03010006 CI nul� c my sonNO PERMIT bCON RA.GTOR INFORMATIQN;
BUILDING ADDRESS: PERMIT NO.
10390 WUNDERLICH DR 03010006
OWNER'S NAME: APPLICATION SUB DATE
STAN TSU 01/02/2003
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
K ZLICENSED
p� LIC ENSEDCONTRACnOR'SDECons of chapter
�a Fpp I hereby affirm dist 1 am licensed underprovisionsPremn of Chapter 9(commencing Job Description
�y with Solitin 7fgtOpsfDivisitin3of NC OuxlncexanJ Pmfcasinns Cndc.end my license is
inmB(oreeaweffect. CHANGE SERVICE PANEL.
0yA License Class Lk.A
Z Da¢ Convenor
O ARCHGECrS DECLARATION
1 understand my plans shall be used as public record.
WLLP� Licensed Pndcssinmel
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from she Comnctor'&License Law for the
00 following mason.(Section 7031.5,Business and Pmfcubma Cock:Any city or county
$ which requires A permit it,construct.aMr,Improve.demolish,or repair any structure
0 print to its issuance,Also myuiresdhc applicant for such Permit file a signed statement q $1gs'QII�t100
that he is licensed rsuantmthe rovisionsofthe ContractuiaLicense Law(Chater9 S Ft. Floor Area
$ (commencing with Section 7")of Division 3 of the Bmimu and Profcuions Code)or
y Nat he is exempt themfmm and the bust for On,alleged exemption.Any violation of
Scction 7031.5 by Any applicant for a permit ubjccu the applicant to a civil penalty ofa Occupancy Type
not more than five hundred do[]..0500).
❑I.a owner of the popery,or my employces with wages At their axle compensation,
will do the work,and the mucture is not intended 9r offered for We(Sm.7044,Business - �ppyly{'p�Tp$pe
and Professions Code:The Conmcmrs License law does not apply to an owner of 304 — ROUGH F^Lt L'1.1x11'fH tOI1S
property who builds or improves Merton,and who dors rush work himself or through his
own employees,provided that such improvements Am not lmmmded oroffcmd for sale.If. SOS - FINAL ELECTRICAL -
however,the building or Improvement is mid within one year of completion,Ne owner
builder will have the burden of proving dust he did not build or improve for purpose of
Asia.).
'ILD 1,As owner of the properly,am exclusively contracting with licensed contractors to
edhetrucl the project(Sec.7046,Business and Profession Code:)The Contractors Li-
cense law des not apply to an owner of property who bulldr or improves duemon,and
Who
contracts for such mjecu with a contractor(s)liceAsed puuuant to the Contractors
License law.
❑lam exemptu rS .B&PC rovIvirdson.
0 or
—� Di D
r •� WQJIi ER'S COMPENSATION DECLARAT4014
I' Ihereby.01m under penalty of perjury oro of the following declmtioea:
I have and will maintain a Cenificare of Consent sell-insure for Workers Compen-
a0on,As provided for by Section 7700 of the labor Code,for the performance of the
work for which this permit Is issued.
❑1 hoc end will mountain Workers Compensation Iumnnce,As requited by Section
370(]of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier: Policy No.: _
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed true Permit Is fortune hundred dollen($100)
or less.)
1 certify that in the perf mance of the work for which this permit is issued.I shall not
-iov.
'ropityoanypc ym�n fo Klnhccomc subject to the Workcn'Cnmpcnution
Laws of Califon a¢ L/ 1
10Opicaul
ICE'Ib PLICA} If after making this Cenificnc of Exemption,you should
Trauma subject to the Worker's Compensation previsions of the labor Code,you must
(] z forthwith comply with such provisions or this permit shall he deemed revoked.
O CONSTRUCTION LENDING AGENCY
(~ .Ni Ihereby affirm our there is a construction lending agency(or the performance of
ai the work for which this permit is issued(Sec.3097,Civ.CJ
GQ Lender's Nurse
z Lender's Address
U Q 1 cenify that 1 have reed this application and rum that the&how information is
IL F correct.l agree to comply with all city and county ordinances and Auto laws relating m
C U building conamsction,and hereby audition rapmsenmtiws of this city to enter upon the
above-mentioned property for inspection pugmsca.
�" py (We)agree to taw,indemnify and keep harmleAs the City of Cupenoto against
V) liabilities.judgments,costs and expenses which may in any way accrue against tend City
U 7 in consequence of Ne reining ofib is permit.
�•t APPLICANT UN_D.RSTANDS.AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REC IO $ '
Re-roofs
S ApplicanvCy tractor Date
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will
il the eppltofam or future building occupant store or handle haxardoua material
as defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safely
Code,Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
Will the applicant or future building acupam um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I Mardian,air contaminants as dormed by the Bay Arca Air Quality Management all new materials for inspection.
rslricfl
❑Ye "4fNu
1 have mad the Mvardom materiels requirements under Chapter 6.95 of the Califon.
MAD ealth&Sof II C.t .Sadnns35505,25533and25534,1undcrsmndthatifthc building
dma nm current have admant.that it is my responsibility m notify the occupant Orion
mein cy 'd dpdormissutoccofaCenifmacof c suer. . Signature of Applicant Dale
U All roof coverings to be Class "B" or better
mer or aultion5 agent Date