02030166 CITY
BUILDING DrnekoNNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
6445/6447 BOLLINGER RD H & H CO 02030166
OWNER'S NAME:
APPLICATION SUB DATE
BILL FERMAN 725 PIERCY RD 03/26/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 224-7777
OO ARCHITE=NGINEER: BUILDING PERMIT INFO
z F BLDG ELECT PLUMB MECH
5m i LICENSED CONTRACTOR'S DECLARATION ]Ob De$Crl IiDn
i z_C I hereby affirm Nal 1 am licensed under provisions of Chapter 9(commencing p
In I-to .with Section 70m0t(0)of Division of Ne Business and Professions Cade,and my license REPAIR SEWER LINE .
ice,,Q Lic nsc Cldss �kc Lic� S 7
•O�
r"Z -U Canl
j 3 c.0 ARCHITECTS DEC RATION
C g c 1 understand my plans shall he used as public records
r
1 d o O Licensed Professional
OWNER-BUILDERamainfrom
the RATION
Cut.,.
6n, 1 naso.(Bred that 1 1 .sump,from He professions
C s e Any c Lew for He
tzmeowingrens.Permit
7oJI9, t.alterrante ter.dePolicndc:Anyanystwanly $3600
IFC whichis,isrequires a permit a construct,plica improve,demolish,fi repair any ewemrt
A. $ 'prion, ¢' e,also req free HcApplicant roe Contrauch muu fl s gned aw(Chastatement,
pg� p,�� _ __---
(commencing
_
(com slicensed!th Sesuant toction" he of I ns Division
the Ce Business
and rein (Chapter e,�,6 a� S 3�,Z�&l- rlr Am i Valuation
(comme c s e e with Section om un The is 3 of the Business d P yfe. 'ons Code) ,t (- • ,„C . `, _.:1 3.�; n, -
or that he is 31 5 b IhRetrom and the bars for the allegeE exemption.Any violation
-of Senion]0315 by any applicant for a permit subjms the applicam,o a evil prnahy-
:ef not more than h.e hundred dmlors($500). 10 6"PN rtIMMR & WATEI''' Occupancy Type T it
❑1,az owner of,he progeny,or my employees with wages as their sole rompcw,ion. _
-'will do w
the work.-And the sclum is not intended to olfeted for sale(Sm.7044,-
-,.ill
and P+ofcssions Cade:The Convector's License law does not apply to an 301 - ROUGH PRA HPM3pections
owner of pmpctty Who builds or improves thereon,and who does such work himself
orthrough nremployees,p idedtntn'improvementsarennnntendep r 507 — FINAL PLUMBING
offeredf I Ir h w- -ih b'ld' g- improvementI --- sold wlhrd one yea of _.._ .. .___.._...
completion,the owner builder will have the burden of proving that he did not build or
improve for purpose of sale.).
- ❑1,as owner of the propenY.am exclusively comracting with licensed convaaors tor-0 N
c License
,he predoes
no(Sec. 10 a,Business and Prty%he u Cade:)The Couver dur me,
L cense law does not apply, owner of property or Will or seimproves Hereon, - Q >'
(
red-who Licensefor Law.ch.p ; ¢with t ctor(s)licensed pursuam to He _... _ _... .._---_ - - _.._-_.__ ._... .I RI,A
R t.
.. Contractors License lv .B-2002
.... .._._. .. ..._ ...
❑la mpt under Se ..'B&P C far his.,on 1 1"•�
Owner me
--.. . . BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby a1Brre under penalty of Perjury otic of He following declarations:
❑ I have and will maintain a'Certificate of Consent hi self-insum for Workers
Compensation, es provided for by Section 3700 of the labor Code, for ,he
performance of Ilio work fur which this permit is issued.
❑I have and will'maintoin Worker's Compensation lniximoot,as required by Section
_a 37W of the Labor Cole,for the perhaimmce of the work for which His permit is
issued MyW keli Compensation Insurance/carrier arid Policy number art - _
arrie ShZI� FllahOl: 't Poly}�No.
CERTIFICATION OF EXEMPTION FROM WORKERS P_
COMPENSATION INSURANCE
(ThIan need nal be,com riled if he ��--- - -
ISIOo) lets.) P petmn is for one hundred dollars
1 verody IM1a in the perfarnameeofIn o k f which,his permit is issued 1 - '- -"" ' '` - _` ""'"'-- -,- .-• -
shall not employ anY person any mann so ea to become subject,o the Workers
Compensation aws oalifornia
n lf C :Date i
Applicant. .. .,.,
NOTICETOAPPLICANT If aft. km Ih Cerebrate of Ear "_--'- ----- - ---
zWmno subject lo+heW kis CompensationP+o you should
ZM1p of Lobo re, you most Q fonhw tR omply wish su h p o pe I.h 11 be de d ked. ,
(~ s , 'i.r CONSTRUCTION LENDING AGENCY . . ..._ ._.._ ....... ..... .... ..._..... -. 1. r __ . _..-
1 h by auric that there construction[coding agency fo d m
perforance 1
a� Lnd< k fo which H perm, 'ssued(S c 3097,Civ.C.)
e Name-r...
Z of in .... u... ... ... ...
LendmsAddress"
oi
rt.'r•r
V Q I utility that I have reed His application end std¢Hat the above infoemedon is
W r F corieciA agree to comply with all city and county ordinances andstate laws relating
O;V to building conswnion:nnd heretiY authorize representatives'ofdoi city w erterupon
ry the above-mentioned property for inspection purposes.
Fy'A. (We)agree to save:indemnify and keep harmlrslhe City'of Cupnliao Against
w. h liabilities,judg a,costs and expenses which may in any way acceur against sold
V Z City in con of th granting o His perms,."
APPLICAN UNDERSTAND WILL COMP WTrH ALL NON+POIIrT" I -
` qD G aen.Tf '. L �'� Issued by: Date
,igaamre m app
HAZARDOUS
r fSC Re-roofs
-'„HAZARDOUS MATERIALS DISCLOSURE- - '
Gwnyt Applicant M building occupant en Handl naa ma sty T of Roof
s Carl
Sed by H Cupeni Municipal Colic Chapter 9.12.and H Health e d Saf<tY yp - _ --,-:._• .._._ _ ..
de,SaY 255R( - , + .• - r4 �: i t.. ..... _ .
❑Yes' I til >>i li'' rztcl a jY va . � ( f>. � ,4. tt y r
i
All roofs shall_be inspected.,pnor to any roofing,material being installed,
egy
Wdous App
licant o furore Wddrngn<upe, Y equipment devices wn,m If a roof is itistalled without first obtaining an ins ction;Fagnee to remove
Det harand a conmm n t as defined by :Bay y Arw'Aii Q il I Mena cm g pe
District y g
0Y _ all new materials for inspection Applicant understands and.will comply with
,• t I all'non-point'source regulations t "
1 1 n e' d the hoz d s ,erieIs requirements under CM1 A .,go ,'the
Cal ift is Health&Sufny Cada Sections 25505.Q5533 and 25536 1 understand that
ifthc buildiil8 does noltacce ly have n tcnanCHui+is my responsibility to notify the
1h .. ... ..- ..- '_'
neuPunt o e requirements which m st be mei prior Io issuance of a Cubism,,of -
Occupme
g
.ner rauNoriz egrnl " '. „ -- - -
Signature of Applicant Date
Date. All roof coverings to be Class "Br' or better "
. OFFICE. .... . _.... _ _ . _