02050028 (2) ctBUOF c DN
PERONo
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11631 UPLAND WAY ROGER WANG q 02050028
GROGER E WANG A0 5c/T0 7 y2 0 0 2
PHONE: SANITARY NO. CONTROL NO.
❑ex 2 ARCHITECTICNGINEER: BUILDING PERMIT INFO
Ft O O BLDG ELECT PLUMB MECH
Ci
¢d
N i LICENSED CONTRACTOR'S DECLARATION
t Z_� 1 hereby affirm that 1 am licensed corder pan Pirie of Chapree 9 and
(commercial, lob Description
v_etm with Section)000)of Division3 of the Business and Pmression>CWe.and my license TEMP POWER POLE
.j in roll force and affect.
t eenea License Class Lic.x
O n O Dam Contractor
a LL t; ARCIUTLCT'S DECLARATION
g1 understand my plans shall be used as public records
i >
3M,0 Liccnud Professional
OWNER-BUILDER DECLARATION
so 1 hereby a(Onn that 1 1. exempt sinfrom the CmurProfessions
Co :Any c Law for he
{=3< following reason(Section]cro Business and Professions Cod,:Any city ocounty $200
Y F p
which requires a pe mit r e w t Icer p d cro t ore a signory swment
dam part s ss also q theapplicantf npemutmicense gaw(stnmmr 9 -
- mptn ' a apt;anti top on. nn<Connector's LanseLaw(cnaptet9 I, '1 '3659'C)'3.CfJopr„®T®a t ) t Valuation
(cont a Cng N Sm "1000) f Division 3 of the Business and Professions Code) i..1 1. , i,f- Ix f
or that he is exempt rnciefrom and the basis for the alleged exemproa.Any violation
-of Se,uon 7031:5 by any applicant for a permit subjects the applicant to a civil Penalty
of not mom than five hundred dollars($500f 103A PN 0FI#RrOccupancy Type
❑L as owner of the y
epropcnormyemployeeswithwagesntheirvalecompensation. 304 ROUGH ELECTRI AL
w10 do the lark:and he aroctum is a.,intended or offered for sele'(Sac.7044,' Required Inspections
'Business and Professions Cade:The Contractor's License law docs not apply to an ^
owner of proPeny Who builds or improvs thereon,and who does such work himself
or erect h his own employers. rovidm that such improvementsa arc oar intendedcar or
.offered for sale.IL owner
uia he building or stir en of rov rs sold within no, year of
'completion,the ownerbuilder will have the burden of Proving thin he did oar build or ”
improve for purpose of sale.).
r' sho
QLaadwner of fire p(Seenyam Business
and cent with lieensThro ommitcouna t•
and n'e a c project(Sec, to a owners and property
who
Code:)The Contin reon,
andwhco does oar apply m an owner of a comm ono builds se improves thereon,
co
. ec contracts for s. projects with a commends)licensor pursuanr.m rhe
License
1•
w Contractors' License Sw.
' O❑I��a((m cum u der Sk. ,B&P C for this reason I
WOR 'SCOMPEN, 10 DECLARATION v�
1 hereby affirm under Penalty of NUury one of the following declarations:
❑ 1 have and will maintain a Cenificme of Consent to self-insure for Worker's
Compansaeon, as pmAdcd for by Section 37W of the Labor Code, for the
Performance of the work(a,which this peau is issued.
-' O I have and will maintain Worker's Compenwrion Insurance,as required by Section
3700 of the Labor Code.for the performance of rhe work for which this permit is
1' issued My Worker's Compensation Insurance carrier and Policy number are '
Cum ens r :, • Pol,y No.CERTIFICATIONOFEWORKERS' 1 "'s
COMPENSATION INSURANCE ;
,
dw
(This section need not he completed if the permit is for one hundred dollars t "
(SIW7 or le".) _.
I 1 eenify than in the perfnimance arm,w forwhich this permit is issued.1
'shall not employ any person in any manners to become subjen t c W'kcra
cam too Law Calinmia.Dar
.Applic sa. -
N d .If,vfer teeing his Cenificme of Form you should - -
Z become subject the Worker's Compensation provlidne of ubor Code,you must
Q Q fonbwirh comply with such provisions or this Permit shall be dec red revoked.
f" .moi ' CONSTRUCTION LENDING AGENCY
' I hereby affirm thatthere is a construction lending agency for rhe performance
r of the pe_ .. 041.Civ.C.)
ark for which his into is issued(See.'3
a.Q Lenders Name
;D Z Lender's Address /U\ 1*�---
V 1 certify,but 1 nave read chis application and orate that the drove information isLaw '
P E.c t ohold 1 agree to comply d he all dry and a rept ordinances and amm law,relating
Q V the above mentioned
menaherrinspecium uposenmtives of this city venter upon
'�„ ky rbc above e)afire to Pmpeny for inspection purposes. - ..
G eWe)spree to save,indemnify and k,cp hanmas the City of CLpanino against
W liabilities,judgments,costs and expenses which may in ally way accede egainn said
V ti co 'n consequence of the graining D WILL
permit. v V
'A PLICANT UNDERSTANDS AND NILE COMPLY WITH ALL NON PO NT " Issued by:
Date
' 1(IURCE ftP ILATIONS. S"
Signature of ppb~ ommn r - DateRe-roofs
HAZARDOUS MATERIALSISCLOSURE
.Will theap,llcant or romp,building occupant store or handle hazardous material ..Type of Roof. . . .. -
z def r, Ne Cupcn o Municipal Coce.
-Chapter 9�-M12,.am Ne Heaalth ad Safety
Core,s,imz553z(a)
_ ;
oY , t : f ..1.
All roofs shall be inspected
ted rior to any.roofing material being Installed.
Will he applicants'f bmWl asompanr me i,miument or des ices which If a roof is installed without first obtaining an inspection, I agree to remove
co
r lumeaudcaus id,cont darts a,d ed by the Bay Arta Air Quality Management
Dism,t all_new materials for inspection. _Applicant understands and will comply with
SS °!" No all non-point source regulations. -
ylJ1 I have read the hazardous m.bcmi requirements'under Chapter 6.95'of the
Celifismin Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building class not currently have a tenant,that it is my responsibility to notify the '-' '" ""-' - -
cupant of the requirements which must be mer prior m issuance of,a Cenifica c of
ee`"p'"`y'es
Signature of Applicant Date
ram,genAll roof coverings to be Class "B'• or better
... . - OFFICE - -