02020035 (3) CIBUOF ONUDPERND
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
02020035
OWNER'S NAME: APPLICATION SUB DATE
MOHAN RAM P AND SHEILA 02/08/2002
YHONE: SANITARY NO. CONTROL NO.
O OZ ARCH]FECTIENGINEER: BUILDING PERMIT INFO
to- BLDG ELECT PLUMB MECH
u u L_1 u
c y i LICENSED CONTRACTOR'S DECLARATION I �.t� irrraaa��'��lO
A Z C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p. of
sasto
mt-u with Seciion]I100)of Division 3 ofthe Business and Professions Code.and myliceme Yon��
e x E- ',in rnn(mpr«�and crc 2 BATHRMS REMO L.
i c w u Da¢nsc/H O—� (DaLienn in,
o LL o a ARCHITECT'S DECLARATION/ AUG 0 2 2002
E } 1 understand my plans shall he a ad av public record,
p zLicensed Professional
v E R a.v OWNER-BUILDER DECLARATION BUILDING
1 hereby affirm that 1 am exempt from the Contractor's License Low for the
E'=$o fom:wing onson(Section 703 1.5,Business and Professions Code:Any city or county
$28300
uai 3 e ..prion is I u ns Ute i ` S ,l:�l FIOOr
nn3 anncdeu=onc�anti Prorcas ads cadet ..- - - ---
which req pe t t t co wcl II prove pair any s rue ure
req pp mfar such permnto file aligned smmmcm
(as. births I' ,audpu -anthepm .t n3ofteBusinesandPelaw(nsCor9 Area., Valuation
orm < ie, insect ]000) rD i ;. a�SAAs`?
or thus he s cxempi any applicant
li and the basis for the alleged exernpibn.Any violation- 3- 613'0 0 3 0 0 r
of a, 7031.5 5 Fy my aped dant for 1 Permit suFjwu the applicant m a civil penalty
for not d,ore man Bve hundred aalWrs(.5.500), APN Number Occupancy Type
01,as owneruf the propsn,.,an,employees with.,,,as thei,,cle ofmpem 101 - FOUNDATION
-.ill do the work,and the amcture'is not intended or offered for sale(Sec:7P ,
Business add Professions Code:The Contractor's License Law does not apply to an Required Inspections
owner of propeny who builds or improves instead.and who does such work himself 10 3 - UFER
.-Or through his own employees..provided that such improvements are not mtandead a, 104---- RE BAR
ffered for sale.If,however,the building 6,rop,onemcnt is sold Sfihin one rear of ------" -- - -- ------ �,'- ---'
'completion.the owner Wilder will have the burden of proving that he did not build or lO5 - ANCHOR BOLTS E�
improve for parpase°r sale). .
h'ar,anc,orthe pr�� "o�.- ..-1. ....-. - _. _ . ..106.--_.SEWER . &....WATER...,------ - - _ ....._..
a r y ennimnldg who banned contractors to
- - unarm, a Projen2 0 2 - UNDERFLOOR PLUMBING
(sec.]Oaa.nosiness aad Prnfessluns Coned The Contractors t",
License law does not apply men owner or n no builds or improves thereon,
°PY property ° 2-03 - UNDERFLOOR MECHANICAL
..and xho contracts fin.auch.Proj«¢wiN.a commnor(s)licensed pursmnt ao.the_ ..... ._._ ..._-... .._.... _. ._.......-_._ ._
codranors Li«nx l-'s"' 204 - UNDERFLOOR FRAME
❑I am exempt under Sec. .B&P C for his reason 'I
205 - UNDERFLOOR INSULATION
Owner Glue
WORKER'S COMPENSATIONDECLARATION 301 - ROUGH PLUMBING
Ihereby affirm under pamxpt ofP=yarytineortiv<followingdeclarations: 302 - TUB & OR SHOWER
p �•,Apr ❑ 1 have and will mammm'a CmiEwie of Consent m selfdnsure for worker's 303 _ ROUGH MECHANICAL
sy�;3 campen,.Ii as pmvidw for by section 37W or the lanae Code for the 304 ROUGH ELECTRICAL
_ - p<daimon«of the work for which this Permit is issued. 305 - FRAME
have and will inalntain Wmker;s Compensation Insurance.s�riegmrcd by section 306 - HOEDOWNS
'
00 of the Labor Cada:for the performance of the work'mr which this Permit is
'xsued My Windomsccinnipersonaran I soma eranePoncyn x ._ 3.07_ - INSULATION
came'R ey pO5- ZU ,sir..---k.k308 SHEETROCK t ,,.. ,y.! ..,nH
r _I .R 3'IFIGATIONOT C%EM ION FROM'WOR KERS' = + N +' s•. ��� rt ,. , ,
..,._ .,� __ COMPENSATION INSURANCE""•'•?_ ...3.0.9..._._._EXa.ERIQR.._LATH ._-._._�.
'3'I (This so<tion need not he complcted Hitt,permit is for one hundred dollars 310, - I'NTERI OR LATH
al0o)ar lesx> 311 - SCRATCH COAT ,
r.. . _...<. .. ._
' 1 cif it t til r fibs work for which this _
sna01 t employ ;Per y- eject o me w«ieal 313 - ROOF NAI L,',ic•' Ii1. t; '.°'i r .
Pena 'roxr° ` n 501 - FINAL ELECTRICAL ENERGY
Com uon Laws or California.C bfom a Dat manner
yr . .. t. ... . ._ : . . ..
NOTICE TO APPLICANT If,after making this Cenificam of Exemption;you should SO2 - FINAL PLUMBING ENERGY .,
Q Obecome subjecto the workers Compensation provisions of the harbor Code you must 503 - FINAL MECHANICAL ENERGY
fdnhwith comply with such provisions or this Permit shall be deemed revoked,
z _ . . -504" - FINAL- BUILDING ENERGY,;- — --
•' """•"" CONSTRUCTION LENDINGAGENCY
a'71pIhereby aifirmthit th6icm
isacoboation lending agency forth'perfoirnanea 505 - FINAL ELECTRICAL_ -
fU kf which this°g t' -d(S 3097 Civ.C.),
a"p 1ne Nme
°< - ..aaap,r .. 506 - GAS -TEST - -... .-
U ZO and' aad 507 - FINAL PLUMBING
1 chary that I hand,read this application and state that the above inf«onion is 508 - FINAL MECHANICAL
: Vo-;r correct.I agree to comply with all city end county ordinances and nam laws relating
01V to building construction,and hereby dnboriae reprcsetnmives of this city m enter upon 509 - FINAL GRADE
r:;4 the abnve-mentionep,property for inspection purposes., _
1.. A. (%,a)agree tiskive;inm
deniryand keep hamlessth'cCityofCupekmaragainst 510 -
FINAL PLANNING
Z) liabilities.judgmems.costs and expenses which may in any way aocmer against an, 514 , - I N C WORKS
tJ'Z City in conuquence of the gmnting of this permit.
APPLICANT UNDERSTANDS At; COMPLY RH ALL NON:P IN d�-f
'a gOURCE'REGULATIONg. Issued by: Date C/
n.o _�
Sig onto re,of Applicabntonnaaor "1 I :: Dae. ' Re-roofs
Will the ppl cant future bu Wing RIALS DISCLOSURE
HAZARDOUSM
«
1t xr . q ald. mnal ....Type Of Roof
Coraat def d by @ C pen no MupI Chapter
912.arid the Healshand Safety
CoU S t -25532aln + ..
.sp .. ` - , - , .- _ -.. --•
stO 1 1 .
❑re ' ` } __ All roofs shall be inspected prior io any.roofing,material being installed.__ _
Will the applicant or future building p t usec lu p tordc ices which If a roof is instAlled without first obtaining an inspection;I-agree toiremove
it hiaa,d rconta- ms as defined byth Be,Area A Quality Maaagem t
.,nam *� all new materials for inspection Applicant understands and will comply with ..
DY all non-point source regulations '
1 h e Health
the e',Coons Stations
2 505 temena' ndc Chapter 695M Ne
Calif Hdoesntcorrectly
or Cod Secuocann. h25533 d235361 d t dtht
hhebuilding el« not ire tlyh a st t ie, t Y p bl'ryr IfY the
accordant.drd qu nt. N 1unb IO loam re C<n fict of "�
Oce p
7{/' Signature of Applicant Date
(- All roof coverings to be Class "B" or better
Ownc n 0o d ag t f m
_ _.1 + _ .. _. - _. .•.� ' .. OFFICE .. .. ... - .