01080097 (2) OF CUPERTIN
CI BUILDI G PERMIT
DIVISION � CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22102 HIBISCUS DR GLADYS KWOK 010800,c97
o(iLA�NY KWOK 0T[ONUB DATE
84 2001
: - SANITARY NO. CONTROL NO.
7PHONE
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereb ffirm that I am licensed under fCha, V(commencin Job Description
Y a pr°visions a Per a REPLACE FURNACE .
PwithSec,ion]000)of DivisionJofibe Businexn and Professions Cadeand my licenseais in full farce and effect.
License Class Lic.M
mDale Contractor
ARCHITECT'S DECLARATION
t.;!E�'O g 1 understand my plans shall he used as public records
Wa K Licensed Professional
OWNER-BUILDER DECLARATION
.—I I hereby affirm that 1 am eeempt from the Contractor's License Law for,he -
following reason.(Section 7031.5,Basioess and Professions Code:Any city or county $1200
E ❑_ which requires a permit to constrict,alter,improve,demolish,or repair any structure
n 3 m prior to its issuance,also requiresthe ppl'ant for inch litt File a signed statement - -- - - -- -----
thc rtmhme is
n,nlicensed
pursuant t]Wthe lpravismas
v ofthe
f Contractors
.L dP Lfeawss(Chapter 9
Chapter9 32( U Ptot1goyeValtValuation
or that he is exempt therefrom and the basis for the alleged exemption.Any violation -
orSection 7031.5 by any applicem for a permit subjects the upplieom to a civil penally
ofao,more than fire hundred dollar,S500) 301 APN A�9QbFI PLUMBINOccupancy Type
❑1,as ownerof,hepmpeny,ormy employees with wages as their sole compensation, 303
will ne the work,and-sC rick mThis'n tr intended a e offered for sale
no (See.ANJ; 3 04 — ROUGH ELFIgTdROAPeetions"
•
ownero and Professions Code:The Contractor's License Law docs not apply m elf
o f property Who
-:' '
W p' ,h n and who does such
'work employees.provided ent, nimprovementst .eels 50.5._.._ FINseeAs..L ELECTRICA
L
c pf n theb IJ Ilhrse thbden rygtoaatb 'd
offered fors 1 Irn however,,h building r 'pet la ,n yermOr PLUMBING
W 0 508 FINAL MECHANICAL
P P Y, texclusivelycontracting ..
less
t t g ,M1I n dcont-c,
p J t(S7c wet the B d Pmficsimnas Code.)The C , t r a
a L a tapplyr-suc t f P pent who builds p thereon,the co Licam f r such projects w1M1 v conuvaogs) d pursuant m.,he _ sell... __. .. . . ..
Conuactors L rinse Loss.
❑lam exempt antler e � B&PCfar this reason nt
_ - WO R'S OMPENS ION DECLARATION
I hereby affirm under penalty of perm.ry one of the following declarations.
❑ 1 have and will maintain a Cenificme'of Consent to self-insure for Worker's
_ Compensation, as provided for by See inn 37W of the Labor Cade, for the
_ performriae of the workfar which,his permit is issued
_ ❑1 have and will maintain Worker's Compensation Insurance,as required by Seodon
37W of the Labor Code,for the Performance of,he work for wnich this permit is
is6ad.My Workers Compensation Insurancec my
er and P number are:
Gamer Policy IO -
CERTIFICATION OF EXEMPTION FROM WORKERS;
COMPENSATION INSURANCE
sell. .eis
els _less.
(Th s iectinn ed nm he wnplema'f,he permit is f r one hunJreO dolWrn -' ' '
(SI W 1 ale's)
Icenify that N war f fi k f h lb his pe -t d.l - - ... •. ...:. __ .. .
shall no,employ ws t person m any my as,to Mea a mdie e Worked
Compensation Laws of California Dare
Applicant c Certificate
NoTICE
mps,sTOct1. he ANTIL Cmapimki gm's isonsf fExa ptiode,Y umuld
must
become sunjecty.tl,e inch
Cbmpen.cmmn provisionsofthe ented Corte you must
z O rorih ,h cried 1 with. h mvisinnso ,La's deemed revoked.
r - sell-.eels sees_ _.. _.
pY P permits al e
r CONSTRUCTION LENDING AGENCY'-
:a. 1 he eby vain ,his lam ' s ton t t Iending uben y for Me cerfonnanm ,les s
utas ' arae ch th p' tis issued(S3W7,Civ C.) '
,a1a -L der.Name:
-Z Lende sAddress .
V'�r I n(y that Lh d,I s aPPltc t a.,airtallnuffir.lovicummonfroi,
'ry'ri
amlcl,19 I agree to comply with all city and county andinarces and state laws adoring
C:) tnb 'Id g msuuct do by art- p \a,iva.of this irymemcrupon
.{>..nt.W 'the above-manioned property for inspection purposes
Fa .
.;Li (\V).9.in d "niry and keep h harmless C',y ofCpenino against
judgment,.n,s , and asp..... Inch m
)to any ay c e agar n said
U, City liabiin lities consequence f,h g tying of this pr ,
APPLICANT 4N iWp W_'hhcoM .Y N'ITH ALL NON-POM',.
APPLICANT
: ULATWDE s L/r" r Issued by: Date
Signature of Appf'o- w A Om S MATERIALS DISCO .,,a Re-roofs
H
wul m FlPIi , wit e mind�s P nt staid an ale ha:a anus mmeM1m. Type of Roof. .. -. - •, ..- _. . -.., .....<._...
'c a s �t nzsinO e a Chapter e.lx and the Health and Safety All roofs.shalLbe.inspected�prior.to any..roofing.ma[erial beim .,
a y t open Municipal
• ... ❑Y.. ". . . -- reinstalled.
w u m oppl cont r, b'fi g cpm a eq p t a me ni<h' if a roof is installed without first obtaining an itispecuoli;d'abree'to.remove
emthazrd us°rc rimed sasdef dM1y th ByAreA Q Ity Mamp meni
DI, t all new materials for inspection. Applicant understands and will comply with .
°Ye
, /len�a '
a
-all non-point source regula1tion✓s,
I have alheh vN tome al q , mems under ChapterEf
Cal mm Health Safety Code.S tion si I understand the
U^
ialdt goesnacurrently ha Room,
that
itis responsibility notify
occupant of therequre I h L ct be met larliAbro,mareFmetcifnCeiificate of
r/
-
i Signature of.Applicant Date
'o aptnorizea agent: -
Data - All roof coverings to be Class"B" or better .
i :. ; .I .. _. . :.. . .. OFFICE