02080037 (2) TY
CI BUILDING DIVCrISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21888 SHATTUCK DR 02080037
WNER'S NAME: PPLICATION SUB DATE
CAROL GONG 08/08/2002
pHONE: SANITARYNO
O A .
W O RCHIFITUIENGINEER: BUILDING PERMIT INTO
F BLDG ELECT PLUMB MECH
u� IJ I--U LJ LJ
8o:Z'
z Z y= LICENSED CONIRACnder provisions DECLARATION Job Description
OZ_ ction7")oI most, f ivisiohat I or 3ofthudundesandof Chapter 9 sionsCde.anommecense INSTALL 2 SKYLIGHTS & LIGHTS
ing
s in Section 7")ofDivision l of the Business and Professions Code,and my license
psi °"r°ro°a"'°°°e'' KITCHEN/HALLWAYS
6 U Licc se Clms Lic.N
X0
Dam" Contractor
to 3 a.l;; ARCHITECT'S DECLARATION
C S I understand my plans shall be used as public records
w M p 2 Licensed Professional
n a m Oat I am eU rept Tr DECLARATION fy
1 hereby affirm that 1 am exempt from the Comractor's License Law for the
F¢< h mr dreaa(Section]031.
which
4 Boniness and Professions Coda Any city or county
F x 0 who h req permit construct,aherimprove,demolish. p y structure
ment
u°73m, pant t purls q pr inion ft ochre permittois Law(Chapter
Oat rte r xcd pursdam to the p provisions of Contractor 1: W (cnapmr9 S FL F1oorArea,.,.• ; - • Valuation
(commie gs th Sati7ddid f0 is l of the BusinessdProfession;nCode) ?_{�•y .51, _1 9'i `, r;r, „r t l;)'x h�i:
or th rf he A exempt therefrom and the basis for the alleged Bump ton.Any violation '
'-of Section 7031.5 by any applicant for a permit.subjects the applicant to a civil penalty
of not mom than rive hundred dollars 650o). APN Number Occupancy Type
01.a,owner of the propid,in my employees with wages as their sole compensation. 304 —
'
will'do'the'work.addthestmform is nm'iamnded or offered for sale(Sec.7044, -"-
Business and Professions Cale:The Couldremr's License Law does not apply to an 501 - FINAL ELHVq &d 4Nylecd?NERGY
owner of property Who build,or improves thereo,and who does such work himself 505 - FINAL ELECTRICAL
or through his own employees.provided that such improvements are new intended a
oeckrl for side.IC however.Me Wilmr,or ire' . . yen,of. .. .._____... __.._. _.__._._-. ._----- _._...__... ...._...._ _..—._._ a ._ ......_ .
8 pm of prowngthJ wit hid ma
•completion,the ownmba e.)r will have the burden of proving that he did tat build or
improve for purpose of sale.).
is f the pI 'v lycontracting-with : e
,.,a in
enset the project
(See 7044,Business and Professions Code)The Cmme
License Law dos not app to owner of property who builds improves thereon.
and-who contracts for.
nuchpmia¢.with.a comractor(s)lianad
.- .
pursuam.mfie _ ..............
Contractor'sLicLicense . .
Cle.lI am exempt un er1 el<c. B'&PC for his mason
ow rr
WORKER'S MATIQN AUG 2 3 2002
I hereby o iron orale,penalty of perjury oat of the following declamtiom: p /'xr
Of have and will maintain a'Cpnificae of Consent to self-insum for Worker's
BUILDING
Compensation, vs provided for by Section 37W of the Labor Code, for the
'ped'ormance of the work for which this permit is issued.
'- O 1 hale and will maintain Woiker's Compensation Insurance,ai required by Section
'37M N the Wbur Code,for the ppeomianee of the work for which this .it is
1i;i My W kph C pe i I m d Pof y bcr aa: - _ .
1.Cam ' 'a a•,`h 7(sn;,h 7, •r�s Polcy No r5•, r ,4s';�'r Yr Iy.,.,:n. .
CERTIFICATION OF EXEMPTION FROM WORKERS"" i + e • I'�
s
COMPENSATION INSURANCE .,......,,
(Thu section need not he completed if the permit is for one hundred dollars
d§1001 or le,$)
'«.
Q r. CshoP`mPI I CanEns t TisOo APPLIC'ATCNTI fth k f 1h
' '
_._. _ ... .. .. t_�I � n pe sWd 1
aO n kn
fat k gm ifct rE pt yo should
Omlie W k Y C p npna or the Labor Cod,you most
ath comply with such provisions or th permt shall bed realter
-- - -
'
CONSTRUCTION LENDINCAGENCY
C '1 he eby 'frim iM1 t J sw i n lend ng ug y f the perf°irnance t '
W w. ofk to hieh th pe t :-trued fs< 4(197 Civ.C)
Q WndcraN a '. .... ... :.. ..... ....._. _.
=;I Lendir',1 Addes,
U p
fy"a"
have read s applicationd statethat above
boapinformation
reply with ail city and countyJi esatl state rcleineg
C U imcuo the by amhorierepresentativesfth yl er opnIca
forms' 1.8
to ba othed a met dproperty for inspectionpurposes.M. (We)agree C yoC _ n ago.est
S '
ya
1 dgm nu.costs d penis which y rs any y az against said !' O 2�-
U Z . y of th g i g of th P nit t r• Q
\T )NDE IND AND WILL CO PLY WITH ALL N0 'Ps'NT Issued b Dale
ijl GULAT .'S. 8 S y:
pr Appliranticnntrarro " ' " : ,. .D t Re-roofs
HAZARDOUS NA RIALS DISCLOSUREu m pplicant or fuurtb IJ ng p tiro or h ndle hazardous m t I Type Of.ROOf.. ......... .......... .by U Cupem hf c p I Code Chapt .9 IL nd th H hh and Safetytors 25533(,) 15 q,_ r i •s t I I '�„I1j° c '� '
❑v. oN t , All roofs shall be inspected poor[o any roofing material.being Installed._
wn m rpt t r t b Id ng oc<up t eq omcm our devices hieh If a roof Is in'stalled'without first obtaining an inspectlon,'I''agree t6.remove
amit hasandmisarrot an¢as defined by the Bay Arm Air Quality Ma nag int
r Dist i all new materials for inspection. Applicant understands and will comply with
❑ver ON t all non-point source regulations.
.t 1 loose is d milbWardo.,malands,ise,maternmos voile Chapter 695 of the
Cilifiabla Health&Safety Code.Sections 35505 5533.md 355341'understand that
jftImbuldng does not cudendy have a tenant.that It is my mesprailaility Orally the.
',alci pant of the recut to which allot be met rani to i...ance ofu Centficae or
Oicu n '. Applicant
e
.rc
nature of All -
erorautnodaedagent roof coverings to be Class "B” or better;
„ OFFICE