02070049 clBUIL GDrEeONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO
22575 ALCALDE RD 02070049
OWNER'S NAME APPLIC,(S'QOI)I HD/\T 002
TIMOTHY & SHELLEY GUO U //// �/ L
PRONE SAN IARY NO CONTROL NO
Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w 2 BLDG ELECT PLUMB MECH
r Z or I_J 1---
ie«
h" LICENSED CONTRACTOR'S DECLARATION Job De.c lion
Z O to z I hereby.a(firm that 1 am licensed under provisions of Chapter 9(commencing
pv, -. wrrhSection 70W)of Dm,oim3of th,Buvnes,and Photo ssmmCateandmyhccnse ELECT SEREVICE UPGRASD
xt e ad ce st Lubmse nd cRc
Cl...Clas. n.
Lid.x
%O a U Dam Conwcm{�
w 3 u f, ARCHITECT 5 DECLARATION
O 1 understand my plans shall be used as public records
uet a p O Licensed Profesvonal
OWNER m BUILDER DECLARATION
u I hereby.(firm onv I am exempt slam the Contractor's license Law
or for the
z which re rceaa.Permit 7031 5.B.ahem and improve,demolish,Cale Any city or county, $1000
E D which requires a perms to comwn,al¢r,improve,demolish,or repair any stmewm
ca
—p poor to its nsuvtre.Also rcgmtes Ne applicant for uch pertruuo Gleusigned sutemens - .-
3—' Unit he is hcrosM pursaud to the pfodmns of the Commdors License Law(Chapter 9 Valuation
(denuncnung with Section Iwo)of Division 3 of the Bourret,and fcsion.Cole) 1 C•'1p 34 3'�lh Vll 1 f i ' r'h �
or than he is eaempi fi'errefrorrimid the basis for due alleged Gump ton:Any od.lmn "'4- " - < _ \3 A"�.M1 1.t n f t), t
of S«iron 7031-5 by any apphant for a permit subparts the tr,lmanuo a civil penal.,
• of not mate than me hundred dollars a5rro) 103 APN� Etter f r a: . Occupancy Type
0 1.m owner of the property,or my employees with wages as their sole compensation. �n4 — ROTTGH ELECTRI L
will do the work and the situation is not intended or offered fir sale(See 7044, - - - - -- - - - - ---
Business and Professions Cade'The Contractor's Laenm Law does not apply to an 505 - FINAL EL ectionsTl'^ �•
owner oI property Who build,or improve,thereon,and he does such work himself t
or through his own employees provided that such improvement,are not intended or
offered for sale'If.however.
oolde the i building improvement is\hr within one year rid of '-
improve for she purpose of sale wrll have sfie burden of pronng flint he did not build or
improve for purpase of sale) I
, 1.itsdwner ofthe(See 7,amemlumdydPerccmgwithodenude Cottontail.,csonm -- .... ..
woe the oes du Iapp ]0W,Business and erty who b Code,)The eon.
n
and%h Live does sat apply loan owner of p cortmxho builds seimprove,thereon.
and what evmrnem far such prmecu with.,conlW ctorpl licensed pursuant to the p
contractors License Law U ® ��_. . .
❑I am exempt under Sec { �A>�r ��{] lPB k P C rnnhts reason U k 'su P
10 ncr H'ORI R'S CO\1PE? ION DECLARAT O� 1 U� O 6 2002
1 hamby storm under penally al pc,,one at the fallowing dcdara vwro: F'
" II ❑ I have and will maintain a Cemficete of Consent to self-m...e for Worker': BUILDING
`'�+����
1 Crformnsneaol the provided
odfor wtor bynSection 3700 of the Lobar Cade, for the BUI D
pe a permit is nsued
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Labe,Core.for she perfosmaoee of she work for which dhts permit is
issued My Workers Compensation Insurance canner and Policy number arc
Cerircr r No
CERTIFICATION EXEMPTION" b WORKERS t rYt. .
COMPEN SATION INSURANCE .�C,,�tT'..,.n l l..l..,.:, i s.�Li l4 f r ,a•A f-T a
_
Ino,ecchon need not M completed if the permit is for one hundred dollars ' tom' •• `
(SIW)m level
I emir thu m U¢ tamcacce�aRhe\a«k for whrch�thi'�� --
y p� t permit is i.ttiea.l - - --- - --
thrill not employ any poison in any m net so m trepy subjc th5„WOrkerC
i+
Compensation Law, Calf I —I �U
tANICE TDAPPLI A ,sins g cmnoaoft Exemption.lsnyouuhmulst -
ZZ becomeh comply the Workers Compensation ish ta%hsll the Lafior Coda.you nna
0 tnnhwitb comply with such pmmonm or this pdrmn shall be deenmd mhknl. -
VI " CONSTRUCTION LENDING AGENCY
Ihemhy afRnn that them tsaronewmm�lending agency for the performanm ' i t
�. of the xmk f y with a L Issued(Sec.1097,Cry C)
which 1hrs p tat
Lender',rk nc h s
�.Z Lc der',Addm,s
I andy that 1 have With this H)and my slate that the above laws biddi 1s - t
F cartes.1 agree to comp( II air and county sedative and cute laws enter upon
to ba'ageonstmctmaann,hereby ooaothari<e representatives ofthn cnymcnmr upon
�Sn W the above judgm nts Prvsts a d e penses n which m a, -
.Fs L (W'ul agree W<uve.mdemmfy and keep hawtess the Cnv of CUpcmno agmnst
V] Cliabilities,
1)I lc o,glodmn¢,costs and expenses which may m any way seems against said
yU Z Cn)to comequc DERS he gmnunND WILL CO. r
APPLIC.\M'Up'UERS"fANDS AND WILL COMPLY\PITH ALL NON-POINT
. SOU-CE RE 1'ATIOY - Jy Pt Issued by: i � —.__ Date I
.fuse of tp scan 'ontmct I)a4 a Re-roofs
as defncdb t�CH^tARDO SAIATERIALSDISQG5 and(
Will yte Cupantor Mhoipel Coe.Climnlstorcor, handle Health and material . _..,Type Of Roof.-....
y pc �I Code.Chaptct>12 :nW the Health end Safety
Codc,Section 255321x1"., i '1."{"s'...,,:_1 ••fe is i 'r Pi'ri A,Y'i• _7)4 tt,a1
D Yet • • "•.jIN. •All roofs shall be.inspected prior to,any_roofing.ma[erial being installed, _
ela ,wtitn,e.�pn!reanior'mt na�s,ngadnpmnosecgnipmemu�dev�de.wlncn If a roof is installed without first obtaining an inspection,;[ agree to remove
n hazardous air contaminants as defined by the Bay'Ar..R1r Quality Management g P g
D...on,' _ all new materials for inspection. Applicant understands and will comply with
ove. `(�r+a - -all nori=pointsource regulati6ns. -
I have read the hationl'i�.\amnals requirement,under Chapter 6.95 of the
Caldonua Hen!th&Satcsy Codc Scnrons 25505,253)3 and 15534 I underord that
occupant requirements which mmmntmhattu.to issuance -
occupant of the rtgmrcmrnt,which muse be met prior to rcwance of a Ceroficate of
aeapant !
net xA �o11 Signature_of Applicant - - -- Date . .
ar aathariaea agent D,t All roof coverings to be Class`Br' or better '
`, -OFFICE - -- -