00080130 CITY'OF WPERTINO CONTRACTOR INFORMATION:
BIDLDINC.DIVISIon,• - ' PERMIT -
BUILDING ADDRESS. .k " PERMIT NO.
ft�17.06 COLLINGSWORTH ST BUDGET_ PLUMBING 00NfS�Zl7.30
.OWNER S NAME: _ e .-LL APPLICATION FOR DATE,
I_EOhIG' THEODORE E" TRUSTE ^8695 ROANOKE`_ST •e :08/17/2000
ONE: - - - SANITARY NO.'a• CONTROL NO.
.,.
(51)3)'303-7847 -
volOOTETI
ARCHICENGINFER: - t - - -it •IHIILDINGPERMITINFO 4
y, • - •4 BLDG 'ELECT ^.PLUMB MUCH
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Z�<� LICENSED CONTRACIOk S DECLARATIONt Job Description 't • '
�' - 1 h n by ori tlit l 1' eJrude,p r Chapter9(commercial, - p - _ -
F�Ca with Section 7000)ofDavisiun 3oftheBa a„irted ProessionsCorle.andmyl „
�Y
is mar < andeffe t WATER HEATER-
K W 6 License Class L # r 1 �
3 w y Date .Cmrmmr - ry•
F Q ARCHITI CI S IIECLARATION 4,f
�y J
I
demand y plan, hall he Used a,public J.
of m C O Licensed P le., , / r
% OWNER BUIL DTR DECLARATION
mI hereby, ff ti t, pt f m,M1 Contractorl L ,1 C + -
- Z� IIIown,oeir,au(Section 7(THSB IPnf Coale:Any city or County '' • j
fY❑ which y p tl 1 1 Iter,improve,demolish, p air any't- t ., O ..
mF prior to its..srance.also rcyuac'the applicantl h,permal'a rile a signed scanner, -
�a
that hool,sOnedpar,mal1 fh powroehieftheC tint License L (Chapter 9 Sq. Ft,Floor Area i ,Valuation -. ..
(ea with Section 7000) fD' . t
freedP r Ca) $550
a thin he is esompl thcreform and the bar+for,he allegedascription,Any vulation
of Section 70315 by nn,applicant for a puri,wb)nats,he applicant if,a civil""fly. 7:1 "
Occupancy Type
of,,.,from than five handed dalmry($5(0). ri -,,, APNNumber” °
` 356] 7053. 00 ;
°I,as awnern_fihe property.;mmY employees with wages_as the ifsolc ed.np....cl se, t ,
All I the k J The smcture-s not ir d J off"d......1 (se'. oD,,," „
Ba .and P nc,hous code Toe Channel law does not apply 10 at - Required Inspections
weer nfpr..peny Who bond, p a,thereof, d too Uses inch work h' If . '502 — FINAL' PLUMBI.NG' .ENERGY
or through his pl y- ,provided,h,such'topovements are ant'intended or
offered Lou sale.In mb'1l 'g or arpoostater,i Id livitlen oneycil,of '30E, — .GAS TEST
pl t n the ee b Ila rdet c
will have the hul aiming da,he did not ateld or
completion,
for purpose 1 le)•f1. o. I , .. 507 —.°FINAL PLUMBING.
e I,as owner of the progeny,un exdunively d Pfissi with licensede Contractor's In -
Lo cf til parent(Sea 71144,&S tea J e fission,ilE n, The Conn e
Llc ash contends
far .o mint owner fprageny'whn)licensed ves
)em .1:- �.� _ -
o'nd who co tlraens fo eM1 parents with a eanarnor(x)1 c eJ P um 1 'he -
01 ,acaContractors License Law,
❑Ian ercemp,under Sec. .B&'PCfonhls ace,con1 , �• " r
Ower' Date
WORKER'S COMPENSATION DUCLARA9'ION
J
u Jc twlah of c e of the R II w elnmli°ts. ,
�I herehw vRrm n r
Y I Y P rluiYo i b .
'I "
° 1 base and will Ontario a Certificate f f l t;leff-insmalor Worker's
Compensation, as Forsidod ror by Set i U.3700 Of.the Lha, Cady Il r ,he _ • - ( r' `
perf,mtvnce of file work for which this permit is issued.a S�' - c • 'y
O 1 have andwill muimain Walker's Compenmiian Insurvnec;as required hy,Section 1 t
v 3700 of din, r Code,'for the performance of the Antk for s'vhlelf this permit is "
issued.My Worker's Compensation Insurance currier and Policy number are:
Carrier. Policy No
CERT IFICATION OF EXEMPTION FROM WORKERS' '^ '
COMPENSATION INSURANCE
+ a
(ThissectionHantd not benple,dTlM1 fault Hilt is future ht Hared Jollnli'
($100)or leaxJ
I unify that in fire pcffnrmance of(he work for which lhlx permit is ienued,I - . •. E'.
shall hot employ any person in tray manner 9nvsgn hccomc'subjem to the Workers
Cmpensetlon Laws of California:Date
Applicant - . .
NOTICE TO APPLICANT If. Ii k gtl :Cn'Ict (If B%eltllnloe,you should • -
becanesub3ecf to the W feces Cron,pro,ation p' f the Label Code yo st
fnnhwth comply with suchp ry o ms per nif shall bedra ned revoked.' - -
FH CONSTRUCT ION LENDING AGENCY
aI lincbY air,,,. that flacion is a ccannorknoleading., y l'°r Its Onfo herace �a- -
W 'nf,hc weak for which this-pconat is kated(Scu 3097,Civ,C -
❑ Lenders Name
r7 Z Leader's Addressat
V ] -
1 tGthtrtIh ercedB , gill t dine muh ti of rniun'a
tis Fat small I agree to comi with all city and county ordinances and state laws relating'
V tabusing construction,and hereby authorizecpmsentttile h
ol, :ciry to enter upon'
tbe b e menti n d property f 'inspection purposes.
e,
(W)'g to save,indicantfy andkeep l m1a(haCTy ofCaat o agents,
r y ,lairini . idg 1: t' tl pc:th wh .. Yin any y crue -P tt d, e a WITy�
U Z
City regUND of UNDERSTANDS
of,h ire , -
'^
APPLICANT REGULATIONS, AND WILL COMPLY WITH ALL NON�POLNT
"
SOURCE REGULATIONS - ISSU y 'DflIO
_ . sis�marearAppucnMCmracldr _-' r Dai Re-roofs-, .
HAZARDOUS MATERIALS DISCLOSURE
Will the apple t or fame naiimng aeeapam amrc ar handle hamonan Undo al Type of Roof - -as defined by Oe Carrot noManneipal Code,Turner 212 d the firsthand Salmy
• Ede,Section 25532m) ` a 'y -•+ - - '
°vB5 ( -°Nd` All roofs stiall�be inspected prior to any"roofing material being installed. °
`
Will the ppli or fulare h old,s orcupoofUecommend or d- era which If a'roof-is installed without first obtaining an inspection, I agree to remove ,
all hazardous air commitments as delit l y th Bay Area Air Quality Management
rale,?. all new'materials for inspection. Applicant understands and'will_comply with
° C1 °No all non-point sourceregulations.
- 1 have and the hum um mmenals no,or ems ander Charlie,6.95 of Iho _ r'• ,4 ° "
California Health&Safely Code Sections 25505 R5533and 25534.1 nndcrstind that
if The huilding tl"a,not currently have vtenvm,thm hoc fay responsihil'ny mnntify the • -
rceupunof the r,,utrene its which must be me,ap' ,o ir. f a Certificate of "
Oecupancy. .. - r,.'
r ,Signature�of'Applicant , Date
Own erorauthoraea agent Date All roof coverings to bp'Class"B" or better
OFFICE
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