01050122 (2) CI TY GN
UPERTNO
IPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7583 ERIN WY X 01050122
OWNER'S NAME: APPLICATION SUB DATE
1 «( WONG KING L AND YA—WIN 05/14/200.1
PHONE. - SANITARY NO, CONTROL NO.
q '
M o4 ZO ARCHU ECfQ!NGINEriR: BUILDING PERMIT -O
w BLDG ELECT 1`1 I1 MECH
ya O O L
O�w'L LICENSEDCONTRACIOR'S DECLARATION Job Description
O Z_C 1 hereby affirm,ha,1 ant licensed under provisions of Chapter 9(emnmencing
p:l-w with Section 71NN13of Dlnsl.o3.flhe Business and Professions Coll andmy license
,in fall f1 or en Ices. /Vth, cy
o « SEWER.
3 w oam cammm.r
l: O RC InFCrS DECLARATION
w
i 1 un lcraand my ill as shall be owd as public reconl.s
i K O O Licensed Professional
F.o OWNER-BUILDER DECI.All ION _
u� to1 herehy affinu that I in,osaa,l from the Contra......Uceme Law far the
F Z< following mown.(Section 70313.Business and PrufessidE Cade:Any city or county
I F D which birds
s o e.also o,conetrva,aper.improve,dcmo..11 file
repair any atorde t
3�
hit(
scensd person rc to there,movisiat os o,roe ConOn renni„oiceseLdw(Chapteent
tharraisangwitpmamion7")ruDivisi nf)neCoBusines andpr6awntor;Cer4 - Sq. FL Floor Area Valuation
p that he is a with Section 7t Eno(Division 3 of the Business and nd.An ,ii Calc)
of Scandal
is 31.5 by herefmfi trod the basis for the allege)exemption.Any via natty
of.,,[ .f than
L5 by any applicant for a pemhit whjecu the utpllcunnn a civil penalty
.r oat m.re man hve hundred dallam(sslMl. APN Number Occupancy Type
01.as oneror the piopcny,urmyampinyHeswl,It wages ruse their sole compcnxat _359200 12,
will do[lie work,and the structure is not intended or id cred for sale(Sec 7W4, Required Inspections
Business and Professions Cade:The Cnmractor's License Taw doss not apply,o an
owner of pnquny Who hold,.),imprnves,hercon,and who does such work himself
tr through his own employees.provided that such itnprovemeaa are not intended err 1.0E — SEWER & WATER
offered for sale If,however,,he building or improvement is sold within one year of
innhpletion,the osterbuilder will have the burdat of proving that he did not build or 202 — UNDERFLOOR PLUMBING
n"ove m.Purpose of all"). 301 — ROUGH PLUMBING
01.ns owner.(the dopelant exclmively ca boned,with licensed camrucul to
construct he proved(See.70,14,Binanns and Fromxs....I Cale:)The Crinmmor's 507 — FINAL PLUMBING
License Law don nal amply man owner of a calluy who delicts se inpursua t to the
and who Lietm3 for such trujcns with a nmtmna(s)licensed pursuant to the
0 1 o nor's License Law.
°lam excrnpt anile,See ,H&I'Cflnhlx,war - -
Owner Dole f
WORKER'S COMPENSATION DECLARATION /
I hereby o ffrnt under pcE of pc jury one of the following Jeclara,iom:
❑ 1 have and will nnuinmin it Certificate of Consent bt self-Hound for Worker's
Compensellon, ax provided for by Scc,ion 37ho'of the Lebo. Code. for the
perfomunce of the Work for whicM1,his permit is iswd.
1:11 tome and will maintain Wader's Contpenxmion Insurance,as required by Section
3710 0(Ne Labor Cade,for the perliamsAAyhhlllcc of the ark for hick this permit is
issrncr Worker's Cnmpe� aay.minsu litD.: �Nieumber are:
tCERRTIPICATION/lO[FJ164GMP1NI tON I Mf
FROM KF, I
COMPENSATION INSURANCE
(This section need not he complercd if the FEE is for one hundred dollars
(S 100)or Ica.)
1 caddy that In,he frr'ifnrmanac of the work for which this permit ix issued.I
shall not employ any pecan in any manner so as,o become s rtgat ta me W.rkea'
Cmnpensa,inn Laws of California.Date
APPlarat
NOTICE TO APPLICANT.IL after making this Cenlficate of Exemption,you should
Z berome subject o the Worker's Compensation provisions of the Labs Code.you must
Z
Z u C Iimhwith comply with such provisions or this pco lit shot Is decided revoknl.
f" y
CONSTRUCTION LENDING AGENCY
1 hereby aRmuhm there is a amamaion lending agency for performance
W al nice work for which,his pernJnio issnal f5w.31107.Civ.C.1 -
L Q
I-snE Name _
� z Lender's AJJress
V 0 I ready that l have read this application and state that the above infiltration is
W. F. correct.1 agree ta comply with all city and county ordinances and state law.sela,ing
0 U to building construction,and hereby awhonze representatives of this city to enter upon
,hc ahovo-n mtorcol anpeny f ries vrinn puymses.
F. p, (W gree to save,lode 'f dIIOphormles,the CiIy of Cape91a.against
V1 lindloie a Igmem.,on is aa, c uses which nay in any way ocervc against said
U City in , s UNG n c goal
in d this ppnnit.
LA
A L. UNG SAND , . WILL COMYLY�jfTH ALL NON�P( NT
O 1 c uL no s. — Issued by: Date
S nuoreo( pphoao/Comrnwar t Re-roofs
HAZARDOUS ATI°RIALS DISCLOSURE
Will the applicam or failure building occnpam start or hamllc hazard..,material Type of Roof
as Jeracd by the Criterion Munir fal Code.Chapter 9.12,and the Health and Safety -
Cmle.Section 25592(0)1
0 Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will ter"hean,car flat holding compote use equipment or devices which If a roof is installed without first obtaininginspection, I agree to remove
emit hazardous air contaminants as defined by the Hay Area Air Quality Managerial an p }
Districe all new materials for inspection. Applicant understands and will comply with
.10 °Yeses 0N't all non-point source regulations.
I has n ad the hazardous leriaks acquirements under Chapter 5.95 of the
Cnifnmiut al &Safety Cale. ,inns 255115.25533 and 25534.1 understand that
ifthe hail,' des urn 2urently •anden.ban 1,is rdyrespn Windily m rotlfyncc
or am 1 t e rcyvimmenls x1 nmst be ten tri rho issuance sf a Cenifcate of
e . Y' '` Signature of Applicant Date
r amh.nacd aged, �/v Date All roof coverings to be Class "B"or better
OFFICE