02060049 (2) CI BUILDING PERMIT
DIVISOF ION 0 CONTRACTOR INFORMATION:
BUILDING ADDRESS; PERMIT NO.
21408 KRZICH PL 02060049
OWNER'S NAME: APPLICATION SUB DATE
BAB00 KNOT 06/10/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHMCUENGINEER: BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
Pto 6 E
LICENSED CONTRACTOR'S DECLARATION
�O S 4 C 1 hereby aRrm Nat 1 am licensed under provisions of Chapter 9(commencing Job Description
�L withSetion9WgofDivision3of,heBuscn>.ndP kuionsende.mdmyR«nx RELOCATE FURNACE/ADD A/C
is in full -n
ellen. ✓
i O u Licenx C ,. `" Li.x
Date Comr�aal�
a..t'i ARCHITECT'S DECYARA ,'
3 1 understand my plans shall be used as public recants
p O Licensed Professional
es OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Commator's License Law for the
< following reason.(Section 7031.5,Business and Professions Code:Any city or county
O which requires a permit m emsuro ,alter,Improve,demolish,or repair any structure $8300
� $_poor m its issuance,also textures the applicant for such Pamir file a signed statement - - - --- —
- that he11Rotated p.ouromtotheproMsionsofheContractors License Law(chapter9 s Ft 131 or-�G�y`�ea. „ Valuation
(cdmmenemgwith Section 7000)of DivisionJof the�ysincuand PPmfusioms Code) 4_I,;;1� ;,3.6'L�i(.04lj.`V Vl1l�t{:13! 7�'.: 1
or Jim be is exempt Nerefioin and the basis for Ne alleged eStempatoh.Any violation � l
of Section 7031.5 by any applicant for a permit subjects the applicant,o a civil penahy �7 l3���
f not am than live hundred do frs(s500) 303 APNR8gh MECHANI AL' 1!. Occupancy Type
111.as owner of Ne propeny,or my employees with wages as their sole compensation,
will do the..,it;and the someone is not intended or offered for sale(Sec.9041,- ---394 RGUGH- - -- "•. - ----"""-
` GP
Imime.and Professions Code:The Cmitra 'a License Law date not apply m ao 505 - FINAL EL y,7 actions
owner of pmpcny Who builds or impmvwthereon,and who does such work himself
onhruuyyIt his own employees.provided that such improvements am not intended or _ _. 508... FINAL-..MECHANICAL _,....___ __...-_.____
offered Toi-sele.'If,"fimwever.the building or improvement is sold within one year of --
completion,the owner,builder will have the burden of proving that he did not huild or
improve for Purpose of sale).
_. -._. .y_ contractors
❑I;as owneof he propeny.am exclusiveBusiness a contracting ns Hamed co ontracta m .II I e A LE D' -.
construct the res n (app.JOS),owner o and property
who
Code:)The ves t Contractor's ■ ed t.• _
Liana Law does no,apply m an owner of property who builds seimproves thereon.
and who commcas for.Lasuch.protects_with a-cnnwctor(s),Iicemed.ptusuant.m.Ne. ._._. ..___.—.._ . ._........- ... .. ._- _..... _..._.___._i........_.___.._.'._._.'_____._..._. ___.__.'_._.._...
Cammc,ors License La .,
Al am xe a S /y�APGf for .a JulJ.'0,3 :200211:'
rRKERPEION CLARATION BUILDING
thereby elf.under penalty,of perjurybnG of she following declarations:
Cl 1 have and will maintain aCenificam of Consent to relf-insum for Worker's
Compensation, asprovidedfor by Section 3700 of the Labor Cade, for the
performance of On work for which,his pemtia is issued.
°1 have and will mainmiri Worker's Compenudon Insurance,as required by Section.
31011 of the Labor Cade.for,he performance of the work for which this Permit'is
is d MyW k C pili a nlnsurance comer andP y' tuber e
.. '
PolicyNo.
e...CERTIFICAg10NOFEXEMTION FROMWONKERS -
�Y R:51E".? 'rP,:l Alh r'
COMPE,^.SATION INSURANCE s'�"l F'
0) This sd,ion need not be completed if she panni,is for one hundred dollars -
($100)or leas.)
I nfY than InIh p f cc Titre k.f �, h ,M1speamt s d 1 _ � � � � ,
sba11 m e pe n y a o t n b a ao Ne W k rs I�' 1
Com ria, as f ` -
:APPI an
"NOTI 1 Y - makl g this C n fat fE empaion you shoo
O Obet rise_bl s ti nmpen as m P o s ns of lh Luhnr Coae you n st i
_Posh l mply with ou h proves tens or this pemm stroll be deemed revoked. n
W
I" s' r1CONSTRUCTION LENDING AGENCY -
> - I hereby Bion that tee construct d - - a
r 6 agency f N pert rte nee
�► Lrk for which this penal t ssu d(S -)091 Gv C) ,
Q
Lender Name
u t - .. .. -..._ ..._ ... ... ._ .._. --" -
Z'Z Lender's Alpreas
Icon ly,h,lha d,htsapplchn rid team NmN bo atitant.
W:F.I corren I g , romply nh all city and county ordinance and mm laws
mining
OV ,o build ng conmm�mn and hereby amhonze rtprcunmtive of,htsc,y,o cnmrupon
�,r� Mahe hbnve�memioded propeny for inspersion purposes. ,
d (W)agree ao a erode mify anJ kaph taste ttie G,y ofC pen no U aid
Uz lib IUJgmcnts c t n I Pens h ch m yin any y roe ego q spW
Z Ctymc seyuc<e ohhg ang uhh pant fv �O
'APPI IC '1 VDSAND WILT COMPLY WITH ALL NON-Pf IN I
_: soulxc• I L uv . � 42 Issued by: Date
gdaao vc
in Re-roofs
.HAZ RDOUS'MATERIALS DISCLOSURE '
a,� WII ah ppli ant rh r b IJi g«cuP , mren h dl Asia doses material Type of..Roof w -_ _. ..., ......... .
s d t J by the Cupe t a Mun pip CoJ Ch p, 9.1> rid the H-IN andf S ty ....� ... .',.
CadeSctnn ? k) �e( 'I t f'' s '1 a1".2 d- i• r s :
_ °v 1 ' ¢'" ` ^ 1 ' J S All roofs shall be inspected prior.to_any roofing,material-being installed.__._._ -
Will the a
' hum c`Id yy occupant q p t e which a anew materials, for`without
D t A ' i + _ comply.-With
em a M1 a d o , a ter d by N B y Arc n v rd ty M ag ens If t - btammg an mspecuon tI'agree to remove
Dtaart=e all rApplicant understands and will
C hfa aHeahh& ...... -.. ... .
PPe c
❑Yea -.b"° 4 ' ll non-point source regulations.. .
ha a read Ne h rdo . ratimmk requirements under Chapter 695 of aM
ty Cod 'Sectio s 35505 25533 and 35530 1 understand Nate _
'if,heW in otc rentlY havearenanC,hm it is my responsibilitymnmi ,he "' " " ' -"" ""'-'--'" "-'" - -' - —'-'S- "--
6c p he Ire m h'ch'macs he m a p ter m issuance of a C ifie to of -
" _ a Signature of Applicant Date
Owner d a ate All roof coverings to be Class"B"or better
OFFICE .._ . .. ._ .._.. __ . .. ... ......_..._- '"'---- ._.. ...