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01100018 (2) CITY I nDNGDpERTNO BUILDING ONPERMIT INFORMATION: FORMATION: BUILDING ADDRESS: PERMIT NO, 11631 UPLAND WAY ROGER WANG 01100018 OWNER'S NAME: APPLICATION SUB DATE ROGER WANG 10/02/2001 1 PHONE: SANITARY NO. CONTROL NO. O ceZ ARCHITECTILNGINEER. dUILD PERMITINFO IJ O❑O BLDG ELE PLUMB MECH a i W r-1 'J LJ LJ y a LICENSED CONTRACTOR'S DECLARATION Job Description z_O 1 hcmby affirm that 1 am IittnxJ under provisions of Chapter 9 6ommcncing mt-m withSection7")ofDivision3ofthe Business and ProfosionsCode,and mylicense TEMP POWER POLES . is m fall fmce and effect. s a Lacers¢Class Lie,0 O n U Dote Commuter i 3 u.G ARCHITECT'S DECLARATION '-O g 1 understand my plans shall be,used as public research, t s p CO Licensed Professional e OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the C Z a following reason.(Section 703 IS.Business and Fictitious Code:Any city or county $200 E x o which requires a permit m construct.ulrce improve,demolish,or repair any structure aw t: priort t '. also cq e N applicant for such permit to file a signed succi am. _ _. _.. _ -......__.._-___—._.__.__.__._. that h rltt w sed pursut the promons of Ne Conuectws License Law(Ch.d.9 f ,,,_.t �yyFF{{,, yy''.II����{{�gr•p�@a '+h Valuation hemnmenc g with Section 700(1af Division 3 of he B cticess aril Professions Coda) C i—j Sas 3 MCA r'1'. v., 1 t ?,A I f-,:N s: or that he ii exempt ilhairefitortiC and the basis for the allegcJ esempdon.Any violmion of Section 7031.5 by any apPlieam for a permit subjects the applicant to a civil penalty' of bar rmre than five hundred dollars(3500). 10:�PN NyAK a' Occupancy Type °1,as owner at the property,or my employees with wages as their sale compensation. will do the .,it.and the stromure'is not amended or o0'ered for sale(Sec.70441: - Busher;and Professions Craft:The Contmcmr's License Law does not apply to an Required Inspections`•'- ' owns r of pm,ny Who builds art immures Narmit.and who does such work himself or through hr own employees.Provided that such plod is sol art not intended or oRered f 1 If hos rl - w bu Id g p t Id ih n o Year of - compll N nc bold illh cN<bN !pro gthat hcid tbudd or 'rep f cut 1<) on,owner 10 Pmpcny lycontracting ithlicensed contractors to .. construct thproject(S 7610 Business and Professions Code:)ThContractor.1 License Law gets not apply to an owner of property,who naiads or improves thereon. _ wad who commus.for_such projects with a mmarlims)licamed pursuaal to Ne- _. �y y�_C Contractors license Law.. .ALEO-- - emptorder Sae. ' r :e'kPCformlareason, FiN •,t•rpurr. oda' �ARAzLl� OCT 15 2001 R ERS I'LNSATION DECLARATION {. I hereby aRnn underspenalty of perjury one of Ne fm lowing decimations: p ° 1 have aad'vill maintain'a'Cmific:it ofConsentIo self-inure for Workers BUILDING eampcwtion. as novided for by Scceon 3700 of he Lmor Cade, for she_ �peRonllmlce of N'e won far whidt Nis permit is issued. 01 have and will niainialn Workei s Compensation Insurance,an required by Section 3700 m Ne'L.b,;,Cale,for the permormnce of the wmlr;for which this permit is isamed.My Worl, iComproe,c, In....net carrier and PoGcynumber arc:'" _ tamer `f aN.e s A S'i`_Policy Nd ,-t. .sta,.7.,, . . l'1. CERTIFICATION OF EXEMPTION FROM WORKERS" - t - • ' s 1:'`r4( ii.ts "1�4t Il s r .rP COMPENSATION INSURANCE,: s mos wa snap nccd not bs'evinpleted if the Permit is for one hundred dollars SIW)orlcc. ,,e nm .,. .�. . , u i _ e...,...�...._ . .. _ _ . .._ _ ._. - 'aemploihmtjpe pc in "nmaria, orkf a.s. pe 'Its i.saeJ l ls:•t Lrt C llpe shall en anon L wi of alt in any manner m as to bu6mc sublecttd Ne Wwlen Coplicimktion la'1Califomie.'nam` ...' .'. Agi �'NOTICETOAPPLICAM:IL star making Nis,Cemificme of Exemption:you sM1amlJ °'' become subjectre the Worliat's Compensation p tours of the Labor Code:you rintiest Q O forth ith ply with h provisions or thisI pe hall bed d evoked CONSTRUCTION LCNDINGAGEkY '� ' •' 1 he by affirn thindami,.c.nomert land,'ngg'ogmty f he perfommode of Nc awls for wtiich this permius isaad(Sec.3097.Civ.CJ. L Q —(war's Name _ _ _ - _ z 12nAers Address" , U - I cmi fY Nat 1 have read this application and mute that he above information is, -F correct.I agree to comply,viih all city'and county d' ret d state laws relining, U to,he ma g sono' r ndh art N p e... en ofN tYt e err upon ,he bo t d p pen3 f De h Durpose .F y 15rydg m sat d su'fY d Jeep harmle.die Ory f C pen agvmt to I ati I t g ms e t d penin. which may in any way acme again..said UZ City' oaqu nee of Neg i'gol Nis pe t /a O2 �/ ,APP CANT UNDERSTANDS AND WILLCOMPLY WITH ALL NOYPOINT !I so RCE ,u_LATIONs. . (, J' ,•+ �� z o Issued by: Date _ igq canVcamr Da,r' ,.; " Re-roofs HAZARDOUS MA rERIAL ISCLOSURE W II Nc'ppbcam&f ture mildi.,occupied sam 6 aside hazard r mdmil Type of Roof ` as d fnW by theCupcn Municipal Cal Ch pt 9 12 and theHealth and Safety r o •-.1 r t1 Cade Section 25532(a)?, OycOblrillfv,_ All roofs shall.be-inspected prior to.any-roofing.material being.installed.______- Willeheupplicamrntumrebuiadingoccu Pan;useaquipmanlordevice,which If a roof isiifstalled'Vitt thoutfirstobtaining aninspection;'I'agree\[oremove emit hazardous air mmamiwds as'depard by the Bay Arca'Air Quality Management Diatdee all new materials for inspection. Applicant understands and_will comply with.-_ ❑y, C. 9No ;r all non- oint source re ulations. . have,read Ne hazard...nout.1 quiamenu'. chaptm 6.95 of the C dmnu Health&Sareiy Cade;Sections 25505.35533 and 25534.1 understand Na 1tie buil ding doe no, .me ly hmxomnanr that it is my rtsponsibiliry to notify Ne - - , , 'cuPa mcon�h uit here tP tin ane f CnEcde of -_ _ en c= `)' �'•- /C, Signature of Applicant Date // All roof coverings to be Class"B"or better [: Oancro Narixcd ng t, I }' Data _ OFFICE - - -