02030105 (4) OF
CI BUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
20091 FOREST AV NGUYEN HAI T ET AL 02030105
OWNER'S NAME: APPLICATION SUB DATE
NGUYEN HAI T ET AL 03/21/2002
i(. .,HONE: SANITARY NO. CONTROL NO.
`_l
o x z ARCHITEC(ENGINEER:
p p BUILDING PERMIT INTO
z 0BLDG ELECT PLUMB MECH
m i LICENSED CONTRACTOR'S DECLARATION Job Description
Z_e 1 hereby affirm that l am licensee under provisions of Chapter (com
mencing p
mem with Section](llOlofDivision3oftheBusinessandProfessionsCodeandmylicense KITCHEN REMODEL,
C a I is in full force and erten.
pce5 License Clas Loc,p
.i 3 d. Date
G GD CLr
o
ARCHITECT DECLARATION
r
p� ARCfRT
1 undersinnJ my plans nM1all be used as Public rcrnrds
3 d p o Licensed Pmfexai°nal 4 200p
- �, in.,I i C.CurnEr DECLARATION AY 1 L
1 hcrtso affirm ohm 1 1. . usin from,he Lesions o License Law far he
t i a following mason(Bouton)031.5. it alien and Professions Code:Any city or county -
rcr o which requires v Permit to trust nit ullnr.impmvc,demolish,or repair any structure 10000
..pnort , ideate, Lm fey rcsthe ppl cam for such pemuuo Bleaaigndd unmmenl cp !
,tut
1,1, gwap uant to the o ,sion3 eche Bustors a, P fmionsCWe) _.-� y3 S.t�'-Ft, Flewr: tl�' )�
s5`.50,67 .-- __ _....
(comm nc g uhSeao i]000) fD onJof,heBusinezaandProfessmnsCode) {": t" f -Valuation
nr Iha,he,i exempt Ihertfroatand the basis for the alleged demp4pn.Any violation
-ofS d ]OJLS by any applicantfora permit subjauthe applicain roacivil penaly-.
:ofraukmorcm.nrneharaareddolwrs(s5Bo). 10 I"PN 'f"�DAT ION j'"`"' Occupancy Type
L asmerarofthe property.or myemployeezwith wages as their sole compensation, 109 _ '
will'do the'1mL'md'the intensero
dure is ma intended'or r (Bac
d'for sale .7144,' -
Bosineza'end Professions Code:The Contractor's License law aces nut apply to an 103 - UFER Required Inspections 111.-.'B i„ r.
owner of property Who Wilds or impmves thereon,and who docs such work himself
.-or Im
hagh his own employee..provide!that such improvements are not intended or 104 - REBAR I
ffered fol sala'If however,the Wilding or ilnpmvemenns sold 4 ittiin ono Yearof - """'--""'-'-"-'--'--"'-----
reomplelion,the owner-builder will have the burden of that he dm not build or 105 - ANCHOR BOLTS 'i'•� ' r� ' t:. ': - --- -
improve for Proving
p"'°°"orsale.). 106 - SEWER & WATER
on ai owner of the p(Sec.7•um ex sines a conuveessi with licensed eontmcmn,o. ..__..-.... . _ ._ _ _ _ _ '— -- -- --
202 - UNDERFli00R'PLUMBING " '
onslmcl the project(Sec.](W4,Business and Professions Code:)The Contractor �
203 - UNDERFLOOR MECHANICAL-'--
Loconsc tawx
Js non apply m an owner of p perry h build Dues(hereon. :t, Lt
1. ❑Inei _or ch <mrtz)I d.p rsuanl.,o.Ne -
0w me to n L° - "--- '-2 04-- UNDERFLOOR-.-FRAME--'- -- .
Cnn 1 License P 1 ns.wim o f
CC, ' ' B&PCr this 205 - UNDERFLOOR:' INSULATION
a' Data �' 2/�OZ 301 - ROUGH PLUMBING
„'I -'WORKER'SCOMPENSATION ECLARATION 3OZ - TUB Sc OR SHOWER
1 herebynrfinn anal,penally orfe"J`y apr ofthe following declaration, 303 - ROUGH MECHANICAL
❑ 1 hove and';iiIl'mnmmdin'°Ceinficaic'of Consent to self-in,ore for Worker'. 304 - ROUGH ELECTRICAL
Compcosaiion.. as provided for by Section 3]00-of the Labor Code, for me
_ 'performance of the work for which mi:permit is issued., 305 - FRAME
111 have and will mdinizid Worker's Cmatere tiov In,...ra .m r,inned by Section 306 - HOLDOWNS
3700 of he Labatt.Coad,far the performance of me work`for which this permit is
sfined ln.",peCompera:adonlna...neteame anePoR 307 - INSULATION
.,., ..,... - . ry barn
..-Io' -
Cain fra f}1 l:S'1'1'�tF,)M1i! of - -
X l "[_' 308 ,- ;;SHEETROCK ,• -Y,
° r( CERTIFICATION OF E%EMPr10N FROM'W'ORKERS - - -s r-� f 309 '-' `EXTBRhORLATH
.gra „_COMPENSATION INSURANCE '- ' l-'
r.:.. , , . -INTER IOR--LATH—__
on nee :--'----- -- ----------
('11ns sextd not be<ompined if the pcnnit rs far and hundred dollars ) , .'I
aloo)or tans=? 311 - SCRATCH COAT � '
I'
1 nify that n the pert - oflh work f which this -- -_-, -
- - C
h.unl nJY,so %bb�deo a b1 t m Workers'
501 - FINAL ELECTR'ICAlii1ENERGY
Cnmpen 01 O 1 to 6 o C.I f ryr D{ \ /Y�!°�2
rape"' 1 �"''' 1 fia6 502--. F-INAL PLUMBING ENERGY--
Z
rrtge�[[''••� ((�� .. --
NOTICP�TO�APPL - NT If II k �f'I�ofL sho Id -
gthsCn sof,hLWpC&ly 503 - FINAL MECHANICAL-
"ENERGY " •`�
become b1 n the W k C mans sat p o "'
O O frah ,h<o ply 'itis hp ,h permo shall bed d revoked 1
z , Ft _.... 5.04...-. .EINAL_BUILDING. ENERGY
' CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL,
1 h by' hie mat th n.true er d o "
ai-J - � 6 g cY for th p Korrnh
w ,rah storktoowhich v, ail s' ars ,309] Ci,,c.1 " 506 - GAS TEST
Q Isnde N m " �- .. _.._ ._.
� Z Lanae Ade 's .
507 - FINAL PLUMBING
U O ' a' 508 - FINAL MECHANICAli '
„y ,, I«mfy that l he read ths apphcauon and sloe that theabove information z
cannel l gree to comply., th all city and county ordmances and nate laws mining
O.r_1 mbuildingconstrction.addherebyeumisiDdrepresenlali Itfmiicity1.enterupo509 - FINAL GRADE
me aWd m ed p.penyf .p<mm prpo s - 510 - FINAL PLANNING
tom. 0. liabilities,
m v Brandy and k pharmless the City fCiiiihn against -
Cityinshag m osis daspctieswhch a,, any way craeagmstsaid 514 - FINAL PU IC WORKS
t.) Z City n cons qucnce of th<gra,nB of thlx pc t -- /'� 2
'APPUCANT UNDERSTANDS AND W ILL COMPLY W'rrH ALL NON Po YT" I
SO rRCE RErr ILATIO r y Issued by:
Har. ` racus, /L?.,, /3/t/�6l y Date
bgpawrt of AppbcanVConmelor ... T.DIe;',•:... Re-roofs Y
( „ HAZARDOUS MATERIALS DISCLOSURE v
WII the applicant or fulurc budding«cups°,store car ha rda hvardous melcnal _ Type of Roof.,. '
as defined by,theCupen no Municipal Cod Chapter 9,12,and me Heald and Safely
Code SMI 25532(.)] - ... -
OYs 11lf M.j 1 -2 t tir-. . i r q 9r a ; ?•a f
'FN ^ __All roofs shall be mspec[ed prior[o any roofing,matenal being msta_lled.
W II the nppl c 1 r 1 building occupantequipment a which [f a roof Is installed without first obtaining an'mspectlon I agree to remove
l r1 M1a ` contaminants defined by me B y Are A O I tY M "gem 1
h aM se,
' all new materials for inspection Applicant understands and will comply with
"all non-pont[source iegulattons -
er 6
y responsibility to notify the
CC
Wilding
g did nh`currcM hh he aran requirements
ttit is nor ro,espntt f!ty to notify the
f ..... .. .. . .. .. ..._ - _ _ ..._. .. _. ,-_..
CSI 4 H Ilh&S kr Cmle S t o 25505 25533 and 25530 1 u d sland,hot
'
m
am flhe u g 0 ... _. ..__.. _
p p yZ1,/. g
Si nat_u_re of Applicant Dale
0 °` ^ sea a e 1 D� - All roof coverings to be Class `B orbetter