01110046 (3) CITYBUILDING DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7536 SHADOWHILL LA 01110046
VNER'S NAME: APPLICATION SUB DATE
JARELL PRESLEY 11/07/2001
/f PHONE: SANITARY NO. CONTROL NO,
1 -Z ARCHITEC'1'/ENGINEER: - BUILDING PERMIT INFO
C BLDG ELECT PLUMB MECH
LICENSED CONTRACT'OR'S DECLARATION
5 i2 g T herebyaffirm Irk.,lam licensed ander fCha ter 9 aommenctn Job Description
a pndriceo p g
'�tw witScaion]OfX3lafDivi' 3ofteBusiness andProfcssionsCMc.and myliccnx SOLAR PANELS ON ROOF
Y f- is in full force and ZU
+s.< Liansc Class Lin.N
O a`-' Dau Comnaor
I ie o�a.. AR HITECT'S DECLARATION
4 I understand my plans shall he used as public o nards
i o O Licensed Pm essiowl
n' OWNER-BUILDER DECLARATION
o I hcehy afrm that I am erupt form the Contractor's License Law far the
L:z_a- felf.mg reason.(section 7031.5 CBusiness and Professions Code:Any city or county _ - - - $10000
I t o which rcyuircs a permit m mnstm0.whir,improve,demolish,or repair any'immure
w3 _priori t also q sthepp ant for such perm+uo file a signed statement __ -------------- _
Nat tie fl« ed pukna uoChep sof the Convacton License Law lCM1ap¢r9 r rl t r Valuation
(ammeeytg, NSeetio nioB) rDwal«3orteBa.htea,anaP ,raafton.cme) (:()`ti ;j3'�4' �(1B,92.. Bai•. try:L' "i-
ar Nal ne a exempt tcmfom'and the basis for the alleged exbmptbit.Any violation I
-of Section 7031:5 by any applicant for o permit subjects the applicants,to a civil Penalty-ofnon mal<than five hundred dollars(s5oo) PNrk � ELECTRI Ali'" Occupancy Type
°I,as owner of the pre,am,,or my employees with wages as their sole compensation,
waroa the•work.feand-saamctreCnrfimendLcene Law for sale ot applinan' 505 - FINAL EREDWEI[Mipgctions
ownerof and arty Who
Code:The roves Contractor's License law s such
not apply e m '^
owner of property who Wilda or impedes daemon.improvements and wood«s such work ndedhimself
or
or throw h his own em 1°des. ovided that such e etc not intended or
- offered fm-site.I(,howevee the building or improvcmem is sold within 6ne year,of `"�'---
contplction,the owner-builder will have the burden of proving that he did not Wild or
improve for purpose of sale.).
_- w r,o he proi,e ]0a4 Business end Profess ran Chen The contractors
— ---- ----'----_- --_--- --- --- --- — p - — _ - _- ---
❑,I;as owncrof Ne ropcn am ..,. .. - --
exdiness ommmin tit licensed convenors to t
- _
consumer the Project a ., ..
License law does not apply-.rac t. an owner of property who Wilds or improves thereon,
-and.who ctors nuts fLow.. .pelects.wiN a comraclmis)licensed pursuant m.the ___._.._.__. -__.._._------------------
Contractors
_.__._.__._.._.._
1fp�ILq ..
' Convamrs License tow...
❑lam expmPt uiWcr Scc ,B&Actor this mason
n,-ep �t " TIC•::t[ '•
y
T.late :� ,, .. ..,.
WORKER'S COMPENSATION DECLARATION
I herby affirm under psnalryof perjuryone of the following declarmiman!
O 1 hive and will member a Certificate of Consent m adf-insum for Worker a
Compensation. as provided-for by Section 3700 of-the Labor Code, for the
performance of the work for which this permit is issued.
❑I nave and will maintain Worker's Compensation lneurana,as required by section
- 37M of the Labor Code,for the pedommnce of td work,for which this permit is
L lIC_ss.u..ed'My W n t o sures d Policy numberJ ^
car abeyNo E 4 VAAt �1!' 3 !K` lK . 1
r :CERTIFICATION OFEKEMP ION FROM WO
4z.f
......_- _.h_.L;,.'..:.COMPENSATION;INSURANCE'_. - ,.., ......___ _ _ ......
(This sect o.neeJ not be complead if the permit is for one hundred dollars t!G:::�,n d..• 1:
ISI00)or less.) la. , . . .. t . ..
which _- •.. ..,m_ .- ..,_.._. ._... _. �. .__.-...,,..............__....... _ - .
;Nc
1 nfytha in irk nit mynannera of Ee okfon ct t Wmucd 1 , s; t•.� h
shall not anon Laws
in any manner so as to txomdsubjm to Inc wor4ri
Compensation Iswi of Califomin:Date '
OTICETO APPLICANT:If.after making this Certificate of Exemption.you should. s "'F••'
Z become subject to the Worker's Compensation provisions of the Labor Cade,you must
Q forthwith comply with inch provisions or this permit shall W deemed revoked.
- .-.-._.__._. .. _.._ . ....-___.._..._-_-. __ _ - .-.. ._. -_ _
h r., "'tf"CONSTRUCTION LENDING AGENCY ' `I• a
I hiktch'firm ohm tit s' constructionTena ng agency for t pert ren •' '•-+
of tit f
Usha Namme
h a+.th pe t issued C(S 'J09] C) �
, � ,
LTA ' .. ._.c. .. ... ........ ..... ...__ . s� .-_ - -.
p" LenAc Adds, - -
C7rZ 5
U'0 i cenify.Nm I have read Ila application and state that the above information is
'ks F c'ormct 1 agree t°`am,have
wit all city end count,ordinances and state laws mlatine
Q.0 to Wildinnsv
g crwthrif and hereby authone,representitives of this city to enter upon
me above-mentioned property for inspection pugloses.-
'ff�....`s, 0.s (We)egntt tosave.indcmNfy and keep harmasi MeCity of Chpeolra against -- '' -"---- --
'ir C6 liabilities,judgments,costs and expenses whichmay in any way accrue against said
U Z City in consequen«of to gaming of tis'not."
APPLICAIS4XINDERSTANDS'ANDWILLCOMPLYWITHALL.NON.POINT"• Issued by: Date
SDILATIONS. y:
SignatureI-Ap� ma Re-roofs -
I HAZARDOUS MATERIALS DISCL URE T
Dole
_bell tit applic.ft or fartrini building can, t store r hand le haaardo metenel Type of Roof.
as def ted by Wa Cupem o Municipal Cad Chapter9.12,,ayyn,d the Health and Witty:
Codes to 25�32(v) *,n , , tl y „ e. ;'ti 11,!,!, ..�J .- ..•)' .t { )�-,
All roofs shall.be.mspected.prior to.any-roofing materia]being installed.._-- .. ._._
tWill the applicant orfuture building use equipment or devices whidi
emit Wairdous an contaminants is deftnM by the Bey Arta Air Quality''Management If a roof is installed without firs[obtaining an inspection;I'agree to remove
Owne,Z a, all new materials for inspection, Applicant Understands,and,will comply with
°Y ",t,• °No all non-point source iegulatioris.
"t T baa read the hrsmEoui lma¢Hals icgmscmrnts uMae Chapter 6.93'of the
Cali(amia Health&Safcry Code.Sections 25505:M533 and 25534.1 understand that.
tithe,building does not currently have a fetamahat it is my responsibility to notify the' - - - ._... ._.. .. . . .. .. . . ._ .._ _ ....
nt of tet requimmevu which must be met prior.a issue«c of a Certificate,of
Signature of Applicant Date
Own, moniaed.9 n +
Dan, All roof coverings to be Class "B"or better.
- '-OFFICE