02070107CITY UPVIRoINO
ONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
'E"".
10050 MOSSY OAK CT
DON WADE ELECTRIC CO
82070107
OWNER'S NAME:
BRETT REEDER
16320 HARWOOD RD
APPLICA S�
zi�%il
PHONE:
(408) 377-2323
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT NFO
BLDG ELECT PLUMB MECH
y
lJ C:J L. 'J L i
z LICENSED CONTRACTOR'S DECLARATION
I hertb',Rsm lore licensed
lob Description
P
th I underprovi m,'Gr Cheplar 9(commeaamg
with Sttt n` loo Divisioam" the BusiQ�vnd Pm he
ELECT OUTLETS
somanCode vndm linnu
m ren rat an et. f-
Licen 4 L4. a
Comma
G ARCHITECTS U TI
7 /� O
Q
� I undcnm d my plans shall be used az hlic records
OLicensed Professional
P OWNER-BUILDER DECLARATION
1 hereby affirm that 1 um exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any
$900
city or county
o which requires a pcomit to constmct, oller improve, demolish. Or repair any motion
n -prior to in iuualue. also tequirtslhe applicant for such grmino BlcasignM neutnem
-
- tMih<naisinsedDursuannotheDrm+swnsoftheContrxtariLicenuLaw(Chager9
(commeoein8 with Scnian ]000) Division 3 tM1<Busimss Profeasiom Cade)
q
j,- t, I, •, "I-3,¢J2F"A f
Valuation
of of end
or (het M1e li and the basis for the alleged exemption. Any violation
t.5 b
1 ,..; - S ). \ r �S s I
ILt�k %-
" ` - -
of 703any applicant for v
any rep subjects the applicant to v civil pcn,lry -
6.1 a e than v
ardotmoratnan Bye hundred dollars ($50o).
300).
3041PN PRGii1361'H ELECTRI
AL .'.a-":n Occupancy Type
01, as Owner of the property, or my employees with wages astheir sole compensation,
501 — FINAL ELECTRICAL
----------
ENERGY
will the work: and me svolaud'is not mteridea'in orbrad'forsalic (Sce: 7(744,-
-
Business and Professions Code: The Contractors License Law does not apply to an
[ipng" • .
owner of progeny Who builds or improves thereon, and who does such work himself
or through his own employees. provide) that such improvements art not intended or
Offered for sole: IL however, the building or Improvement ix sold within one yes, of
completion, the owner-builder will have the human of proving that he did mol build or
improve has purpose of sale.).
_ _..._.__—... contracting ..__
q OL,aowner of the p(Seeny am ' licensed contractors to
_ - — - LL •'L' :r, Yw.:'.: is `t: _
the (Sec. a, Business and Professions
Business a ions C Contractor's
or The
r r' I
Liconcense does no us
License Low docs not apply mon Owner of ills
who builds or improves thereon,
improves
1 `
and.whI'(1'
a comm
_- .Comosco comms. for such projects with a comrectoltx) license) pursuant m.the.
_..___.__._. ____..- _._.____.. .. ..__- ......................._.......__._.__._._..__...
Convaaoh Licenu Law. ,,. ..
___.. __—...__.—_........_...
' 0lam eacmpt ulydcr See„_.��, ..�._c - .. :B&PCfw this rtaun
- Owner'' "'' - "Dale'
Br��9p
.��1 •�.�
WORKER'S COMPENSATION DECLARATION
-” I hereby aRrtn under pima t Of pcijury one of the following declarations:
JUL 9 O g00s
J L L
01 have and will'un indict a Certificate Of c.ii io'ulf-insure In Workcr's
'
Compensation, ss:po ides far by Section 3700 of the Iwbor Crde.'fw-the
performance of the work for which NIs permit is issrud.
BUILDING
s Com srsition'Insumnce, as qui
01 have mid will maintain Workers rc iced by Section
3700 of the Labor Code, for the gdorn... a of he work for which this permit is
I ucd.M Workers Co pensatianI�m�/��e .
.• Lmncr end Polic number ere:
m oluce
-
s."'
CERT CATOMPE14ATIO ON FROM,WORKERS'�
'...-. , COMPENSATION,IN$URANCE'. :_ ..:. .,...
_.....,... _, _........,. _.. __..-..
"r ffhu;anion need not be compldmd if the permit is for one hundred dollars
C$1001)w lcssJ
that ill the n the work for whieh this
1
T.
'.
Out a
Person in any manner
employin
pl ct to due
so ox m become subject to the Workm'
.� ... •
Com anon Lon Of California
Compensation Laws of C I fore p. Dam'-
is Data
Applicant : .1
NOTICE O APPLICANT: mins this Canons,
of Exemption.de.
totheorers ompeter
su Pon could
subject she Workers Compensation o
p taof the Labor Cada, you must
forthwith this .its
� fonhwidl comply with such prvviriom or this pertnit shill be deemed rewked.
comply
1�
3 n CONSTRUCTION LENDING AGENCY
1ul by affirrin that there 'ss issued(Son lendingagency for the pedomunce`
of Ne k fo which this genu is Issued (See 7097 Civ C)
G'. L 'rl
1;
� Lenders Name _�_ du ..., .. ...:... ._,. ... ..n.., ... ..
... ...._._. _ ..__ ._. .... _.. _... __... ..__..-' _.
Lend r'I Address'"
1 ttniry.Nat 1 have mad this application and state Nn the above information is
aoiren.l agree to comply with ail city and county ordinances and state laws relating
)' to building construction: and hereby authorize representatives of this city to enter upon
the above.. ptiomed pm for insperson purposes. ,,, __
eWe)d mu ususe mdeexpedf, and' keephuM ss the City Of Cnaminost laid
]'. liabilities, Judgments, cons expenses xhlch may n any way accrue against said
City
City fin C SCq tlltt of lh g=Mtmg of lM1li p[rRll
r
'
a" APPLICANT t' A.\ ls4 tiYLLC 1P H9TH ALL VT't"
Issued by: Date
sou D
namtc or dna r,-,. , , ., ;: ^'. ,.. Data
' '
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
-•,1fd Idealfait futtlrtwue nt ocwpud stole in handle hessiddus material
Eafned
.Type of Roof ... ..__..._.. _ _ __ _._...
u by IMC pan M niclpil Codc CMpscr 9 I] and Ne Hcilth and Serny
Code 255311a?T� '.
` .; 1( , t t, ,•t, t '' .
Oxon _
o; 1q ,i It ( .5
..
t.`
All roofs shall be inspected prior to any-roofing material. being installed._—___..._.
is W 11 the, t devices
! ❑fled by
dfined
If a roof is installed without first obtaining an ins ection;Ta i'til remove
g P g
Co.'to(mturc
cm t hazard come t he Bayle aAi
the B y A At Quality M agement
gement
DOmict
Dues
all new materials for inspection. Applicant understands_ and will comply with-
'non-point
all source regulations.
r
1 ha "read ihe. hazmdo s materials Ch
uqu rem nts under apter 6.95 or die
'
CAlif oris Health'&Safety Code. Sections 25505, 25533 end 15530: 1understand that
it is my responsibility to nmify the
i(Ne bot score ly have fflut
.. -
of in raquot
ocbupanf of the 4equiremcnts w " m srbe'mei prim to issuance bra CeniOnte'Sf
b firsit
'
Signature of Applicant Dale
All roof coverings [o be Class 'B" or better '
wnw r to =edgagent D,re,C
_ ..
- OFFICE-. - ... _ _.. ....