01100163 (2) CIBui DING DPBRON. PERMIT CONTRACTOR INFORMATION:
•
r BUILDING ADDRESS_' PERMIT NO.
10062 'FIRWOOD DR i GREENHOUSES ETC 01100163
WNER'S NAME: APPLIC TION UB DATE
'.OBERT . & AIJAN MOONEY 1546 S DE ANZA BLV . 10 1/2001
'd 'HONE:', SANITARY NO.' CONTROL NO. -
(408) 446-1224
OW ne z ARCHITECTiENGINEER: - DING PERMIT INFO
g u G D ELECT PLUMB MF,CH
' t' "'LICENSED CONTRACTOR'S DECLARATION: ?
5 z Job Desert tion
rz�o 1 he b arfim m fl licensedunder- p .inns or Cnalner 9(commemcims
E wias B0o)ofD 3 f,haen dPmf son ode and my license INSTALL WINDOWS & DOO S
,4E 191 (yc rid eR A f r ''///$lt/_ ,�,"
iy� nxt hers ' +'LC.p_�r•"/.IG 1
F. "Coni, or
1 0 ARC jTEC a'S •Y AR . .. ... -
� 4 1 .tad Ypa Il be u 11 pit lit
12:00 lk,icon. pm imad-. 44 ;
OWNE 'R DECLARATION
,w^ 1 hereby aHim1 that 1 am exempt fmm the Contractor's License Law for the
t_ < iollmwing roson.(Section 7031.5,Business and Professions Code:Any city to county $8000
f O which requires a permit m construct.aper,improve,demolish,or repair any awaurc
.,in 3 _pct ! 'n ssta c.vlao rcy -
ilatn sd e-nard pursaina tsidni pravisbans of the Contractors License Lu (Chapter9 ty r a a• Valuation
ao g int sect- 2000)pr D w:9 3 Pr a 6norte x and ayrew ons ante) <�: !\ 3 413yt�l ,1Z. _-t�f.)`
.,,bar he is exempt Wemfrdm and roe basis for the alleged lmpubn.Any violas on
-of Section 7031 by any applicam for.permit stibjectsnhe applicant ton civil penalty ��ff,.,�.y�.
:of not mole than Ove hundred dollars($500). .516APN tipftL BUILDIN I"'`" "� Occupancy Type
p I,as owner of hhe property,or my employees with wages as their sole compensation,
-,Will do the-work;and the structure is Out.intendcd-or'off ered'for'sSlc'( 1 a -
'Bn'i a'and I'mm'amnx Code:The Contacts:'License hw goes not ' ' LED Required Inspections t•'
r of pmpeny Who builds or impmvcs thereon,and who docs such w hi f
ownc ...
.or arough M1is own employers provided than such imprnvemems are no intended or
uRarcd for sale 1L ho ever Ne 6h lding p vemem i Id wiih n one Y
omplcuon,the ownc bu Id w ll have the burden of proving that he'did not MA 3 0 L0002
improve for purpose of sale.).
o
O1.as owner of the pope^y,amexdusi,v'Y contracting with licensed contactors to _-__....____.-._ :.
i
cionsurallLa dp es a(Sec. to a owBtiner o and Professions CodoO The Cnnwc ILDING ' r'' `t' 'l "'f
License Law does not apply w an owner of property who builds or improves the --
'^ and.wlm'sia cn.fncmch.projects.wilh a covlrutorls).lircnsed.puauantao.as _ _
ciannoxi License la - - -— ._ .--- -. ._.__ ._ __. .-- __... ._..- ----------
7! ' ---;'�1 a pt under Sec ( 1 'LB&P,C funis reason
"e,,.r.,: .:mboic- 1.....',.:.L -. r
WORKER'S COMPENSATION DECLARATION' -
�' 1 hcrcbY aRrn under penally o!perjdrybrie of the to lowing declarations:
❑ I hdve'nnd willmaintxin a Cenifico¢or'Consent lo'sdf-insure for Workers
Cam pc6xalion.'u-provided'for by section 37W of the Labor Code, for the
performance of the work for which this front is issued..,
❑1 have and will mainuin Worker's Co'napabsatloo Insurance,as rcquiicd by Section
3700 of 'Lbor Coal;for the p4lormince of Ue work for which this permit is
ss yWWSJrk/3eY�s�Compee}�ntonlaui ee mer and Policy
f�a be an:
C1met J'✓/a/fir sr✓/�lr''Pohc No 7343T10 AW,' }. _--
Q'! CERTIFICATION OF E%EMP320N FROM,WORKER$ t t ,]iy �i �` t1;
COMPENSATION INSURANCE-
action-
NSURANCE
' s1`L,:n• a..,, r
rD1ii lection n&'d not be completed if the permit is for one hundred dollars
(S�W)mlcssJ:.b tl. .
7ormiY that in rate performance of the work for which this perm^is issued,l
shall'n not pl Y any_Pe son in any manner,'.as to become subject u,the Workers
r
Compemation I<ws of Califomin.Date" "
-Applicant .. .. .._ ,...� _. ..
N AP " W k If Cfm pmeank'sai gth Ceftificate of
Exemption.
< pt -you should
bDun,subject
to the
foM1 ldy C a youmust
O pldoom d
revoked,
F"�•a h tCONST oNLENDiNG AGENCY "--•' i(+
1 hereby affirm that them is a a constry 1 on
W � ' sIendin8 6gencY f h pcfdmmic<of th ork fo -Inch permit's issued Sec'309] Ci C)
-
r.
�. Lend Add s'
C.1 1 on fY lh 1 a ha d th s pylic 1 o d a1 Nn the above mformafon is
k+ c6rrtct l,agmeto romply,with all,city and county ordinances and sate laws relating
OU tato bold g coiastritictirm.andh rcbY trindaminer0 sentti cs Of this et 10 enter upon
g� kthi above t oned firopony for inspection purposes.
•.
la, (W)ngic to ser e d urn fy and kelp harmless the C'ry f C peri ger nst
tie) It 1 t es J dg encs,c b d expenses which y in any Y vS n said - -
V s�' sty conscq of tit - trig of penny •• i
APDL R SA LC WITH ALL hON�POIA '" - I
souR ro -� 3�_(1� ' Issued by:* Dale
ab ApplicanUCb- nor ;. t Ilan(,. -- Re-roofs
'r HAZA TERIALS DISCLOSURD - - '
' Wn pptiwnt or future budding Doc pant bore of handl naiardmn material ._Type.of Roof .._
6 def tied by the Cupemrto Municipal Code Chapter 9.12. d the Health and Safety -
Cod Seems.25532(a) -_ "•:t -V, -
I% W
.,
yes:'.; ❑N."1iN ' 1'h t4�'t g .. a, a-' i tai'. nil wily. .f.9 �yi,,.Wl ` r ... '.. ,
. ,1i All roofs.shall.be.inspected prior.to any,roofing material being installed.
w n the apps t o r are wildingg c pa t se'equ p t d' 'wm,n If a roof is itistalled without first obtaining an'ins ection`, I'agree Solremove
mit hazardous m t sx def ed by N 'l yAre A Q alit M nagemem g p
�( Dixtn OY a pN all new materials for inspection Applicant understands and will comply,with
K 3 -- - -—
1 I; �,' t i .. all'non poilif source regulations 'lq-Ir, `
1 h rasa Nm hasard us mamrial rtgmremcnn tint Chapin 6.95 of the
Cal f mho Health&Safety Code;Sections 25505,8533 and 23534.1'understand that
'if, does no rterely haca tenant,tM1tit is myrcp bl tyt oily the
Y t of 'rc"' menr9.whhch most b' poor- i uance bf s Cenificatc'of t,r
P c
... . •". -` D�'�� �), - _Signature_of Applicant_. Date
ow ranaona agent .Dale• - All roof coverings to be Class 'B"or better
i . .