00120075 (2) CITY UI oNCUm DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING AD PERMIT NO.
c �i90 F I RW I N LA01c�120075
OWNHR'SNh APPLICATION SUB DATE
1-11-1—FEN SUNG WANG hp12/7.2/2000
PHONE: SANITARY NO. CONTROL NO.
o z z ARCIIITECT/ENG1NLIiH:
BUILOING PERMIT INFO
1.1 PLUMB 7
1=1 0, 11
NibI=1 1.1 GJ
y
nerenr mI.ICI?NSBON'1'RACTOR'S DECLARATION
o o m,o,:,tUC'o
1amrtenxam,ifil nmvixn,nx afchnpmr9(camme„ring• Job Description
HF with Section 7000)tfDivio'm 3fthe Bmarc,sanl Ivnlimirnu Codc.andnyliviri-
-f� bin lull n,re,ameneu. DEMO OF SINGLE FAMILY DWELLING
z O y U Livens Class Lic.M
Date Cummn”
3 a 1—n ARCH]I ECf'S DECLARAI'IUN
1 understand my plans shaft M uscd as public mu,.us '
ce
iu�O O Liocn.ced Prafcxxinna]
S e OWNER-BUILDER DECLARATION
u3 I hereby uOSnn had I tun exempt Ii'a I the Cent nmmr'x License Law for the
C 5< following reason.(Sectio:711.31 S,Business and Profession.Code Any city or vanity
3 x p which requires a permit,o ransomer,alter,improve demolish inmpair any structure
Prior,,it,oviocc,aha requires the appI ican,for inch permit to file a signed stntemenl
had he is licensed pursuant h„he pmvsions old.Cantracmfs Liven-Law Charlie,9 Sq. Ft. Floor Area Valuation
(¢xntnteram,with Section 711000 of Division 3 of one Business and Professions Codc) $15000
or that he is exempt therefrom and the breis for the alleged exemption.Any violation
of Section 7131.5 by any applicant for a pem,it subjects the applicant to a civil Penalty
or am more than five handled dollars($500). APN Number Occupancy Type
❑I,:m onhtpaq,my,o mynhq,myee w,d,wagexobci,vilerany,cn.amm, 35923,006. 00
aIllwill Ja,h,work,and bac line[he is not dor', i nr al't'ered liar rule.Sees 71,44.
an
Bax and Prulm ,.x cher.rl,r cnntmemrx Liernxe Law dra.•I m.,apply m an Required Inspections
turn.
ow work NO ASSIGNED INSPECTIONS
r ihmugh his own employees. budded that such inmnwnncnrx are nota.intended of s�
complef le If,hnwa'r,thenu Id ge p n I IJ elit y aro(
cnmplt rh hu'IJ 'll hartue b,me provingIth,h did not huld nr
improve far Imrposc ofs.R.I.
❑I.as mi of,h faofpenY am exclusively contracting 'tat 'J contractors to y '00
construct tit p Not.7N4 Bu- I d t :Cork.) rhe Contractor I
Loc 1 d t o pply t t p 1 ty h it IJ mp th•rem O�
ml III vonar cu Lr Itch p,veo, wlh au,draO,q,) Ila.,rd pre a oro the
(',,ntruv,nr',License l.aw.
0am ere Pt�a,fI it Sec._ I&1'C Iia his mals
Uwl��fe� ��V�'�lQ Dae (/ .,1
VNO '. CYY. PENSA'I ION )I/L,RAId
1 hemby affirm under Penalty of paltry onv rel the fallowing declaration:
❑ I have and will maintain a Cenifmam of Consent it, self-inure lin Wokcr's
Can,.....i eat :s pmk on, lar by Senior 37do of the Lancer code. lin ,he
purfnnnann eat work for which lhls pc alt is ixsucJ,
❑I have and will mmimuin Wuder'I Compencnion bournrec,as required by Section
370C)of the labor Code.for the performance of the work Fir which this Iknnil is
.succi.My Worker's Compensation Insurance carrier and Policy number are:
Carney. Policy No.:
CEN I'IFICA'1'[ON(lir EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('this section decd Ing he enmplem l it'0m permit is for am hundred dollar
(R 1001 or le—)
I cemry that in the penom,ance of the work Ila which this Extra Is issued.1
shall not employ any peon,in any manner m as n,become subject to are Workers'
Compensation Ivw.x of California.Date
Applicant
NO[ICE;TO APPLICANT IL after making this Cenifica,of F.m ntaina,you should
become vauvet to he Wader's Compensation provisions of rhe Latin Code,You must
O fon oath comply wait web loo,ki ,or this permit(hall ac deemed revoked.
tiCONSI'RUCfION LB ND I NO AG ENCY
' I hereby anion nun tame is it construction lending Igen y for the perti,mmmx
of,hc work far which this period is issued(Sec.3197,Civ.C.)
S Q tender's Name
Lantdcr's Address
V 0 1 certify that I have read,his application and state that he above information is
to p correct.1 agree no comply with an city and aom,y ordinances and state laws mlaing
to building construction.and hereby aamod.e mprewntmiven conk city to enter upon
he anmc-annot pact pros+,y for'msprcrtan parporas,
(We)agrce to sae.indcnmily and We,buns less the City of Ca,cmno u,now
fi,di Wes,ludgnent..anis rind wpcnscr which muy in:my way action,againxl paid
U City Inronsequcncc A the ynmrmg ofthis pun...
APPLIC T 'NDIiRSTANDS ANU 'ILL COMI'I,Y WITH AL .NON `DINT Issued b Date
,XSkae
nS.
alar,ar pli 4n3C `,rac `r Z1--Da� Re-roofs
HAZARDOUS MAT F is DISCLOS SRF.
W II he applicant or future building ovcupunl slam or handle h:o uduus m aerial Type of Roof
as delin al by the Cupcnino Municipal Cole.Chapter 9.12.and the Health and Safety
Code,Section 25532(a)1
❑Yen 0N All roofs all be inspected prior to any roofing material being installed.
Will [at at,fli,cnnrludvhaildinyavvnpantuwrgaipmrmordevlctSwlticlh If a roof is installed without first obtaining an inspection, I agree to remove
limit hvardnus air nnnamitwmx ao drfincd by,he Buy Area Air Quality Munagnnenl
. I)ntnct+ all new materials for inspection. Applicant understands and will comply with
❑Yes 0N all non-point source regulations.
I have read the hamrdous materials mquimmcnts under Chapter 6,95 of the
California Health k Safety Cade.Scnfons 25505.25533 and 25534.1 understand that
if the building docs not cursorily have a mount,that i,is my"Nonoail'",In ratify the
I num of the nluirannns which molt Is,tun Prior e,ixxrusc uj a Ccniyyy'cam or
? �� Signature of Applicant Date
H
maam._nmi' ,yell) — `l ).rte All roof coverings to be Class "B" or better
OFFICE /