01050146 (2) CITY ON CUPECONTRACTOR INFORMATION:
BUILDING DIVISION
su)ry PERMIT
BUILDING ADDRESS: PHRMITNO.
1.0300 N PORTAL AV BUDGET PLUMBING 01050146
OWNEWS NAME: APPLICATION SUIT UArE
YEH LONG—CHING AND SU—)".NG 28695 ROANOKE ST 05/17✓2001.
1'IIONIi: SANITARY NO. CONTROL NO.
(510)303-7847
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FFN_ LICr:NSEDCONIRACTOR'S DECLARATION Job Description
OZ✓J rte d ,ultimo ow,I ion IicenW under......d sien%of Chapmr 9 d m y license .
r,�,:j with Section a and Ot Uirisinn 3 of the Rucine>s and Pml"%.eion.c CeJa:md my licence
_x LOU fm°°°wolf°°` WATER HEATER REPLACEMENT.
z a Lieen.w Clain Lie.p
a�' Dale Contractor
3 a.H ARCHITECTS DECI.ARAITON
t=O? I understand my plan%shall it,and as public record.
ei`oo,
sO O I.Ice-rd Prnt2,'sional
a.a� OWNER-ItU1LDER DECIARA'I'ION
I heahy acorn,hat I ma cavmpl from the Coronation'.%License Law for the
In loxing ret.(Section 703 S,Ration,an I pnlfcnsloe,Cn 1,Any city n unty
Him
which req pendit t o alta p e demolish, pe, y chutta
priort t issuance al 4 s th applicant I ' h permit i (I signed statement
bad it. 1 dpar% o tt t I' tau fn c ,-tar's Licinke Law(chaptnr9 Sq. Ft. Floor Area Valuation
(commencing with Section]Help of Division 3 of the Ravine,and Prufc,ion%Calc)
or thin he is cs mpi therdron and the bad%for the alleged exemption.Any violation
of Section 91131.5 by any apph,im'fm n Penal,wbryuts the applicant to u civil petty
of sat tame than R%c hundred doBam f$5aa APN Number Occupancy Type
D 1,as owner of the property,army employee,with wages us Glair cede contpvnsmion.
will do the work.and the svucoa i,not intended or offered for sale(Sec.7140.
Itoand prole, m Code:'I Connector',License Law does not apply h,!in Required Inspections
owner of prupcny Who builds or improves thmmm,and who does such work himself
r though his own employcc,provided that such improvements arc rt intended it 502 — FINAL PLUMBING ENERGY
alrsred It,,vide.11:however,the nuildlng or lntpmvemont is sold within one year of
completion.the axner-builder will have the burden ofproving that be did not build or 506 — GAS TEST
improve for pumo,eof,ac.) 507 — FINAL PLUMBING
❑1,tie owner of the Robert am nclusivcly contfncting with livened contractors In
consmet,he project(Sec.10,14.Bu%inns and proh-sum,Cade)The Contractor's
License Law darts not apply loon owner of progeny who builds or improve,thereon,
and who ,I-i"o for such pmj"vts with a e,mtmu,da)IittnxJ punuum to the
Conmumks Lic itle law
❑1 vin wanpt under Sec. .R.Pa Is C Iia this rani
Owner - D'a,
WORKI?R'S COMPENSAT10N DECLARAIION
I bmuby atilt.under pcoulrynl',,,jm,,awol In,I...... ingdcdarations:
•� ❑ 1 have andwill maintain a Cenre o
iE,,v of Concent m elf-inufor Weaker �J
Compenm0on, pro.11ed I'n by Sa:dan 390 ,1 the Labor Codc. Gtr the
perrorimuccofthevork linwhich thispermitiskvind. f J
❑1 have and will noimain Wader's Compen,wdon Inmost.,as rcquiad by Sm,ion
37NI of the LaMar Cade,for the performance of the wmk for which this Recruit is
ewul,My Wooer%Compennudon Inurence carrier and Poli%nnmher are:
Carrier:___CI
No.:
urric
CI[Il I'IFICATION Of I XIiMPPION FROM WORKERS'
COMPENSATION INSURANCE
('lhic Ivalon need nm lac,completed if,hc re ill is for ane hand,",dollars
(SR10)or Ica.)
I eerily that in the Fedin'mmaa of,he work for which tW,wrmit is iswcd,1
shall out eipPlay any pervert in any near er so as m become subject to the Worker:
Coo.txnwtion Low%of Calif un.Doc
Applfeam
NOTICE TO AI'PLICANI':If.otic,makingthia Cmiti.t ofB...paid.,ynuhhodd
boon mtbjecl,n the Worker's Cannonvoia i,o—kio ,of the LuMa Calc.You rant
Q Q forthwith comply with.such provisions or this peril.hull he deemed mnkcJ. '
z
r/J CONS I[anthere is. ON LENDING AGENCY
1 oak
far vRr that there t I,conatr sec. lending agency for the prrli,rancc
of the work far whish thi.%permit is is.vned ISe<.3107,Civ.C.)
6. Q .nta
d-,Nan
z [.enJcr's ndJrta%
1 anlfy that 1 have read this uppliuvtinn mN slam that the above Intiammlnn i,
[r. F.. entice.1 a6ree to comply with all city and county on inarac%and state law%relating' '
O VIo huilAing con,Itn tion.laid nemhy uathorivc repaewmatives of this city m enter upon
W the anove-uncrooned pmperty linin%peeion mopowl.
F y (Wc)recent save indemnify and keep hatless the city of Cu,ma,against
Ok ,,celomic,judgmm"a,cos,,and expenses welch nnay in any way acctn,against said
U Z City in conaquvme of the coaling of this Iwrunt.
APPLICANT UNDERSTANDS AND WILL COMPLY WIFE ALL NON-110INI' Issued by: Date
SOURC17 KEGUI.A'I'IONS.
Signoras of App icanticonhacon nate Re-roofs
HALARDUUS MATERIALS DISCLOSURE
Will me eppbcat or future wading eccawat%ocea or hamlR hmvJoas material Type of Roof
is I,fa,d by the Cupcnim,Municipal Code.Chnptcr 9.12.and the Headband Safety
Calc.See,
El ye, 255320 oNa
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or lionc building oecuponl use cgmpnnnt or device%which If a roof is installed without first obtaining an inspection, I agree to remove
hnuNnuv sir ammamimms as dchncJ hY the Buy Acta Air Quality.Nanngcmem
District? all new materials for inspection. Applicant understands and will comply with
0Yca ❑No all non-point source regulations.
I have read the bwamon matcriul%oquircmcn,s.rode,Chapter 6.95 of the
California Health h Safety Code,Sections 25505.25533 and 25534.1 uodeatnnd that
it the huildmg dcec not"urcialy 1,11c it court,the,it is my tesp..l,da lty u,mail,the
cupam of the rcquiremmtb which nmvt be met pour m luaooce of a Ccrlifcem el -
Oeeapmcy. Signature of Applicant Date
Owner or authorized agent nate All roof coverings to be Class `vB" or better
OFFICE