00060194 (2) CITY IMIL hCUP DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PBRMI'INO
OWNER'S NAME APPLICRI'ION SUIT DAT 1;
22360 SANTA PAULA AV GiT. CONSTRUCTION 01 00060194
HONG SANITARY NO. CONTROI.NO,
ALLEN HSU 20711 FARGO DR 06/30/2000
net ARCHITECANGINHER: BUILDING PERMIT INFO
kC w_ BI.UC Iil.liCl' 1'Lt1MH MIiCH
,U_ (408)725-1499LIC2
Gam
F N_ fines; I CONTRACTORS DECLARATION Job Description
1 heruby uffinn msu I nm Ikcnwd under Pn,visiuns of chaps','9 nd(Ionfavacial
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a with Semien7lX(11 nl Division Sof the Bwincvx and Pro(c c�}�{ Imyliccnw
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s in fuss r,ax//me odd effect.S:eff
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% Licence ClLic.p
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n a, uiIunderstoodanyIdea,hallberecord, TEMPORARY POWER
ce a°5 Licen,cd P fe..wed
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UWN[R-BUILDER DECLARATION
1 hereby aftnn that 1 am exempt hour fire Contraco is Liar%c I.aw fm to
C Z holhm'ing reason.(Section 7031.5.Ru ins.,and Pro1i„ion,Code:Any city or nmmy
C c which mclifire,.pe-it tcommoel,alt r.innanove,demolikh.or rvict,.ray, wmmc
aimpro.t if alio oripri..m ,hrea ,our omir pi 11,. i,ncd.t nmte.I
that fe,,licensedparsurout m I .fair 11c C t t Pec (Clapf,r1) Sq. Ft. Floor Area Valuation
(emnnencing with S,efinn71X(1)ol Dimsinn Sof the B.,inc„and 11 firs,,ion,Code)
or that he is acmpt tltemfmm and the basis for the alleged cumption.Any violation
our Section 7031.5 by any applicant for a pertain subject the applicant to a civil penalty
of not morn esu rve humlreddO.wn($50d). APN Number Occupancy Type
0I,a,owner of the Prpary,o.my employee,with wage,as their sole cnmpedsa tar,
will do the work,and the suucmm is not intended or olfeecd for sale(See.7(Wt.
E lora,and Prov,sion%Code:The Caahacfor'r License Law does not apply to.an Required Inspections
r or pn,pcity Who u
build, .hapmve,thereond
,and who oe%%ouch work him,eli '
our through his own cii pro ole.!thin sac.,imprmemems are ant intended or 35705035. 00 -
uttered for sale.If,howm'cr. he building or improvement i,sold within one year of
vcompletion,the owncnbuilder will have the burden of proving that he did not build or
n...a"errparpownf-ode')' 304 — ROUGH ELECTRICAL
01.as owner ofthe propeny.ameclu,ivory. contracting with Ecemod comm.mc`1O 501 — FINAL ELECTRICAL ENERGY
construct the project(Sec.70.11,Business and Professions CodeO'Mc Contmcmr',
icen a Low does not apply ,, m of praperty who baud, ,incl— •,thereon. 505 — FINAL ELECTR
and who cunlrOX fat nue1,pmI,,,, ith a aununaml„ ncen,ed puwnn, ,, he
Cammemr',License Law.
01 am exempt under Sec. .B&P C for this naso
owner Due j
WORKER'SC'OMI'f perpryron, inef1RlION
wing
1 herchy aRrm under penalty of perjury one mine following Jttl;wtionx:
J hoe i it will mmimaio a C,dircam 0 Convert m,elf-inorrc rnr Wodcrs Q
Compensation, ;is provided IF by Seen 1 9701 .1 oho Labor Calc, far the O
Per(nrmance of the worA for which this pcnnit is is.,uW.
01 have.nd will maintain Worker's Cumpmrcation Irournnce,as required by Section
3701 of fife Labor Code,for the Iefloonance of the work far whirl,this pcnnit i,
i%su 16AWz kr� C mution Insurance carrier oil Policy anta
carh` pamPOEey No.: N2o`125y,A
(((777 IIICAI ION OP EXI3MP'I'ION FROM WORKIiRS'
COMPENSATION INSURANCE
This section need not be completed if the Permit is for one hundred dollar,
is Inr or I'llI ,
I eerily that in the pedi nomoc of the work for which this pcnnit t,issued.1
%hull not employ any person in any manner so as to by omav subject to the W'orkcrs' _
Compemation Lax a our Calitumia.Data
Apphcmt
NOTICE TO APPLICANT':11,oder nuking this(2en'dicum of Exemption,you should
bscome%object m the Worker's Co npensminn provision,of the Labor Code,you stmt
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forthwith comely with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING ACHNCY
> I hereby affimt that dmrc i,a commuctimi lending agency for fife perhnnnunce
.f the work for which mi,permit is issued(Sec.3097.Cil C.)
coon's Name
u. Z Lender',Add,,,
U Q 1 ceed y urn l have mol this application and stain bar he move information is
4. f•^ correct 1 agree to comply with all city and county ordinances and state law,relating
Q U thmheildirg ctmWmainn,and hcrthy eumario,mpmennuive,ar0i,city renter nHis'.e nMwe-mentioned pmpeny I ra'in,p.ction arpnw,.
0. (Wel ngrecrosact.indemnify and keep hamdc„fire Cityof CuPerino ogaina -
V) liabilities,judgmems,vow,and expenses which may in any way accrue against said
City in consequence of the gmming of this Perin.[.
SOUBCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
5ignmumob Appuemut Camracmr Dole Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will thenpprcmt our cafehuddingOeO,pam,tom or handle hmudon,mmmiab Type ofRoof
a,defined by the Copeninn Municipal Cade,Cnapmr 9.12.cad the Health cad Safety
Code,Section 2553201F
O Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will list apei...Iorfntar.huddiagantpardmeegnipmenOrdevice,which If a roof is installed without first obtaining an inspection, I agree to remove
bort hmmdow,air contaminants as defined by the Bay Area Air Quality Management
Di,nicn all new materials for inspection. Applicant understands and will comply with
0Yrs% 0N all non-point source regulations.
1 have read flit,hmmdom,material,requlmmeas under Cnupter 6,95 of the
Cabifomia Health&Safety Coale.Section%25505.25533 and 25534.1 understand that
if the building dues not curemly have a term,that it i,my responsibility to notify the
ccnp:mt of fh..........enu which roust be amt prier to iswanm of n Ccnifictnc of
Occupancy. '
Signature of Applicant Date
owre+ser mtmariaen age
Dane All roof coverings to be Class ••B•' or better