02090115 (2) CI BUI DING DIVISION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
10250 STERLING BLVD WILLOW GLEN ELECTRIC INC 0209019915
TE
MN"`�FOWE 1085 WARREN AVE APPLICATION
09/18/2002
PHONE: 408) 289-9725 SANITARY NO. CONTROL NO.
(
O O ARCHITECGENGINEER: r BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a h= LICENSED CONTRACTOR'S DECLARATION Job Description
Oi: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing 2OO A SERVICE�REFEED 100 A
with Sec' n] )olDivisionlo(Ihe Business andRmfessions Code.and my license
-f= in^�11 fu deRecl. dam[_,
R
o w u ace . Clava (O tic. l .
DabiCummcmr
e. RCHITECr'S DECL7sR .c. 1
t- g I understand my plans shall be uud os public mrords
Q Y
0 Licensed Professional
�ne
OWNER-BUILDER DECLARATION
w=rn I hereby aRrm that 1 um exempt from the Comment,License Law for the
F z< following nown.(Section 7031.5.Business and Professions Cade:Any city or county $3500
E z O which requires a permit to rmstruct,alter,improve,demolish,or mpair any structure
nits prior t e.also q thepplicanl for such permul fl gedstuemem - ------- -- ---
Ih3(h" Ir,nscd punlNvto rhe pf sons of the Conwcmr.LCC . La IChapler9 O ea nq a• Valuation
as me< g i�ns<aQ 7fiBBl,ro ialon3- In B..-F adP faafnaeoae) ('�)y'[3`7.����`0��13?.4'7QFi;5� u.kl�T('tii:
or ib l an ii excrripl thcrcfr6m`ArM the basis for the allegaf ekLmpdun.Any violation
-of Seaiun BO3 LS by eny upplicain fora-permit whjcasthe applicant wacivilprnalry� 1.,.,d.r,- „
I.ofnotm°mtmtnrvehundmddollaiS5W). 304 A•P�9F(§FT ELECTRIC L'• Occupancy Type
❑Las owner onhe PmPerry,or my employ«a sults wages as mdr sole eompenaenn.l 501 - FINAL EL¢E� TRIC L ENERGY
-will dome work..aril tie'structure'i�sol intended as offered for sale(Sec.7064,-� '- 505 - FINAL ELyy QC[ibnS
B.,inA,'and,Pmrsssinn.Code:The Comrecmr's Licensee Law das not apply with; l) "„0.71
ow
r of propeny Who builds or improve thereon,and who dues such work himself
or through his own employed.pmVIJCJ that such improvements arc not intended or ._ _ _ __ _ __ ___ _
i;uBcmd'fr sale If hu the building -improvement is sold within one year of - - ®�--- — l, 1 J ,_--- +` RA v..
01a,o°ner of the property.am exclusively contracting with licensed contractors to 'g
prove puryuuu proving ._. __.____-_._ ____.._.-_..
tom In on,dic owner ba Id ll have the burden of that he did not buildor
t comma the ect(Sec.70Li,Business and Professions Code:)The Contractor i a � yl_li.::'"O i !.Ul: '+•
z- : License law attics not apply to an owner of who builds or improves(hereon,
_ „and who.comracr_su
ts.foch.projccta.wish a a com commcwrts5 IiccnuJ.pursuam m.the- SEP_.2._3._.
Co roar Ltt rola II r t\.'� RL' - 1
> 01 la do Se B:4PCf rthism
Dwner " BUILDING
WORKERS COh1PENSAT10N DECLARATION
r�
L" IM1 by ff n J P IIY f a Jt Y S f the following declamuons:
11
❑ 1 have era aw mmde n f Cby Section
of 37M of t uLansurc for Worker's
e CompenmeeO i provided for by Smion s i X) of the Labor Code, for the
_ - - pcdommnce of the work far which this pcnnit is issued..,
0I have'and will maintain Worker's Nnipenatioo In'sumnce:as occurred by Section
3700 of Ih Who Codi toi the ii&oOrmance of th k for which ths pet-mit is
I..v<d MYW rk sC pe 't li. c a Po"y"mberare ,-
I�� y. A _._ .. -.. a vaia.,v............_...-,..�,.�
sa rltb'IJPICA�(QNfOF EREMPTIo:� FROM wO�ERSO2 } �u fs z� ) Ist i.k s� -NI j0:i
!!T ,
COMPENSATION INSURANCE•i„r.J OL) __ . ._ .. _._ _ _._ _._
'"'' seta not be i'oinplc¢A if the permit is for one hundred J°Ilars
ISIIXII Ia�J::, Is., i- I. .�.. . -
..v.ql ._ �r aar :..» _.M..n.. - .u. : . .tea
` L cen fy that'in she pert Bala tl lM1" kfur whthth pernil sl11m`
',hall t ploy'miy Pc oriin 6,mann to Wcom bled to the Workers
Com I Lws of C f '.D to
c
._APP( t - must ._-....
:NOTICE TOAPPLICAVI`If fm - kl gthsC nfr to of Esc pr youth' Id ' .','t
Q O 'bee bb) Imlh,Wd.e :C -P t pnv vsm flheL Aa Gdc yn
fisithwith comply with h prov stuns ur Ih s permit shall be dcemaf rewk<J. .
"z" y ' - !` '" `CONSTRUCTION LENDING AGENCY 11 n �
a;; `'' I h by nBiml Ih t th b 2onswn on lending3gcncy fur the perfon o ` '• - '1 "'
bf the rkf hlcM1 th pc 't .ucJ fS c'J097,Civ C1 c; n
Lendcn AJJreu - \ Jul
lttn fy th tlh erecta th apPlict dstam th ub bo' of matron is
'ta+ [r n 11 g I omply rh 11 c ly end IY b c J I Irelium,
�,G7 ter nu ld ngc namcriun thereby iutho ze rcprcsen alive °f ti scity to en er upon
.�-fgl dhe abovcrosntioned pmpmYf�r inspccuon puryoscs_ _,
I aa'j,dgmems. t enpenu ec .m y:nanywiyaycfaCrv`eigno
against
e. nt said
UrZ Gly n c q nc hfi g tingbf ihl pcm t ' - '
APUUCANT U�IJ,DATf�fASDS LLCO\Ii'Ll'N'ITHALL\—ON�POINT' Issued by Date v
of Re-roofs
gn, wBtn<aBrlica ormwr<wudin tstorebrhandl:w,�rd-le;;al. . Type of Roof._ •... -
I�
HAZARDOUS MATERIALS DISCLOSURE
esdef cd bytheCapert Municipal Code Chapter 912 and the Health and Safety -t .� s tt•-,-' tai_:
-Cod Section n j553h( 1 1 I t i p j' s YI ` t_+.: e t i t < -z.,
❑re t' °,, . - _ All,roofs shall be inspected.prior-to.any,roofingmaterial-being installed.,-
• tun� pph stn future t (ding p t p t devices which If a roof is installed:without first obtaining an inspecnbn;•I'agree to' remove
em t havtdu a <omam est az d fn d by IM1 B Arca A r Q I ly Manag r I
District, all new materials for inspection. Applicant understands and will comply with_ ..
-all•non-point sourceregula .,L , 7 . .,•o�,,,,
, 1 haw rcad,ihe hazerdous maienah mqde
u nerneris under Chapter 6.95 6r the,
California Health&Safety Code,Sections 35505.25533 and 25536.1 mul ramnd that
if the Wildin does not current have a tenant,that it ism 'bilit t - df Ihd
g 5' S'respons y ano y
nccupabt,bf the.1wromem ort°issuance ofa CeniBCam of
< Signature of Applicant. Date
Da All roof coverings to be Class `B"or better
. . r-e
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