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CITY BUILDING C DIVISIONNO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10201 ALHAMBRA AV DON WADE ELECTRIC CO 02090082
OWNER'S NAME : APPLICATION SUB DATE
TERI ROY 16320 HARWOOD RD 09/13/2002
PHONE: SANITARY NO. CONTROL NO,
(408)377 -2323
ZO ARCHITECT/ENGINEEJU F BUILDNG PERMIT INTO
❑ BLDG ELECT PLUMB MECH
i O CI CJ L=
LICENSED CONTRACTOR'S DECLARATION Job Descri tlOn
1 hereby affirm that l am licensed under provisions of Chapter 9 (commencing
4 Simsecii 7 )erDivisien3ofineBusmes Pmlcs.,i.mCcde,andmyrcenae � UPGRADE TO 200 AMP PANEL
m^ II
ua Y u O j
Dam D <mr
g+ri ARCHITECT'S so, r
un mend m plans shall be uxd asp is cards '
sLicensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law far the
< following reason IScedon 703IS. Business and Professions Code: Any city recently $2000
which requires a Permit to construct, alter, improve, demolish, or repair any structure
-prix to s'ss «a alto req vudo applicanrtor wch pemmt fl ig«A Uaxmem - -
- thit fd f I b2d pursuint tQ the pro Ions of the Contractor L law ( Chaper 9 Valuation
or congWth Scci ,7,OPB) fDrvlrtion3o[the BUSlre. end Pr f5¢ions COde) {,�i1115 ?AY":�'�aJuO,_•9`: "' a�.il J_i t.9 .4'A.�..ti
or thin he i5 exempt tnecfrom and the basis for the allege) exemption. A y violation t
-ef Scmm� ]OJ I6 by arty opplioin fora pmniusubjttn Ne npplicant to o civil pmalry-
: efnm.mOremanfivenemreddogrms($'B), 304A2N�q�tI ELECTRI AL "" "`r'':r• Occupancy Type
❑ I, m owner of the property. or my employees with wages as their sole compensation,
-B me work: aW the sw: The Cormi uo's Lie offered for Baler &ef to an SOS - FINAL EL�fIII'�ID 4hFS�eC[lOPIs ^' S'- a r;:\r f: - -
' Business arro,an Who Cade: The Centmcroro License law s such not apply m an
owner of property em builds or improves thereon, and who does such work himself
m through his own employees. provided that such vemcnt mrnw art nm imenJW m - _ -_ -_ -. _,
';oRciW for sale -If. lmwevcq the buildin tis aald withinoa ear of- ' "-- '- `�---- "��-- ' - - -�— "---- -. - - -- '-' ---
gorimenofpro n y
completion, Pu,me of will have the burden of proving that he did not build or t -
improve for putrax of tole.).
- ❑1;as -owner of the p(See.7.xm Business acomrcungwi CWr:)The Contractor
License
construct the project n face. 7041, Business prat Professions CWeq The Conuazmr's
Licenx law does not apply to an owner lh property who builds or improves Merton,
= -- .and..who.conlruameL such.ptoja¢with.a comrenogsj.licenxd. pursuant. m.the.
Contranors Licenx law.
_
Dianne xempt utider'seal.: ,:•,;,'''; % .B &ecrn�tnLcmmon
o eta ER' :. ,PENS . ,.. ECL BUILDING
- "WORKER'S COMPENSATION DECLARATION
cl hereby affirm under penalty of penury ore ,of the following declarations: --
❑ 1 have'and vill'amintian o'Cemfictoc of Content "to self -insure for Workers
Compensation, ss provided-for by Section 3700 of the-Labor Care, for the
'perfoomance of me'-mr, for wnicn this armit is isxtood- . .
❑Ih 'd will m5i w W ker'v Compc u I mdmbie ocq'Q by S-tioit
37W or the Lebo Code f the perto f ibc ik for which this -pore i
siu d My k C ypnnsat I um c ❑ Pdl y robe arc -
... -
er!' ISj }1 :Pal cY Noi WliiB � !! 3 4JUf tr.2 y __ ..._ � <_ -_ __ "n.\•I I'. Cam.- ....�•._Y..- _.....-
f '.CERTIPICATION OF EXEMPTION FROM WORKERS'; !ry
....� _, COMPENSATION INSURANCE
frbss«uon deed nn be cum Icmd fthe ..' +\tz �' ` ftls '.. ,r .a t,,; �_,i,_ .••- .�.�••��
ISIIK)l or les.) P .it is for one hundred dollars
(e.• I emfk th t'tnr pert wince of the ones for M1chN -parer
shall m employ ahY.perwu in any manner so as to become subject to the Workers i I', -, sl f _ -
Co pc f on C s of C f
:. ApplC i.' ,.o i.s ... ......
NOTICE TO APPLICANT If fmr ' ak g this Certificate of Exemption: y xho Id . - ,
bee with t lea m the Work r s vi mm, or ' per . of the labor revoked.
You otiuv "
forthwith with such provicinaY or --- permit shall be deemed revoke).
.CONS._._._ _ .-.__._._._.__.
I ' -�I -- e'I CONSTRUCTION LENDING AGENCY I7:•,' -
I h by R m t th nswn c d g'bgencY fo the perfonn' I. q' 4a
Jtr
r Cene kf ''nmhm perm t' issued (Sec 3097 Cis
: "Geode s Name' u. ' e....r % .. ._._ _.: _ ,u. , .., _
IcnfYthtlh a dth. ppl' t militate thtth Ia frmafo's
correct I gore t comply dl all city and my N d state laws reading
to Wilding c t [o dh by th z p ,rues Rios say m enter upon
the 1 c ti nedp pc try f pet, putpo .
1 nablt(W) agree to s Wa. tfv dkeeph I. meCryofC pen og "nst
I dg coats. L d pc es which may any y azc against xid
Cry in consequence - of thegm'g mes pc in /
APPLIC ° a1A ND WI LL(
v LY NITH ALL NON Y'
LA l s Issued by Date
.. ¢ anUConvaetnr;.,;.'.,.�.,;:.;'•,' Re-roofs
!as dcf Wlbthca Ci� tm,f'NmrecW Id W«cpom smre2 hurdle hizard°ana "nal. _Type of Roof ,
w
• HAZARDOUS MATERIALS DISCLOSURE
Safety
Coat S t '2557 ) , , `r'Nl } - Y :`!,' a.`� .,,.o- :`Ill t't.t "••
CI yaw -f „1 N , t' .: iz s . , w�'ra
---All roofs shall.be inspected prior to any roofing.matena _being .installed..__
emit Will h it corporations; l , t n - g p t qu p t ate .ton h. _ If a roof is Insialled without first obtaining an inspection >I'agree to remove
It I mit h N toed by the Bay se a i Quoddy Management
District? all new materials for inspection,, A Meant understands and comply with
El Y. _., No - . 1... P.- PP.. P Y
fq . r • : - �,, all non -point source regulauong
I hate read the dous mmenal mgmmmcnts aide ChaNutria .95 of de '
Cabfumm Health & Safety Code. Senions 25505: 25533 and 25536. 1 undcrswnd the
ifthe.bit l0 ngd snntcun Oyh fen th ins mY rc.po- 'bBtytoa t fY the. .-._._ -, ".._.... .__ - .._... .. .._.. .. -- _._...
Wc,pam of m2 re ¢mein wh ch mats t prior m us c of a Cemficae of
x Si nature of Applicant
_ '.___" _.... g. - -.._. _.PP..........._. - "...Date . _.
g h.:.. r
Owner
--OFFICE'- - ..._..__._
All roof coverings to be Class "B" oi�lietter " '
e�amm�rizgaa
CITY BUILDING C DIVISIONNO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10201 ALHAMBRA AV DON WADE ELECTRIC CO 02090082
OWNER'S NAME : APPLICATION SUB DATE
TERI ROY 16320 HARWOOD RD 09/13/2002
PHONE: SANITARY NO. CONTROL NO,
(408)377 -2323
ZO ARCHITECT/ENGINEEJU F BUILDNG PERMIT INTO
❑ BLDG ELECT PLUMB MECH
i O CI CJ L=
LICENSED CONTRACTOR'S DECLARATION Job Descri tlOn
1 hereby affirm that l am licensed under provisions of Chapter 9 (commencing
4 Simsecii 7 )erDivisien3ofineBusmes Pmlcs.,i.mCcde,andmyrcenae � UPGRADE TO 200 AMP PANEL
m^ II
ua Y u O j
Dam D <mr
g+ri ARCHITECT'S so, r
un mend m plans shall be uxd asp is cards '
sLicensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law far the
< following reason IScedon 703IS. Business and Professions Code: Any city recently $2000
which requires a Permit to construct, alter, improve, demolish, or repair any structure
-prix to s'ss «a alto req vudo applicanrtor wch pemmt fl ig«A Uaxmem - -
- thit fd f I b2d pursuint tQ the pro Ions of the Contractor L law ( Chaper 9 Valuation
or congWth Scci ,7,OPB) fDrvlrtion3o[the BUSlre. end Pr f5¢ions COde) {,�i1115 ?AY":�'�aJuO,_•9`: "' a�.il J_i t.9 .4'A.�..ti
or thin he i5 exempt tnecfrom and the basis for the allege) exemption. A y violation t
-ef Scmm� ]OJ I6 by arty opplioin fora pmniusubjttn Ne npplicant to o civil pmalry-
: efnm.mOremanfivenemreddogrms($'B), 304A2N�q�tI ELECTRI AL "" "`r'':r• Occupancy Type
❑ I, m owner of the property. or my employees with wages as their sole compensation,
-B me work: aW the sw: The Cormi uo's Lie offered for Baler &ef to an SOS - FINAL EL�fIII'�ID 4hFS�eC[lOPIs ^' S'- a r;:\r f: - -
' Business arro,an Who Cade: The Centmcroro License law s such not apply m an
owner of property em builds or improves thereon, and who does such work himself
m through his own employees. provided that such vemcnt mrnw art nm imenJW m - _ -_ -_ -. _,
';oRciW for sale -If. lmwevcq the buildin tis aald withinoa ear of- ' "-- '- `�---- "��-- ' - - -�— "---- -. - - -- '-' ---
gorimenofpro n y
completion, Pu,me of will have the burden of proving that he did not build or t -
improve for putrax of tole.).
- ❑1;as -owner of the p(See.7.xm Business acomrcungwi CWr:)The Contractor
License
construct the project n face. 7041, Business prat Professions CWeq The Conuazmr's
Licenx law does not apply to an owner lh property who builds or improves Merton,
= -- .and..who.conlruameL such.ptoja¢with.a comrenogsj.licenxd. pursuant. m.the.
Contranors Licenx law.
_
Dianne xempt utider'seal.: ,:•,;,'''; % .B &ecrn�tnLcmmon
o eta ER' :. ,PENS . ,.. ECL BUILDING
- "WORKER'S COMPENSATION DECLARATION
cl hereby affirm under penalty of penury ore ,of the following declarations: --
❑ 1 have'and vill'amintian o'Cemfictoc of Content "to self -insure for Workers
Compensation, ss provided-for by Section 3700 of the-Labor Care, for the
'perfoomance of me'-mr, for wnicn this armit is isxtood- . .
❑Ih 'd will m5i w W ker'v Compc u I mdmbie ocq'Q by S-tioit
37W or the Lebo Code f the perto f ibc ik for which this -pore i
siu d My k C ypnnsat I um c ❑ Pdl y robe arc -
... -
er!' ISj }1 :Pal cY Noi WliiB � !! 3 4JUf tr.2 y __ ..._ � <_ -_ __ "n.\•I I'. Cam.- ....�•._Y..- _.....-
f '.CERTIPICATION OF EXEMPTION FROM WORKERS'; !ry
....� _, COMPENSATION INSURANCE
frbss«uon deed nn be cum Icmd fthe ..' +\tz �' ` ftls '.. ,r .a t,,; �_,i,_ .••- .�.�••��
ISIIK)l or les.) P .it is for one hundred dollars
(e.• I emfk th t'tnr pert wince of the ones for M1chN -parer
shall m employ ahY.perwu in any manner so as to become subject to the Workers i I', -, sl f _ -
Co pc f on C s of C f
:. ApplC i.' ,.o i.s ... ......
NOTICE TO APPLICANT If fmr ' ak g this Certificate of Exemption: y xho Id . - ,
bee with t lea m the Work r s vi mm, or ' per . of the labor revoked.
You otiuv "
forthwith with such provicinaY or --- permit shall be deemed revoke).
.CONS._._._ _ .-.__._._._.__.
I ' -�I -- e'I CONSTRUCTION LENDING AGENCY I7:•,' -
I h by R m t th nswn c d g'bgencY fo the perfonn' I. q' 4a
Jtr
r Cene kf ''nmhm perm t' issued (Sec 3097 Cis
: "Geode s Name' u. ' e....r % .. ._._ _.: _ ,u. , .., _
IcnfYthtlh a dth. ppl' t militate thtth Ia frmafo's
correct I gore t comply dl all city and my N d state laws reading
to Wilding c t [o dh by th z p ,rues Rios say m enter upon
the 1 c ti nedp pc try f pet, putpo .
1 nablt(W) agree to s Wa. tfv dkeeph I. meCryofC pen og "nst
I dg coats. L d pc es which may any y azc against xid
Cry in consequence - of thegm'g mes pc in /
APPLIC ° a1A ND WI LL(
v LY NITH ALL NON Y'
LA l s Issued by Date
.. ¢ anUConvaetnr;.,;.'.,.�.,;:.;'•,' Re-roofs
!as dcf Wlbthca Ci� tm,f'NmrecW Id W«cpom smre2 hurdle hizard°ana "nal. _Type of Roof ,
w
• HAZARDOUS MATERIALS DISCLOSURE
Safety
Coat S t '2557 ) , , `r'Nl } - Y :`!,' a.`� .,,.o- :`Ill t't.t "••
CI yaw -f „1 N , t' .: iz s . , w�'ra
---All roofs shall.be inspected prior to any roofing.matena _being .installed..__
emit Will h it corporations; l , t n - g p t qu p t ate .ton h. _ If a roof is Insialled without first obtaining an inspection >I'agree to remove
It I mit h N toed by the Bay se a i Quoddy Management
District? all new materials for inspection,, A Meant understands and comply with
El Y. _., No - . 1... P.- PP.. P Y
fq . r • : - �,, all non -point source regulauong
I hate read the dous mmenal mgmmmcnts aide ChaNutria .95 of de '
Cabfumm Health & Safety Code. Senions 25505: 25533 and 25536. 1 undcrswnd the
ifthe.bit l0 ngd snntcun Oyh fen th ins mY rc.po- 'bBtytoa t fY the. .-._._ -, ".._.... .__ - .._... .. .._.. .. -- _._...
Wc,pam of m2 re ¢mein wh ch mats t prior m us c of a Cemficae of
x Si nature of Applicant
_ '.___" _.... g. - -.._. _.PP..........._. - "...Date . _.
g h.:.. r
Owner
--OFFICE'- - ..._..__._