02070189 OF
CITY
DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21261 GARDENA DR 02070189
OWNER'S NAME: APPLICATION SUB DATE
TEUNG NGUYEN 07/30/2002
HONE: SANITARY NO. CONTROL NO.
pppl ..
O O ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
d I'-'-I
2 5 h Z LICENSED CONTRACTOR'S DECLARATION lob Description
OM 9 1 hereby affirm that 1 am licensed code,provisim,of Chapter 9(commencing P
�o, sintooll`fn]000)afDivron3oftheBusiprss§endPmtessionsCotle my license OPEN PATIO CpQ'V ���®
a 6 Licenx Cla. L ■
❑ate at
Conuaaar
' °to HITECf'S DEC AUG 2 3 2002
an errand y plum mall M used m publ c cords
CIO
Licrnsed Profcsxioml
'°' OWNER-BUILDER DECLARATION
III 1 hereby affirm that I am exempt from the Contractor's License Law for the BUILDINGt:?< following reason.(Section 7031,5,Business and Professions Cook:Any city or county $2 5 O O
5,FF❑ which requiresm a permit construct,vlter,improve,demolish,or repair any structure -
3 prior to its issuance,also requires the applicant for such permit to file a signed statement,
a - ths[mq is littnfed punuvm tp the PmNsioas of the Contractors Littnu Isw(GhaPter 9
awt, v w ,;Y'\ I'3'23�0 �°ra ty r>.;{�w Valuation
(cornrrcmciti i h Sects n,71%j01 of Division 3 of the Bruin aM Professions Cdel a t5x s r..:�
or that rte 1i exempt Nbrcfroth and the basis Car'
or the alleged at�mpion.Any violation ,
of Sadon)0313 by any applicant for so
permit subjects the epplinm so a dril Pendry
tqr nw.mnre ths.Bre hundred dollar.(ssrlo). APN a.•:n51:•:.;; Occupancy Type
101 ATION
❑1,as owner of the property,or my employees with wages as their sole compensation,
Bidet'-ldoth tl ark and the structure W..,intended or offered far sale(Be, 7044'
-;will a the wndc Required Inspectlonsl
fessiom ilde The Contractor's,and w Law does not apply m an 103 - OF ER owner through
of progeny Who to Wilds or reproves thereon,tine who encs such work himself
or through nix own employees.provided that such improvements amwithin
not intended of 104 '- REBAR
':5amplefoi ulC owner-Wilder
the llhavegeurden of prove old hetdidnot year of 105 - ANCHOR BOLTS
complexion,the owner-builder will have the burden of proving thin he tlitl not Wild or "
mprn.eforpwpnsenfaale.). 106 - SEWER & WATER
--- - — -.._.. -- — - - --- ---- -- - ._.. ---------..
_ I:aownerofNepmpcd,cam xclusivdYcontmningwithlicrnsdconuacmrsm 202 = UNDERFLOOR PLUMBING--`-s�5l:iaa rrr:%e
_ comtruct the projat fsee.704J,Business and Professions Code)The Contractor's f:'r r_t +'I.G•1; \,r:Y
aw do a not spolym an owner of p.,a,who build,or impro.es thereon, 203 - UNDERFLOOR MECHANICAL
end.wbo.conuncot,for-such.projttts with a.commctor(s)_licensed.punuant,to the. _._._._-2 04--=-UNDERFLOOR---FRAME--_.___.-.__::_..,__._._.-._._..._.....__.._._....
Can rets L censeLa
f. ❑I ,erept unJe s ! I' marrcfor,this <a:,an 205 - UNDERFLOOR''I'''T NSUL'ATION
owner ' .,' r,Date• - :'°"I 301 - ROUGH PLUMBING
WORKER'S COMPENSATION
DECLARATION
._- - -- 302 - TUB & OR SHOWER
Ihereby
iiimmunder pcnahYofcmuryoneoftheflowinsdxltiom:: al303 - ROUGH MECHANICA
L
❑
1 bale-and'will'maimnin e'CeAfAie'of 6nsenr5o self-insure for Worker's 304 - ROUGH ELECTRICAL
_•_,i Compensation: arp...idd for by Section 3]00 of the-lsbor'Cde;far-the
71
perfnrmaWdbfineworkrorwhiehthis p mytisis,yd.i,.,, 305 - FRAME
❑I h -dwil modmiiiii W rker s CpmPens tlo Insurnn s retuned by Se,Yon 3 06 - HOLDOWNS
3700 of the'l.abor Code for the pIrfornicarica 6f the work for which'th a gem it Is
307 - INSULATION
-Assued My W rkers Cope t reed Policy number `
1 remora c er
q 308' S
vol Na /cG� 09 HFE�ROGK•
A OFEZEm yFR M ORKERs iii ` 1 309f + `°EXTERIOR'' LSATH\ ... ,..„. -• _ , °°I t1��.�_...,....>,.,-,..,.._......
�_. COMPPNSATION NSURANGE ,/r° It • .ry - „ _._-._�__-_
`.; r);N,T IOR- IATH'' '
(sl�)('rm5r<coonne'w'nntW'Enmpletedinnepermitiaroranehandrcdeonarra 311 - SCRATCH COAT P -,
-.ern 1c nchat the rformana ofm work fit -I htthnpariah .. T .: .. .' 31'3°- ='ROOF-'NA-PL--7;:---
t ... _- .. .. ..
ns rN Pe o. s,i J I I t
holo temploy'vny Pen n to been esublea to r�heW rkei4' 501 - FINAL ELECTRICA'L�"'I)�'NERGY -
C mpenwt InwaorCalf m jDat= '
. `
.NOTICf _ 5.02 -FINAL ,PLUMBING--EN- ERGY.-.--
.-
INOTICE
ToAPPLICANT:If,after as Ccroficato ofExemption, gmd
z bac me subject N Worker compensation provisionso(the VW Cde,you fruit, 503 FINAL MECHANICAL "ENERGY
00 arm tornwhich theachp m perms ball be de and ked5.04 ._ FINAL_BUILDING. ENERGY
Inereny R"CONSTRUCf10N LENDfNG AGENCY SOS FINAL ELECTRICAL
PIY
V
c n owed n ding agency for the pert ire c I'. Y- -11
W.q I;endercNaartx;31 '-: ed(sea�n9] ctac) L 506 GAS TEST
° 507.._ .. FINAL PLUMBING ..... -. ... '._
at a ere s e
thl
q1
U'0�+ �I c ntfy'Nat l have read this apphwt on andlsta thuuhe above information is 508 - FINAL MECHANICAL
't]+:F" 'corrkct.1 agree ro comply with all city county ordi...ges and state laws relium, 509 - F I NAL GRADE
Qs,U Po building construction[and hereby authorize represdmmivm bf this city to enter upon
-tg) itheeW area tdnedpmpenyfo inspeen tip-gwus.:, 510 - FINAL PLANNING
P:
(We) gree to saro tl mnify and keep bumliss ilia C ry of Cupenido against
W) libhOs,judgments,costs and expenses hch-myinany wayacc eagainnsaid 514 - FINAL UB C WORKS
V".� -C ry m c nsrquenh f the'gmming o rhes gems t
\P ICA.' WDERS .'D WILLC 1PL�"N'ITH ALC - ]TOL
s Issued by: Date
t sty bfAPPlleentlC taw tor'.`,' i,. fie i,lp''i. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the appy ant or(mrc Wddmg we pant tore or handle hazarEom material.
Type Of Roof.
psdfnd byM Cpeduw Muncpa Cod Chaprar912 antl theN alth ods fry
'cd s❑«Y ?553,jaj 1. � -N-` n . fid of Pry`" - e t,•� , , ^:'IY' ll-.''{..;..'�:�q �`•1=;:y t, ., tl ft.,
All roofs shall be Inspected prior.-to any roofing material being Installed.,,-_ _
.Will to '- - o"
Isar„ an cartoon
o f to Wilding occupant ntaseeg Ipmcnt itylMana men If a roof is installed without first obtaining an'inspectton,"q'agree`[o remove
mtherard a"omam oat tle0netl by the ByAran Au Quality Menegemm
pl tnct „ all new materials for inspection. Applicant understands and will comply with
Y --._. .. -' -
wb alit ,�t, " r ,r 1 >l 1y, *,; all non-polo["source .... .... -
1 -'I'I' 1 ha rcad',thc h,area s materials requirements'under Chapter 6.95,of the
�Cabfomii Heahh'&Sofety,Code,Sections 25505,15533 and]5534,1 understand that
ftbe building don Dot Currently have a,tn t that it Baty responsibility to notify the _ - _. -
rc panr of me rcgwrc a is bach mu t W m t pn an an.i.stare of a C )fm of '
73'' Signature of A_ pplicant
t an :e agent D All roof coverings to be Class B of better" `
1 :R
IF"! h;J fel ` ; Iya ,...._..,. .....OFFICE _. . .... „ _.. _._ ._.. ...__ . . _.. .. . ... ... .....
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