02070125 (2) OI eta�C DIPVEIRTINO CONTRACTOR INFORMATION:
HERMIT
BUILDING ADDRESS: PERMIT N
10385 MANN DR ABLE SEPTIC `62070125
WU
lt'1R29: MAYNARD E 520 REED ST. APPLICATIgtiSl}B� Y2002
HONE:
(408) 377-9990 SANITARY VNO,./ �'L/CONTROL NO.
O Oz ARCHITEC(ENGINEER: BUILDING PERMIT INTO
w F BLDG ELECT PLUMB MECH
(-n<i U C_I L.,j U
L
2 LICENSED CONTRACTOR'S DECLARATION
;Z_o IherebyaRmnthat Iamlicensedunder provislonsof Chapter 9(commencing INSTALL SEWER/gAq.q�-TPbNK
M t-y with Section]000)of Division 3 ofrhe Business and Professions Cale.and my license
is in full force and affect.
i) u Licen se Clms Lic.c
DataCnmmmnr
3 u ARCHITECT'S DECLARATION
O S 1 understand my plans shall be used es public records
Y
p O Licensed Professiond
OWNER-BUILDER DECLARATION
u� 1 hereby.(Stenon 1 1. exempt from the Cession, is License Law for mefollow $3690
f¢� whichingrtresa peeniotocon1.5.Busitessandve.demolish.
Carle:Any cmyi county
E x O which requires issuance,permit re cnnnrom,uteri improve,demolish,or repair any nrunurt
tw7, t$ .prior m s licenalsantto theres m %halosapplicof for suchPermittofile aicense sew haptern no -- _ — _- - __ _ ___—__
n3— emormiiliceesithSectionTMproDivisiion3o of the
eBusines mad[PeLew...Cod ) pp..5�fft5Bl3 A Valuation
(commenein mplfiefam,andthebasisartheaBusineueption. n,violation
iCode) "' "3'r"t' t \` auation
or that he is exempt tally a bra and the basis for the alleged exemption.Any cioln lty
of genione than by anyapplicollforapermit subjects the applicant mecivil penalty
nr�mtn,nrcmaaE.enanareeamlars(ssl>a). 10APNNSd0RR & Occupancy Type
❑1,aaawas,ofthepropnr.ormyemployee.withwagesaaneiraalecompensation, 202 - UNDERFLOOR PI UMBING
-.will-do the-work:and the su4cmre is riot intended-or"offeredfor sale(See 7614,
Business avid Prdlbssions Code:The Cnmracim's License Law uses not apply to an actions"
owner of property,Who builds or improves thereon,and who does such work himself 3 02 - TUB & 0
tar throw h his ox n empmyees.provided that such improvements are not intended or
off<rid ,r tile.If.hwelm the 6andmq ser imp oyemem is sum wham one year of
_ 502 - F I NAL "'PLUMBING' ;ENERGY '" -
completion.the owncobalderwill have the burdenofprovingthat hedid not build or 506 - GAS TEST
ve fm Purpose of sale.).
-507 - -FINAL -PLUMBING-!----------
1;as owner of the property, exclusively contracting with licensed contractors to
construct the pmiact(Sec 7144 Business and Professions Code)The Commonor's \
License Low does not apply t of p,.,.y who bu Ids or int,row.thereon t"
and who contracts-fors h projeem with o conaacmr(s).licensed pursuantm the
Connanols License Lsw
°le rapt BkPCfm Jas'e... ,� � .!ll t,1l? /
WO KER'SC PENS DE A/RATION
I hereby affirm under penalty of perjury one of tpe following declarations:
T v ° 1 have and will maintain a Cenifiate of Consent to self-ame for Wo ka i
Compensation, a-provided for by Section 37W of the Labor Cade, for the
Performance of the work for which this Permit is issued.
❑I hale sand will maintain Workers Compeninion Insurance,as required by Section
37W of the Labor Code,for the performance of the work for which this perms is
issued.My Worker's Compensation hssorence carrier and Policy numbv art:
,Policy No.: Is
n.CERTIFICATION OF EXEMPTION FROM WORXERS'ii" s f.'.t N'li. r . . t::
COMPENSATION INSURANCE-';'
- .. lir . . . ...... ... ---------.. ------- __ ._.._.. .,._... _..._..,_.... .._,
f tar sect on had not be completed d the permit is for one hundred dollars tom'
(SIM)m lm.)
• 'r I tardy th t in theperfm osse.of the a fo h"h thispermit s issued.I - s
shall t o I o mdnne e s d the Workers
IG
Compo t P Y P � Lfp ��tj JY .
Appt L .._.. .. .. ..... _ .. _ .._
NORMO P ANT is C using this C n f a¢of Exemption.you should s '
Decorrtm✓✓��Wuuant".the Workers Compenvtio pro morin of Ne Labor Code,you must
forthwith comply with such provision or this permit shall h deemed revoked.
Z . . .... ... .. . ... .. _. ...__ .. __. .... .. __.
I
V� J s. CONSTRUCTION LENDING AGENCY
" thereby liftm thei s e construction lending agencyfo shepert ance L
�., .fume okf huh this Permit is issued(See.3097Civ.CJ,.t _ . . ._ _.._.. . . .. ....._ .
i
0 LeneAdd ss .. •', /-t (tet
1 c n ee th t I have ad al s pduration d out the are boa adding
is
Lest E.r to Will Iagreet comply with all<tYand county tlnaveand state laws relating
O.0 the idnoingmramundon.and roNny forinspectiourepmses., ,sof this any to enter upon
thea I(WId ntioned p11. had forinspectionkepmpridesi
y.q (We)1grce m sax:Todd which
hamay in
way actions
iso ejuat
U h cstb dear jud snucc costs andnofexpenses which may in any way attroc agdnst said tl /
U '� City in mnsequcsee of the j{rantn6 of mhis permit: ' :"' V(�
AO ucavT nv STA,'DS' WICLCOMFLYWITH�n'ov-)DINT Issued by: r Date
atu fApollan Jacum' . ,,- Dare Re-roofs .
11 H RDOUS MATERIALS DISCLOSU t
f'1 Will the-pplicant or future tial lagoroity nt nae m handle hanNws mnerid Type of Roof _
as defnuJ by ths,Cupenine Municipal Code Chapter 9.12.and the Health and Safety .-
Code Se°eyes 2553 P)] r f,iYr ra 1 m \.-..'.x,--
t q; i ,N '.:' r. -.
co' 's -All roofs.shall be inspected,priorto.any`roofing material.being.installed.,. _._..._. ...
411.is-'Will Nc apPlicent orfuwrc Wilding acupam use equipment or devices which If a roof is installed without first obtaining ars inspection; Fagr6eao�remove
initiation,tar corritandram,as defined by mho Bay A Ai Q d ry Me agement
Damct " all new materials for inspection. Applicant understands-and will comply with,
� 2 ''. °Yv� .; �"'° - •,� :..,': all'non-point'sotirce regulations:, ,
I h ve lmod Ne.hazvdous ateria11 rtgmremenu under rChapter 693 of the
California Heamr&Safely Code,Sections 25505.25533 and 25534 1 understand that
d0ie bkfirgdxanrearnedvJy h tenant the t Y spa b l ry i notify the - - - -
'nwuparit.fibere,umements. ch muss lie ma p o m use cc (a Cen(tete of -
'' Signature of Applicant Date _
` ge All roof coverings to be Class "B" or better' '
Ruth n t card',
d'
OFFICE