02090174 (2) CITY t OF
NGUDPERON CONTRACTOR INFORMATION:
. PERMIT
BUILDING ADDRESS: PERMIT NO.
10260 DE ANZA BLVD 02090174
QN E APPLICATION UB DATEFARGO 09/25/2002
PHONE: SANITARY NO. CONTROL NO.
GOO ARCHITEC`iENGINEER: Jr BUILDING PERMIT INFO
'w C BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
0 i7 h I hereb (firm that I am licensed under f Chapter 9(commencing Job Desert❑[ion
oy-o provisions o` ( e MECHANICAL ROOF SOREEpZ�rL�,e /p o
F-Xw with Section7")of Division3of Ne Business and ProfessionsC dc,and my license f Itl�Ysf•"9LL.rE
x 4 is in full fora and effect. '�"�®®
Date class Lio.a
a.
is.Yn ARCH( 'S DECLARATION
=mss gers, „ In r bliartada MAY 1 9 2003
�r
w C o O .Ekoned Pmfrss
c
O*_EmBUILDERD the Com ION �� ��
I hereby.(firm on 1 1. exempt s a the Cosions C s Any c Law for the
Fag followingreason.permit to
7onstru Busing m Professions Code Any city or county
IFO
whicheq requires perm,lo< at , he p edml'shrepair' any structure
de
i3� peat r" enc as rty N applicant uch pc itt fl signed statement
e•T ns Ntotle, of e License, a (Chapter e
' .-.
ValuationbromcpgwithS70W)ofDivision 3 of thBusinessand (c sCa ) 363A10$4Ts,1." ,: cJ'
or rte d Bsemp,die and Ne aver Car the eueio Any violation
,Tlui vh
of ion 3 any apliam for permit subjects the,•pplicantnto a civil Penalty
1&.1 more thanfi,,e hundred dollars.sot. 101APN AT ION Occupancy Type
❑Lasow•eronnepropany.arm'yempmyeeswithwagesastheirsolecompen.sation, 102 - PIERS
..will do the work:'and ile's,Nc,uu'is not intended or offered for sale(See.7041, f
-B•sinai and`Profd,d.rs Code:The Contractor's License Law does not•p,ly to an 103 - UFER Required Inspections
ownero(mav=nyWho baBdsmimprove.thereon.aadwho does such mkhimxB 104 - REBAR
or through his own employees,provided that such improvements are no,intended or
offered 07.11:H.-li bcr,the bi ildin ` ---- ANCHOR
_._.__----'---- -'-_
geburdenofprnrsuinhedidnotWiIdof 703=' ANCHOR-BOLTS-- - .
col plcuI puryou o(boi'C'r will hove the burden.f proving,h0,he did not build or 106 - SEWER & WATER
m4e:owndr,nr irie pm-ady:;;�s�w:i��iy���G�2ens w�,n li�e�s�e ro��a�lo���o. ...-----------202---UNDERFLOOR' --PLUMB I NG----';r: l: -'--.._..----
or,N=tmrpNlrc,(see.lou.Business and Pra(essionsCoeeaThe Contractor s 203 - UNDERFLOOR MECHANICAL':.:.
- - -
License law does not apply m an owner of property who builds or improves thcroon, "
n
:r ..ane who.corars.for
.such prolccr.with.ucintract.h.).licenxd pursuaru.ta Nr .__ 204.-----UNDERFLOOR----FRAME-----.--------- -------------- -.--
Co t t License L•
01 ,Alin - --� It t n 205 - UNDERFLOOR::i,INSULATION
w O 301 - ROUGH PLUMBING
WOR. R'S ATIONDECLARATION 302 - TUB & OR SHOWER
IM1eubyaffnm x_ by (p<r,.ryi,pruxmnowmgaed,rmon:: 303 - ROUGH MECHANICAL
-r 11 ❑ I hmeC.ule'will iNin,aid'e'C[niecai<'orconsent'i0 sel(-imme far Workers 304 - ROUGH ELECTRICAL
Compemornmr-as provided for by Seaion-3700 of the Labor Code, far the
perforator.of the'work for which to s sertoth is issued.. 3 0 5 - FRAME
01no4 nd ll pfinihio Wrokai%cmmPe . a 'I = 'rcgtrcde>siclua 306 - HOLDOWNS
37.1 4-flue lea read r m p<rr,rm rine o k r r which this p«mn r
307 - INSULATION
at tme MyNoke:c p to I...ane midPmq . b arc: 'SHEET-ROCK---
Carr l 6 1'.1'1 �a d'� sS P. d,No. !. -
1 1 zCENTIFICATION OF EXEMPTION FROM WORKERS" :_11"+.J 3 O 9"3,',v;EXTERI:OR LATH-.,.
COMPENSATION INSURANCE' A _
310; ;:INTBRIOR -LATH • --- -- - --
"' rla smunn n=cd bm be compin=d if the .it is for one hundred dollars 311 S'CRAT(.'$ COAT '
(51W1 Ic s)
_. .313 -v-ROOF_NAIL._..._
Iem,I a,'n.h pert dithe Af which,h pc ', ass cdl
cam ' t pI°Y an,
Ir o is [+riP �" Z" 'n=w.k 501 - FINAL ELECTR-I�'AL-(ENERGY
A;B� tfS -- 'T� 50.2_.-. .F.INAL PLUMBING- .ENERGY _ .-. __ _ ...
N UAP .i gN."rote, IE npl .y._.I ald 503 - FINAL MECHANICAL'`ENERGY
Z c toes b) a the rk r C t p t nsofd labor Cod y urr.,'
00 forth the plywuh chprovumsor,n pc tludlbed ma akal. 504 - FINAL BUILDING ENERGY
Z . -._ -..._. _
- - - - --- - -- - -
'onh'w kfrwhenN phendrsramodicum,
aicu ,Jco7,CiNCY 505 - FINAL ELECTRICAL 1.-.'
•"� ' r}' CONSTRUCTION LENDING AGE
ine
sc.
IX In c 1r mann q , t -Ina r'rm 506 - GAS TEST `'
Y 8 bv.C lY PC fent e -
p .0 Lind Nme 5.p7 - FINAL;- PLUMBING __.. _....
_...
L rot r Add
s I certify th u I have read this applicmion and sate that the above information is 5 5 0 - F I NAL MECHAN P CAL('„`
Ta"F. mire.f g "complywith ail'it,and county rdinance, d statelaws relating 9 - INAL GRADE
' O:v to building c truaio d heribYa ,ne < rep tuvesrth'.city to enter.,.
the bo :t ed,property r pec. .p mo 5 0 - INAL NG
E•"-6' (w) g toss 'ndemtfy and la=p harron"'he C'ry 1Cpco 'oagains,
.y liabilities,judgments, a arW p=osee n n y in any _ y r against said 5 - INAL B RKS
UZ City in coseqce of the 8com'gofdu
APPLY' NT UNDE`RSTAN,S AND IFLY WITH ALL NON INT
enu REGUL,1Tf1 1 /� Issued bye Date
Sign wrc of IcanUCo r to ,/
,+ ATERIAIB D CLOSURE m
Re-roofs
building span, , orhmWl nazado Banal Type of Roof----.. --=-
. .. PPCade Chaq 9 13 •rod Ne He IN rte Saf ry _-• I__.-_,.a-. _
HAZIRDD 1
Will the I .tort,
' defned by the Cupm n MummgB�pl
Code SY❑ n SSJ2(al .,' t� 1� f, fs\ la a ' b,'. 5 1 y r•\ rr. 'y �L4•'h {'. a id ' .. 'i t 1..-
f
All roofs shall be inspected prior.to.any_roofing.material.being installed.
N II,hc ppl' t t rt bu Idmup
g occant useequ p t d which I / - -_ '
t l z rd 'oto n r e ed by to B y A A Quality M g mens If a roof is mstalled without first obtaining ani inspection Tagree'to remove
�D,�` all new materials for inspection A Meant understands and will com 1 with
PP. P y..
- 'allnon-point regulations;,aa`•_ Ile , - .. .
1 ha reatl the haz ors mamnak rcgmrcmenr under Cluper 6.95 of me -
Caldumt5 He.1N&Safety Code.Sections 25505.25533 end 25534.1 nolcomnd thm
' ffthe bntof h'does irtmemswitichm W;mgPd is FAY nesponsibd,ly to notify se' - ”' -- -'- ------ - -
Z
HNC building does at currcntlhm�eele N:NBtn - -- 'C
amissuance'ofa Certificate of G.J
Signature of Applicant_ Dat
-
Owner --.. ._.. _. _... ..
- _
V. or amhm n ..
gens' Da,= All roof coverings[o be Class B"orb'
etter
.... .__-._.OFFICE'.__ _ -....
I