02010129 CITY DIVE'ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1132 HUNTERSTON PL ALL VALLEY PLUMBING 02010129
,1\ OWNER'S NAME: APPLIC TION SUB DATE
ZALUSKY ROBERT L AND MICHELIN 170 BRANNON DR 01730/2002
PHONE: (510) 376-4816 SANITARY NO. CONTROL NO.
O O ARCHITECIYENGINEER: BUILDING PERMIT INFO
Z❑❑ BLDG ELECT PLUMB MECH
a = f=1 L'-1 1=1
FF LICENSED CONrRACfOR'S DECLARATION
OZ y o I hereby affirm that 1 am licensed under provisions or Chapter 9(commencing Job Description
F'3tru with Section 7")of Division3ofineBusinessandP ressionse&adnamycame WATERN HEATER REPLACEMENT.
<u f; is in full force an feet
i m 0� License Lic.M �D
K Date Contractor
ua A CHITECr'S DECLARATION
t—seg un c Lana )' s 11 be us 0 as recoNs
oLicenses mfessinn
_� OWNER-BU .DER DECLARATION
v I hereby affod that 1 am exempt from the Contractor's License Law for the
t $1500
Z< following reason.(Section]031.5.Business and Professions Code:Any city or munry,
E F O which requ mm
peto construct,alter,improve,demolish,or repair any strucmrt
up673t$ .prior in its asuaace.also requires the applicant for such permit in file a signed su¢menr.
t r a Valuation
tRat bq
Is licensed punusa,to the provisions of Ne Contractors License Law(Chapter 9 tie
(cm eq, gwmSemwn,70,0,01 of OivsionJofthe I 'aincj,imd PVpfiaolom Code) 1sl t`ti�� `36`£'1L`LQ �j snCYV9,{ ry',i,E��i1.i','
or shot he ii exempt theiefrom and Ne basis for the all gel exempdo .Any violation
--of Section 9031.5 by any applicant for a Permit subjects Be applicant to a civil penalty
,of dot more Nan five hundred call ars(S5O0). 5O2AI?NP[yWWL PLUMBIN ENERGYOecupancy Type
Cl 1,as owner of the property,or my employees with wages as their sole compensation, S06 GAP TEST It
willdothe orOfessi's Cade:
is not intended or License
La d-for axle(See]Oda,
'
Business ma il&e.The Contractor's License o d dose not apply to an 507 - FINAL PL!C LHt YQ4#IspeCGons
.nor of progeny Who loy e s or improves at such,end who encs such work himself
or through his own employees.provided that such improvements_art not infected or __, -_--.,,_.___._..__, -,____-_-______.._-__---.._.---------
offered
----{.-,.,.
Completion sate:TLhowever,the buildingoi;men of proving
rove sold within not year of -Completion,to owner-builder will ban the burdenofprovinglhmhedid nothuildor F1RI/'►LED -
mprove for Purpose of aale.l.
FEB
❑I a.ofthe pperYexclusivelycontracting withl ac contractors to
1.52002' _
construct theproject(S 1toW Business and property,
who
Cd ]Th Contractor'sio.
and.wh law ass not apply to an owner of progeny who b.lice dor eimproves thereon, '
'v '. .-and who contract fLow, .pmlect with.a.rontmcta(a),IicenxJ.punuem m.the. . .__..___•.. ._._._-.
--
Contractor'sLicense Lo BUILDING
❑1 mgt ntle S B&P C for this reason I
nor Dom
WORKER'S COMPENSATION DECLARATION
y I hereby uRrm under pemlty,ofarjury one ofthe following declarations:--
❑iI huve'and will maintain'a Ceriific:lc of'Consent w'self-insure for Worker's
Compensation, as Provided for by Section 3100 oPthrhabor Code,for the
performance of the work for which this permit is issued,l,
01 have dad wIII mainiolu Worker's Compensation Imiumnce,si reiluiied by Section
3100 of the Labdr'C& for.tha pert ce of thdwo k farwhich this permit is
is MyW 'ri Co nPe dnln'renc<c rimeoaPly uMru :
ciri of N
1,.CER IPIC 10 OFEKEMPTION FROM WO K RS'se i.:`I is i it, J.L•A S ,.t _ ?s.�. l LL!l'P
COMP ENSATIONINSURANCE•za 'I+ f ' '
(Th. nccd not be Coin,lneJ i f the peon i t I,for one humarea dollars _tit "" ^`✓ l^
(SIW) it less.) '
Y R wh ch t subject
1 the
shall t mol- an
y'by pen n n y mann r as to hccbme. blot t thee
..}. ., ifmate-fExem"p'fnn;'
YoWp oshrkoeunld
Comun Laws f California Dem
icind
NOTICETOAPenyihCen
Otieednieo the
Workr's Compensation
ompetmn dmust
0fonhwht comply with such prrovistons or this Permit shall
l4deemed
, "' ,i':''.i .._ •"
._...._ ..
revoked. '
U!)„ '' !
w,s'7i 1 CONSTRU' GAGENCY
from that themis c.muclimn end' g cY f the pert ich this Pe tissued(Sec.30910v.C)
LendNm6c'
-
Z L oder s Address � �
V-�
I
. candy than 1 have mad this application and state Nat the above information is
eomecf-I agree to comply with all city and county,ordinances and state laws relating
G.:.C.) to building .g
conracion:and hereby authorize representatives oftbi.i city In enter upon
the tib e n donee pr,pe ty f inspe m n p r ,,,
Os' (we)agree to a e n demnify and mI p harmless,theCity f Cup nmo gainst
rip liabilities,judgmenti,judgmentcosts and expenses which m y in any way accrue againu said
U Z CI tyIV c m quence o groan of hi, -it.perms - r ��yy
'A COMELY W'ITHsALL iYON r']IVT` { D (J 7i
sG1, PR nA ° :— Issued by: Date
%
s ? tDa191Re-roofs
I;l Wyll t„' lHAZARDQUS lATg RIALS DISCLOS ands
ppl¢amo portion Wildingle.Chapt tmenrhedleHealthazardous material fety _Type,of Roof. _
m def ted by the
h Cullen no Municipal Cattle.Chapter 9.12.and the Health and Safety � r
.Cale Se tion 2553. ~r,a'f w
All roofs shall be.mspected.prior to,any,roofing,material,being installed
Will the ppl t fu! built use eql proem device which If a roof is installed without first obtamm an inspection� I a ree:to remove
c th b sore tat t o agement gg
'District all new materials for inspection Applicant understands and will comply,with
utlefi by the Bay Air Man
❑Yes 'r fLI�/ I_.: _ ._. - __ _ . ..
,,. " ' •' all non-potntsourceregulahons. .
.. ` 1 hove rcaJ the h zaN n. uteri Is requ rcment der Chapati 6,95,6f the',
Cel Rhii.Health&Safety Code Sections 25505,25333 mad 25534r understand that
iffebuildi.C�( tc rrc tlY haveot t thmdis mYrespo sofa ertificate of _ __ -.. . . ._ _. -
p re nnwhich mug be met prior to nsuatice of a Cemall of r
a III0 Signature of Applicant Date
bee m f the res
11 '
ernraurfi ns, stnt +�' Al] roof coverings to be Class"B" or better' '
...
--OFFICE-