Ie'ago p t '-la m' r _f 603 - ROOF BATTENS ' -�t7. completion,Ne owntorbitiker will have the bud fp -ng that he did tbuldo rap for purpose of 1 604 — ROOF IN—PROGRESS ❑I owbronco, _.IN_P._ROG. RESS ,hl -dc to construct theproject(Sec.7044 B d Profession,Cod )The Contractors fish p pent lye . 1 License Laws does not acridly to of property who boulds or improvesUncover, 1 - .,• " _. -and who.contracts for such projects woe. commicamsl licensed pursuant to the Contractors License Law. 01 am exempt under Sec. .U'&P C fortis.reason ;s _ 'i t D;mer Date WORKER'S COMPENSATION DECLARATION `L I hereby uffimt under penalty of perjury one of the following declamions: 0 1 have and will maintain'a'Cdnificuc of Cdn.icul'to ulbi oom for worker's _ Compenvtion: es provided for by Section 3700 of Ne Labor Code, for the pe anee of the work for which this permit is issued.. ,,.. W o 'Sad will in5inialb Wdrker's Compehsniion Insurance,as na,unred by Section f the Lsbur Code,for the poffca ace of the wmn,c7m which this permit is issued.My�lWoorr�keer'ssCCom�pennssation Insurance carrier CarrierCERTIFIC T I F�Pd cy TI li MW` O`'RKE"RS'} 0 !' .. a s [. COMPENSATIONIWSURANCE . _.. .._..... .. ._-, - .._. - f .. .._._ _...... (Thrs seaian'neco not be<nmpincd if the permit is for one hundred J°Ilars - ` •r ` . I 151001m1ess.l _ ' n .. - len fY shoe the.peA o of the walkf hivh his percent e _ ._ ....... . ... � .. ...-.. -_.- ._ _ -, .. .. . .--._. shall im coat peen y mann r as 16 become s b)em to the Workers ` Compenmunn Laws of C 1 fomta.Date ' ' ' . Aplifictaid NOTrCETD APPLICANT O APPLIeANTII making Cnf fExemption,yshould z bemcn the Kok t Compensation p o fionp of the M Code,you most hhop1Ywi . h previsions othpmshall deemed revoked. 'r\ r CONSTRUCTION LENDING AGENCY I:1 1 hereby off chat inert is a constructiondng agerwy for the performance , W_— of dr ork for which his permit ' .sued(Sec.. 3 97 civ.C.)Lender's Name ' . ...... ........ .� U 0 Icenry,that lluvereuldidnappftemiooand state that mealsove inforounor is O [-1 Derei 149 t ply th II city and try d d scale s rcl'tinglumildinp '(UTI the ba 6 ti edp iYf by pen x rep t i fm. tYr ¢ Inn \SII\--'`wt�y b p4 g .i sx J tfyd k phi I sine C'iy tC pen nog 'nn VI habit dg et < us in of . heti y' y y ia,, aid VIVO "Ill V Z City n yuan of he gr t ng opv iN'R ' APPLA TW,p.R TA'D A\D 'ILL COlIPLY H ALL N NON PO OUR ouR E EG ,rl N r ,. _ Issued by: Date i Pppr, nn °ane: Dale': Re-roofs 4 Jefi el HA RDOUS AT RIALS DISCLOSURE:"' lmcappficantdrrdrn riding«cupamstore or handlenaxardnasmamtia .Type of Roof. as h,ihe Cu Winn Municipal Cale.Chapter 9.12.and she Health and Safety 1 Code,sretinauv_'(a) - ' All.roofs shall.be inspected prior,to,any roofing material-being installed. Will'hgpplic 1 f building spam me egip 1 rdevicex rich.- " cm rhoe b coria r a'declned by the Bey Area If a roof is installed)without firs[obtainintr an ins ectiori;I'a�ree)to remove - Quality ry htanagcmcm b P b •Dix"" „ - all new materials for inspection. Applicant understands and will comply with ov oN°- all non-point source regulations. .. ,. - _ '1I huv read the h and u:material. q ' 'eau inJ Ch pt 695'of the - Cuff inH alth&Safer Cole Section. 5505 5533 and 255.14.l understand that ifinebulldilg•dnesnmc rtemly haecut ant., Tit is mY rexpdmibilitYm notify the "' - "' '- - -- - "tura o the mq ire cats which mu t be et prior to issuance of a Ce74 nifcate of ' 1 O cup:try - .. Signature of A heart --- g PP . .. .... . - ' Date an ont Date All roof coverings to be Class"B" or better- %:..f OFFICE .