01120092 OF
CITY ILDI c DIViSSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21100 WHITE FIR CT 01120092
OWNER'S NAME: APPLICATION SUB DATE
HSU WAN-YEN ET AL 12/21/2001
• PHONE: SANITARY NO. CONTROL NO.
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BUILDING PERMIT INFO ZD ARCH17ECT/ENGINEER: BkDG ELEF PLUMB M ;
LA 1-6z
Z S H Z LICENSED CONTRACTOR'S DECLARATION Job Description
_ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
wish Section 7000)of Divisionlof the Business and Professions Code,andmyliccnse REPLACE KITCHEN CABINETS . REPLACE BATH SI
6 x C� ism full force end eBat.
12-
C,
U License Chas Lic.a
EEE Date Conwctmz l
3 a I-n ARCHITECPS DECLARA s
hgg 1-`0 3
so'
unders d my plans shall be used as public records
S tS
6 O Licensed Pro(essionel
uuf R OWNER-exempt R m the Contractor's
_
1 hereby attrition that 1 1. exempt from she Comsrns Co e:Any c Lew fm the nn\ -'�-s,
z following rto on.(Section]8715.Business and Professions Cade:Any city a county �L l (I I I $6000
F o which requires a permit m construct.alter,improve,demolish.or mpa'v my structure 'I 1 1 l
3, prior to its ismence,also requires she applicant forsuch permit to File a signed statement
that he is licensed pursuant to she Provisions of the Communes License Law(Chapter 9 (,�,y���}'Qn�Qnrrar, Valuation
(commencing with Secimin70M)of Division 3 of the Business and Professions Code) t ',r l ',,.1,13 5�' �ws i'V
or that he is exempt therefrom rind the basis for the alleged ezEmptiah.Any violation axs [001
of Sonoma 703 1.5 by rosy applicant fora permit subjects the epph em,ton civil penalty �y �,�r
ofnolmomthamFivehundreddollars(s5oo). 101APNMift)ATION Occupancy Type
01,asrofthe property,or my employees with wages m their sole compensation.
will-do she work and the souctum isnot intended or offered for sale(Seer 7014, - — - -
Business and Professions Cale:The Commcmr's License Law does not apply to an 10 33—UFER e9Uire Inspections` -
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements art not intended or _ . 10 4_„- REBAR
offend'for sale.1f,however:the Wilding of improvement is sold within one year of "-
completion,the owner-Wilder will have the burden of proving that he did not baud or 105 - ANCHOR BOLTS
improve for purymeormle.). 106 - SEWER & WATER
_ ❑Lssowner orthe ct(Sm.7044,Businessand trfiessiwith olicensed:)The contractors or
202 - UNDERFLOOR PLUMBING
License
the project(Sec.7044,Business and Professions Coder The Contractor's f r•• n..';;
ueemne Law dote matapplr roam awmer arpmpery wba bwlmminnpa,vea thereon. 203 - UNDERFLOOR MECHANICAL
sand-who commcts.for_such.pmjects with a connections)licensed pursuant ta.lbe. -
01 am exempt
pieunde Law.
204 - UNDERFLOOR- - - - --
❑lam<xemptundcr See. . . ' ',,B&PCfor this ratan 205 - UNDERFLOOR" INSULATION
Owner Data 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
hereby croute under, nary of p rja our ar the following declarations: 303 - ROUGH MECHANICAL
.: 0 1 have'and'will maintain o CcNficme of Camem'to xlf-iname tar Worker's 304 - ROUGH ELECTRICAL
Compensation, asprovidedfor by Section 37W of the labor Cade, for the
- 'performance of the work for which this pewsu
it is ised. _ 305 - FRAME -
VW1 have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
of the Labor Cafe,for the performance of the work for which this pewit is
itor 111or at C'mpensationlasomacecurrier and Policy number am: 307 Nii 3INSULATION - __•_,_-_„__,_ -_
/�Sm0�_
cart,et roury06;_ . 'SHEETROCK.,.,
10 D xEMPr1DNFROM WORKERSc' f t309 -__) EXTERIOR LATH_
COMPENSATION INSURANCE fd �
310 ,1-'. INTERIORLATHsectionneed not becompleted if the permit is for one hundred CRATCH COAT� 3 N IL shall not smPl y a y personoany ma n r so o ome bleetm 1m F NA , It. ENERGY
c mpens uon law rc bramna at Aland at �LFFI�NAL LUM NERDY -
NOTICETOAP ICA rte ki gth' enti0 eo xemptom - `�ssq r
becomesbjectto sh W .Coon uon moinnsoflhe Labor Codcymmust 03 { FINAL, +yy I L ENERGY
Q forthw to b riply w th such pro inions o this pe h shall be J teed revoked.
a _. . 504..- ,FINAL�BUI IN ENERGY , -- — -
W "r•” CONSTRUCTION LENDING AGENCY' t
E' ^ I hereby oRw that there is a conswnion lending ageKy(m the perfowmme 505 - FI Nle `'ELFT R AL
of the work for which this pewit is issued(Sec:3097,CoC.1 506 =_-- -GAS- TEST '- - __... .--- - " --- .------ -_--
0..E Lender's Nome- - - - - - - - '-"
96 z tender',Address 507 - FINAL PLUMBING, ,
508 - FINAL MECHANICAL
1 citify that l have fwd a][cit and oro my ordinances
and
stat information is
tilt coned.1 agree to comply with nil city and county ordinances and stele laws miming -
or Wilding conmmcsion, nd h
-aercbyauthu re
onprcumntivcs of thisciry to eater upon 509 FINAL GRADE
'�W .the above.memtioned pmpeny(or inspection parpoxs...:. 510 - FINAL PLANNING
h. 4 I We)'agtee m save,indcmni(y anJ kap hmmkss the Ciry of Cuprriino against
Y) liabilities,judgments,costs and expenses which may in any way accrue against said 514 - FINAL UlllaC WORKS
V z City in consequence of the graining of this emit.
kPPLICANTUNDERSTANI S ih'UW COMPLVrWITHryLL,�ON�PONT ]SSUed b Date
SOURCE REGULATIONS Y
w
Signature of Applaand tract te,,, Re-roofs
H RW S MATERIALS DISCLOSURE ,
- Will the applicant or future building occupant Gore or handle hazardous material Type.of Roof-- _ •.- ..e.._.,_... _ .-.
defmd by,the Colman.Municipal Codim Chapri912 rid the Health and Safety
Code,Section.255J2tn)v `, r'
�Y''r "° - All roofs shall be,inspecied.prior to any roofing,material being installed
• Will the applicant o future buildig occupantuseequipment terdevices which If a roof is installed without first obtaining an inspection,]'agree toremove
emit hazardous ter contaminants no,defined by the Bey Arca Air Quality Management
Didn't' all new materials for inspection. Applicant understands and will comply with
❑vat all non-point source regulations.
--- 1 nnve'mial she hazardous materials'requirements under Chapter 6.95 of the
'California'Health&Salary Code,Sections 25505,25533 and255J4•I understandthat _ _ �� s.
if the Wilding does out euremly have a mount.that it is my responsibility to notify the "" - - / o/
occupant of the rcquiremenis wh' t most he met prior t ssuaom of o cenilmom m, -
Occupaacy. ,; S_ignat of plicant DateIt
Owner or oat mea a All roof coverings to be Class "B" or better
.. ... . . . ._ .. .. OFFICE . . _ ._.. . -...