01110016 CITY ut DING DFERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
7544 FALLENLEAF LA GREGORIOS PLUMBING 01110016
OW'NER'S NAME APPLIC71ON 5 B DATE
dd MC CARTY KEVIN P AND ELAYNA 17044 SHADY LANE DR 11/ 05/2001
j7, ,.'
40NE: SANITARY NO. CONTROL NO.
9 (408) 296-1167
CHI7F.C1'/ENGINEER: BUILDING PERMIT INFO
a BLDG ELECT PLUMB MECH
= O I_7 LJ
LICENSED CONTRACTOR'S DECLARATIONIOb De$crl IIOn
or
z1 hereby afOrea Nat I am licensed under provisions of Chapter 9(commencing pithSestion7")ofDivision3oftheBusinessandPotessimsCode.andmylicenseREPIPE.
amnmrceantld¢t. HOT & COLD WATER TO COPPER.
icenu las_�J �_ Lic.M Oate�A3 Comrscmr
a OI-i ARCHITECT'S DECLAR
j r I underxtand my plans shall he used m public recor s
i C O Li<enud Professional
'OWNER-BUILDER DECLARATION
I herchy infirm that 1 am exempt from the Contmctar's License law for the
!'Z a following reason.(Section 7031.5.Business and Professions Cade:Any city or county
t=D
which requires ape t tconstruct,alter.improve,demolish,or repair any structure -
n3� "poo t a' Iso q the PPTcam for such permit to Bleastgned emremem-
that he a 1 ti p rsuanl Midi the R sal.o s of the CnnL or L cense Lis (Chapter 9 S F( F]OO A e
(commencing NS Don]000) fD' tmn3of the Rusurcs�at�?mfreas code) fi�4; \�rlsq c•.�rn f.St�r iaill.°�j'�EF�' Valuation
or that he is exempt Nercfmm and the basis for the allfgeJ exemption.Any violation J -
-of Section]031,5 by any applicant Into permit subjects the applicant to a civil penalty
of not mom than five hundred dollars(s500). ._. APN Number 't.-'.'r . .-Occupancy Type
°I,as owner of the property,ler my employees with wages as their sole compensation,, 202 - UNDERFLOOR PL BING
will do'the work',and the strudum is not intended-r-offermphar sale(see.70,1,1,- 3 O 1 - ROUGH P p L•
Business and Professions Cod,The Contractor's License law does not apply to an E UJfi1J 4j3speetions -- p
owner of property Who builds or improves thereon.and who does such work himself 502 - FINAL PLUMBING 'ENERGY
or through his own empCver,s.prowled tea such Improvements are not intended or
compile fur sale.If however,then have _e o - - "'"- _- -
- - building 507- - FINAL PLUMBING.._-i'.-.:
completion.far Ute owner-sith,'r will have the burden of proving that he did not build or '
improve for purpose of sale.). '
._.__........_-_.._._ __._._._-....-. .. ._- licensed
....- ._ ..-- -_...___.......-
_.-_-_
property. 8 with licensed Contractor's
m
:: �.. �, - ,as owner nl t c am exclusively contracting- --
.; .;
construct the t.project(Sec.Tor Business o mW property
who Is Codes The.x,t erm it
• - License taw does not apply to an per of property who builds m improves thereon,
--and-%1m.contracts for.such,projects w
th,contruclons).ficersed.pursuam the.
Canuamors License Law.
sup exempt o der Sc B&P C far tis
QTOwner Da rills V
WORKER'S COMPENSATION DECLARATION p
wh
itL,
r I herebyaffi.under pmaltypf laceary oris of the fallowing declarations: �["•a
F 1 have am will maintain a Certificate V
of Consent to self-more for Worker's �\ UDI v
ompcnsation, as provided for by Section 3700 of the labor Code, for the
performance of the work for which this permit is issued..,
°1 have and will maintain Worker's Compensation ho mine,ai mgairW by Section
37W of the Labor Code,for the performance of be work far which this permit is
...
issued.
CCRTI Cape tion Insurance camer.and Policy.nubs reit:'„ _ _..,._...,__... ..__._._ _ .._...
. My W kcr s
bXhM N
KERB��s r t_C.1.':
FICATION OF.EXEMPTION FROM p _ 5 4_2t1 1.5, f~l
_.. �.
-COMPENSATION INSURANCE _ -.___
Crn -sectionneed not be compleod! fth pertnil is for one hundred dollars "•' '•Ll•.'a• If i� 1 . •\
(51 W) 1 .),
Iminifylthaty the pert se r f th work f which to pcim t ssrmd
shall not employ Y P< y in n a 1 be oma bl a theWorkers l �� t t'.i•'
Compen rumn laws of Califomia.Date," `
Applicant._'_
NO]'ICE TO APPL1Cw1T ifafter okin, his Certificate rifEpf yusbould � � — -- - _ - -�� �
Z became n
ubjeo the Work' Compensation p of theLab Code you must s,
0 forthwith smorply with such'revision,or tti Perm h ee t II be dimmed ked.
- -
.t•CONSTRUCTION LENDING AGENCY
o•t
a 1 hereby w firm that themdconstructiontl g agency for the P'crforma c e ll
rte.r la the work for which kis permit is usucd'(See 3097,Gv.CJ
14ntlerS Name'-� : .•.•._ _._-..,.. -.. ....� ..._.. — _.__.
Lender's Address' '
r I ...
. U
0 .n 1 grey to t I have d A] appl d county
and rot that th bo f s rear is
f+,EaCramer0buil1 agree no on[y. than Gnu deo ry,ordmvt and tit la Iupen
�>o mbuJding e-menionedprgenon.and M1ercbyvection upresentat saes ofthisciry to enter upon
,e (v the abo(WO slime 16 progeny for,inspection purposes.
-[r Z) eWeldgmeto save;ands pe and Fenhamayin the Giaof Npcnino against .:. - . . .._. __...- -----_. . .-----.---._ -
h liabilities,judgments,costs end expenses which may in any way attrve ageimt said
C.>.y City n c qucbce of the gm iig f this perm t -
APPLIC ANT,UNDERSTANDS AN ILL COMPLY WITH ALL NON:P0INT•' 1
s_f c Gds r Issued by: Dale
S gnaw itt wppl c 1 ID m' Re-roofs
HAZARDOUS MATERIA DISCLOSURE
i W II he
appl sant or f m building octagon it handle wanfoai ramal T e of Roof
az def d by th C pen Municipal Cod Chapter 9 IS d theHealth d Safety yp
edea s t zss3afan '� `:�-'S f� `_ ;_
t Will theppl cantor future building memo ant use equipment v
_ .All.roofs shall be inspected poor to„any roofing materia] being installed.
mit h d 'r<nthm a t as defne46y the Bay A an Quality Man g m ; If a roof Is installed without first obtaining an inspection, I agree to remove
' m” - „_all new materials for inspection. Applicant understands and will comply with
°Y °No all non-point source regulations,
I hive rced 0lhaa eelmy'materials requirements and Chiple'695 of Ute
CaliforniaHealth&Safety Code,Sections 25505,M533 and 25536:1 understand that '
ielhe building docs not currently have a muam;thvi it is myiespomibilityronotify the
ova para oT the requirements which must be met prior to issuance of a Certificate of
Occu cy. t -
`_ Signature of Applicant Dale
�.
owner pr thmriaeaagent- Date-. All roof coverings to be Class "B" or'better"
" OFFICE