00070180 ct BUw
OF P� N
SIONo
I) CONTRACTOR INFORMATION:
PERMIT,
BUILDINGADDIi IiSS: _ ' - - - PERMIT NO.
OWNER'S NAME: • APPLICAI'ION SUB LATE
7502 DONEGAL DR 00070160
PHONE: - SANITARY NO. CON7RE).NO,
SURYANARAYANAN 07/26/2000
O reo ARCHITECUENGINEER: •• - _ BUILDING PERMIT INFO
O
y BLDG EI.ECT PLUMB M17CH
z;
LICENSED CONTRACIOk S DECLARATION z�y= ine'ahyanrte tl r d Jp ICIIt )1 eneng Job Description.
wth Secton 9000)of Ds1' on3 oflhe Bu sane Profession Codeandmylleeme '
❑W n full farce and effect.
ce 6 Liceme Class Lic,k
�q5 o yu Date - Commc
W 3 a t, ARCHITECT'S DECLtorARATION
t'=}g I uulcrvand it,of n shall Wooed as lttmrc reund, . • ' DEMO OF SFDWL .
o O Liccncd Promsi...I -
E OWNER-BUILDER DECLARATION a, „
I heathy affirm that I nc exempt from the Cmnmcmrs License hw for the
HZa rollming reason.(Section 70.1).5,Business and Pronasions code:Any cityy orcounty -
C Which rectums a ,mrit to< n ora t. fill,im,rose,J list p an,an chum
w pro t t e,al: 1 - 'Ih Iprli II IplmiO IIsignedstatenenla. - - '•.
that he is lia sedpors a a,topic lim,knino of,heContractors Excuse Law(Chaplain Sq. Ft. Floor Area Valuation
(commencing with Suction 7(NI0)of Di em,3of the Humn,a and Professions Cadet -
or that he is exempt Iherc&nun and the basic for the alleged exemption.Any violunian ` .of Section 7031.5 by any applicant for a permit subjects the applicam m a civil penalty
of not more man fi,e hundred dollars(S590). APN Number .I Occupancy AType .
❑1,isn,rcrof the prbpert,nr my employees.vimwage,
as ntcir so le anmpenamlom: � $1200'0
will do the L Pt t n intended ave 1 r - r ISre. toad _ Required Inspections .
Bu- 1Profession,C I Th isno 1: nwL J tamly se,70U, - L .
owner f property WI builds output,...th I who J d work himself 3661.6029.100
or through his own employers.provided that such improvements are not intended or -
offered for rule.If;however,the building or improvcmem is sol!Within one year of
conytlmlon•the ownrn builder will hove the harden of proving halt he dud not build or `
"improve for pnrpou of sans). NO ASSIGNED INSPECTIONS '
oWTcr olthc progeny,ant exclusively contmmhmg with Ilcen.ad cumruann to
onstmm me project(Sea](N4.pashas,and Prolesslons Cantley Tic Unitn¢mr:s '
.i m Law does not upply In as owner of progeny Who builds m improves thereon.
and 'no connects for such projects with.a comotcmrLO licensed pnrsoonl tn.Ihe -
Craft cur's License Law. -
❑Im pt cr Se _,B&PCRn this reason - '
• Own - Dat . ,`f ,g�p0 s ,
WORKER'S C MI'I a�t ATI(IN DEfC ARAT ON
• Ilimod,'ff ntlmade,'I 'lly of Pa .,,l f the fallowing deahralion - f. . ; t • •. .
❑ 1 base d II t Certificate m f Consent scl6 mure for Worker s
Condlet,stiou. .-pct ''d J f by Sertrou 3700 of the Lthor Codr, for the
performance of the Work for which this permit is issued.
°1 hove and will maintain Worker's Cnmpensanan Insurance•its requlrcd by Section -
3700 or the LaMar Craft,for the wrormance of the work for which This permit is
issued.My Worker's Comprns:nion Insurance carrier and Policy number am: -
Carrier '�Ethics Nna
CERTIFICATION OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE - -
This section need not be completed if tire permit is for one hundred dollars
1b100)or less,) - _
I certify that in the performance of the work for which this permit is issued,1 -
shall not employ any person in any manner w as to become subject to the W'orketi
Con verionnont Laws of Califnrnla,Dur -
Applicant.
0
NOTICE TO APPLICANT If. firmaking this Certific,de of Lxempunnyou should
bammme b)el he Workers Counpluout P f d hod Coils,yrs, ut
ohuh comply with p r Ilipt.h II be deemed revoked.
ulekee O
-
- a - -
,' .CONSTRUCTION 1 FNDI NO ACI NCY
of m 11 k fd
bY Which h t them 'I t lending g Y In, perform e
perrout is nssnad(Sec.3097,Civ.C)
Lend 'Nam.
• z Ixnd 'Ad 1'n -UI1 carl lh,Ibase mail this ppl of foof Ohio he done informationis +
LT. (r c..trial.I"ose I ly fill all art,...,it cotm,onfir,arica,;I'll atrialaws ef ung -
U ill building conswctioand hereby authnnze rcpewntmives ofth ity to enter upon - Z
•�, rW the above mentioned property for inspection purposes. I -
r Ai (00).9.In sod,indemnifyaitdk ml
WO,,harmless the City fpvno C ngf is,
rA Inabililles,judgments, t J expenses which may in any Way accone against said - -
s U Z City in commi,scrod,or the form ng of this permit
—` APPLI]]]]]yyyy�NN��,ITT,ll'''UN AND ND WILL COMPLY WITH ALLNONPOINT Issuedb *7 29 �
SOUF//L'IysGp1 lTI044S y; + Date
� S�t is
ne ofnppfia.avcmade,tm - Re-roofs ,
. HAZARDOUS MATE AIS DISC,OSURE e
Will the applicant m future building supero pore or handlghavuJdua material Type Of Roof
as defined by the Cu,s,mno Municipal Code,Chapter 9.12,and Ihe'Health and Safety
Cade,Seellon 25532(;,)'L-
El Y,
5532(n)'L•ElYe4 DNo All roofs shall be inspected prior to any roofing material being installed.
wanhe al,pi,url air f I abupdmb - p ,use c,"poi,al or devi,es Which If a roof is installed without first obtainln*'an'ins ection, I agree to remove
• emit hamrd u. rcom t. :defined by theHy Are.Air Management p g _
District all new,materials for inspection. Applicant understands and will comply with
°ve' No all non-point source regulations.
1 bare mail the hazardous materials requirements under Chapter b,95 of the
r CmifoMu Health A S.nny Cuda,Sratin s 25505,25533 and 25534.1 tmdcmmnd Itco
if the
bullJing does not currently have a mnum.lint it is dy nd msslbillty to notify the
oecupanl of the requirements which must he met prior to issuance of a Ceni6czm of -
Occupancy,.. . .•
.. _Signature of Applicant " . ' o Date -
owneroraantodmc!.sent Date , All roof coverings to be Class"B" or better ,
OFFICE. - _