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CITNO
Y OF CUPFRONNO
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT NO.
10439 PLUM TREE LA
BUDGET PLUMBING
01010086
OWNER'S NAME.
APPLICI'I'ION SIM DATE
JOHN PRICEN
28695 ROANOKE ST
01/19/22001
PHONE:
SANITARY NO, CONTROL. NO.
(510)303-7847
ARCHITECfICNGINEER:
BUILDING PERMIT INTO
BLDG ELEC1PLUMB MECH
LICENSEDCOMI'RACI'OR'SDECIARATION
Job Description
I herchy IJErnnhm 1; limned under po,i,ur, id Chapter 1) fcmnmcnciny
with Sectinn 71KK0 of Div lnion3 of the Busine,% mod Profasionx Code,:md my lurn.m
is in fun force and effect.
REPLACE WATER HEATER
Lieenx Clan, Lic.n
Utile Contractor
Aucnn'Iscrs fir I.ARATION
I ainmmtand my plana .non Iv u%, a%pamie recom]x
'
Licen.cd Prole"iunul
OWNER -BUILDER DECLARATION
I hereby affirm mm I our exengn Tran the Confumors Llemua Law Oso the
'
following reason. (Section 7031.5, Hu%inexa and Profcsiom Coe: Any city or county
which rtquire, a permit to versuucr. alter, improve, demolish, or repair tiny %wmum
1. d t e
print 'thelel tl tt such fl g tntt
Sq. Ft. Floor Area
Valuation
lonh I it II,, he poo,olon, it11heC t f r', Li,eme I (Co-pnr1)
f. ...... neroin, w',SWon 700(h lDivnova3 offic lionow, and In luxons C,xlm
or that he is exempt therefrom and the basis for the alleged exemption. Any vinlmion
$615
of Section 7031.5 by any applicant fora pernat.subjects the applicant u)a civil penalty
APN Number
Occupancy Type
of not more than five humped dollars ($500).
Ol.e, nwncr ofmbe pn,pcny. or my cmnPlnyec%woo wages us socio sole aonmpensatin 1,
31633084.00
Required Inspections
rill do the work, and the nrucm¢ in not intended or nOemd for .to ISce. 701 1.
Low does
Bums,% and Profe,smn%Code :'Ile Contractor % License not apply m an
ownu at property Who huilds or inlpravor there i, a I who dues such work him,clr
employees. provided d, snet, impmncolens are ran imended ,,
or through hls own empm
502 — FINAL PLUMBING ENERGY
affected! forsole. B, mwencr, me building or improveraem i, sold within one year of
506 — GAS TEST
completion, the owner -builder will hive the hmhou of proving that he did not build or
tnprove for pmxw,or.me.). -
507 — FINAL PLUMBING
❑ 1, as owner of the paa,,r , am exclusively contracting with Recused enntruclors it,
comwct the project (Sec. 70J4. business and Professions Cod,)The Contractor's
,
License Lax' does not apply m nn owner of propcny who wilds or improves thereon.
and who amtrees for such projects with a .unlmcmrtx) Iicersnl pursuant on the
Comraclor% 1.1n:me Law.
❑ 1 am tolerator under sec. . B & It C ter Ibis manor
Owner Date
AORKHR'S COMPENSATION UF.CI,ARAT1ON
I hereby affirm under pcnvhy of perjury one of,hc hollowing decluretione
❑ 1 have :old will mord in a Ceniliene of Consent e, ,elf-inmte for Worker',
�,• es p02
Conlpensminn, ax provided lel' by Section 3700 M the Labor Calc. For Tho
• L
Performance of the work. For which this permit is issued.
. `G
0 have and will maintain W .. or', Compensation Insurance. as required by Section
3700 of the Labor Coln, Ibr the perbnmmc of the work for which this permit is
V
issued. My Worker's Cnmponsurn n Imumncn cantor and Policy numhcr arc:
��
Can cr: Policy Na,
CER9l FICAFION Of: E%EMPI'ION FROM WORKERS'
. (IUMPHNSATION INSURANCE
(Thin welion need not be completed if the recruit is for one hundred dollar
ISI W) or leve)
1 renil'y it,,, In the fic,i nnlxnce of fbu work on which his penult is toad, l
shall nm employ tiny "war in any Inunner so as to hannme xahj,ct to the Worko,,
Camp usation Laws of Califumio. Date
Affliction
NOTICE,I APP1.LAN'n B. Inter ranking In, Cenmeane of exemption. you %botdd
resume%uhp,r to the worker, Colmm'anaroa pen Ira of the Ltdon code, you uu,l
limhwilh comply with such pmvi,irns of this permit that he dermad invoked.
CONSTRUCTION LENDINGAGENCY
' I toren, awns drat mora i, n consmaron lending ogeney Far ale NIfontnmee
_
of the work lin which this Immril is ivsucd see. 3017. Cl, C.)
Lender's Nnine
Lender', Add...
I teddy Orf I havcmaW drat, upplie;nion tod "ale flet The ahuve iomnumiuli is
I agree to comply with all city and county ordinance, and %fate laws rcmdny
.
mn.
building construction, and hereby aumor.e representative, ofihl%city m enter upon
herb ... c ounai aced pmpeny far ar"eaon perpme',
(We)ugrm u, save, i ndnnni ly and keep hunnleas The City of Ca Is'- Ino ngri est
'
liabilities, judgments, cokes and c,cnscs such otty in tiny way recruit against said
City in con,equcnee ofthe graining of his permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT
Issuedb Date
y'
SOURCE REGULATIONS.
Re -roofs
Signature of AppBcmNContmcbr Dam
HAL%RDOUS MATERIALS DISCLOSURE
Will tire applicant or future building occupmn%mm or handle ha.:mmoux material
Type of Roof
,,,tan, by the C,fgwnino Mtlldc'Ip:d core, Chortler 9.12, and the Health and safety
.
CIalc, Section 25532fu17
0 Ye% 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicatn or future building o.<urvmt use ewipment or device• which
If a roof is installed without first obtaining an inspection, I agree to remove
an, h.-rodnm air coup tirmar a% deforM by hot pay At,, Air Queliiy Mon,gmncm
all new materials for inspection. Applicant understands and will comply with
Dotn"?❑No
' 0 yes
all non -point source regulations.
I have read be hvordou, meconate rc,ornnond under Chapter 695 of the
California Hmlth & Solely Code, Sccfions 255115.3533 mid 3531. I nndcmmnd that
if the building dices nut canard], have a en:un, that it many ra%ry,mibllhy to nudity the
cepa, of the reyuimments which amt the, mm prior oo issuance of o Cenifieme of
Oecupaccy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
I
Owmeror n,, Date
aulh agcut
OFFICE