00090154 (2) NO
CITY BUILDING DIVISRlon�DPERMIT CONTRACTOR INFORMATION:
IIU ILD I NG ADDRESS: PIFRMI'INO
),
OWNER'S NAME. APPLICA'DON SIM DATE
10460 STOKES AV 00090154
SANITARY NO. CONI ROI,No,
YUNG 09/25/2000
of Z ARCED ECT/ENOINEIR BUILDING III Jt M111'1'INI'
I—�C IH.IIG IiI.FCT I UM MECU
on
D 5 m or L / LICIiNSEII,CON tworo AC.do,pr DECLARATION
I heresy arum mal am Eeen,nd aver provision,nrchalter q anmtnetdng .lob Description
F,o w with Seelnn 7lxxp of Uivhinn3 of me Bruises,mW Prolec,I I,Cohouldmy license
re,< p is iu full Three and c c
o y Liocnse clan,_ 63 tie.« _J z4
comm'no
w 5 a y ARCHITEC I'S IJECL,o
F"v, I ander,tandmypmn.chall lw nsta rtthrtr..od, WATER HEATER
�r
.ce i p O Licensed Professional
a. e y OWNER-BUILDFR DECLARATION
v I herehy affirm that I an,awropt Iron,the Commcmr's Llaa„e Low for the
following remnn,(Sestina 7031.5.Business and Prole-ins Cale'.Any city or county
S rS p which rapture,a permit a.a,nsh mt,ahcr,inmrnve,dun ali,h,ur repair any.amcmre
datm prat hesiscrtancc,duanttorce movisio,atn.forwd,pntor's Neac Lawchaptaenl
(Sane i.rcemed pursuant soma pmvuioncmme Contmem, and]',Lnwons Co r9 Sy. FL Floor Area Valuation
or Ibar(Saunhe is arn,with Section or anof Division 3 nth a leged ex exemption
Professions l Code)
or Sent he is mamba.herdmnt and dtc basis it the alleged excntttinn,Any violmion
of Section7031.5than iv any hundred
run for..500). wbject,aha upplin,m mncivil penalty
nr am,mint man five ntndrw dnllnta as(xn. A PN Number Occupancy Type
❑1.as owner of the pro,wrt,or my employees with wages as their vole candpervan inn $550
will do the work,and the structure is not intended or ntfced for sale(Sec.7144,
Busmc,c and P..fir Son,Crile:The Cmdraano,,License Law dues no.apply...an Required Inspections
owner of propink'
erty Who build,or .prows mereon,and who ars such work himself 3264 7024. 00
othrough his own employees,provided that such in,proventcniv are not intended or
offered for sale.If,however,the building or nnpmvcn,end is sold within nuc year of
completion.the owner-builder will haw the burden of proving that he did estd build m
mpmve fir purpose afsAe). 502 — FINAL PLUMBING ENERGY
❑1.as owner of the pmptny,run nxmusiwly commaing with licensed crome as In _ 506 — GAS TEST
a,namet.he project(See 71114.Bovines and Prole„ion,G,fa:)The Contra,...',
tomLawdot.nmapply rsuchn,.jownert1acon.. whn,oddsmin,pmvodmrenn. 507 — FINAL PLUMB
and woo conned,for men projects with v con who
b ilds or h poo s t er the
Common,I license Law.
❑1 am exempt under Sec ,li&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION /
1 hctcbY nflinn under penalty of pcpurY one of the following dcdananions:
.] I have and rill maintain a Cmilicam of Consent to ,ulf-insure for Worker's
Compensation, as provided for by Section TWO r,1' the Labor Code, for .he
ptiformanse of he work for which flik tenni.is iswcd.
❑I have and will maintain W'orker's Compensation Insurance,as required by Section
37(9)of the Labor Code,for the performance of the work for which this permit Is
11
wed.My W'orker's Compenwron Romance carrier and Policy Irani are:
rti
Caer: PLP,0,kj2i bC16'alicy No.: �kQ�0kIQV1k_P,
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit i,for one hundred dollar,
(SIM)or lm,.)
1 certify that in the perfommnee of me work for which this promos i,issued.1
,hall not employ any pert(in any manner or in to hccome subject to the Worked
Co rd a icamn Low,of California.Dene
Applicant
NOTICE TO APPLICANT::If,after making this Cenihcam of Exemption you should
become subject the W'orker's Compensation Moai,ion,of the L.M,r Code,you most
O Q uforthwith comply xith.such provisions nr this pard.,hall be Jcemed rooked.
zCONSTRUCTION LENDING AGENCY
y, > 1 hereby affirm that mein is a construction lending agency for the performance
of me work for which this samba is issued(Sec.3197.Civ,C.)
LLeader',Name
,U Z Lenders Addis,,
U O 1 certify that I have read this application and state that the above information is
4. F correct.I,gree to comply with all city and county ordinances and some Ii relining
O r, to building convection,and hereby audn,nxe reptewmomisaes of this city to enter upon
the Shave-mentioned property for inspection purposes.
F y (We)agree
(save.indemnify and keep humles.he City or corsair.a gain,,
VI Iiahili.ies,judgments.costs and expenses which may in any way aernc against said
U Z Cay in consequence of the Scanning of this tannin. '7l�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bv: Date /�1J
SOURCE REGULATIONS. y'
ignatum of Applinnt/Cortmaor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
W511 me opplicam ar,future building os. ,at o.or handle has tdnas rmrmnal Type Of RO
as defined ny the Cupcninn Municipal Code.Chapter 9.12,and the Health and stray
Cale.Section 25532od?
oYes oNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicam or name building rotation use equipment or device,which If a roof is installed without first obtaining an inspection. I agree to remove
emu.haxaideas air contaminants as defined by.be Bay Area Air Quality Management
Disoieti all new materials for inspection. Applicant understands and will comply with
ones ❑No all non-point source regulations.
I have rend.he hamthan,(tenth aquiremems under Chapter 6,95 of she �e
if the
uildingdoKSafetyentle.lyhave ho 25505.35]]and yrespo34.1itytonund flout
fythe �-zs-
ifthe builJbg does not
uarmuns whirl c a mnanmMet prior
r toy responsibility of
m notify the f J
p the rcyuircmens whit a ma pour ns ts,mnce tf a Certificmc of
�p'” _ t nature of Applicant Date
t7 a a�nnn mLa�an Date g PP All roof coverings to be Class "B" or better
7 OFFICE