02090091 OF
CI BUILDI c DIVISION
PERMIT CONTRACTOR INFORMATION:
1�74AN� EMBER DR ALLSTAR PLUMBING PERMr02090g0TE91
A` YLs,NAMPLAWAL 656 N KING RD APPLIc09N/ 16/ 2002
' PHONE: (408) 251-6040 SANITARY NO CONTROL NO.
0 O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
8 Pel BLDG ELECT PLUMB MECH
y i LI IJ I- -I L_:7
y i LICENSED CONTRACTOR'S DECLARATION Job Description
oi_o Inot frnnmatlamRan=<annderp,nd.ion.ofChapter 9mommencing - COPER PIPE/WATER SERVICE
F=tat with Sea, 1 of Division3mfrb Busin pnJ Rn io and myliccnu
y p rs in full fo end Liffe ( /�56 )
n up a V License C 3 L Lid.x
Dale Comm
3 u.Ii: ARCHITECT'S DECLVR
t=
01
1 understand my plans shall be used as public re ds
3N
w ,0 Licensed Profcssioml
n n. OWNER-BUILDER DECLARATION
M or I hereby affirm that 1 am exempt from the Contractor's License Law for the
F'z< following reason.(Section]0315.Business and Professions Code:Any city or county $5400
fro which requites a permit m conxtmct.alter,improve.demolish.or reply any stmaum
or
i3$ -
prior 10 l.'issuance,also requires the pplmant for such prmuo file awgned statement. .Nrr --- -- - ----- -
that h5is"licensed toroidal to thF Provisions of Contractors License Law(Chapter 9 ,.,,3,6 n�E'0 g]porvgea I f W. Valuation
(comrne it lith Sw ]W0) f Division J of the Bodiless and Pmfcoicaw Code)
ti-..� .♦ i.lA e;l \'S.a`;y ?lA..
or had he 55 i i thbtiffum arrd she basis for the alleged exemption.Any violation
of section 9031.5 by any applicant for a Permit subjects the applicant to a civil Penalty-
:ofnot more than five hundred dogmsS50o1 202AEN01gML FLOOR PL BING s Occu arc TyP
e
0 1.an owner of the praparty,or in y employm Is ith wages in their able compensation. 301 - ROUGH PLUMBTIN ]C
--aill do the ork:ora rhe st arcs not Intended'or offered for sale(Sce']0 4. 502 - FINAL PL µhT'�ns�nippillyY °
t Bu.tie J P nfes C>v ThContractor's License Law does not apply 1m an M iC1! '
owner of property Who wilds or improves thereon,and who dues such work himself 507 - FINAL PLUMBING
or through his own employ ns,provided that such improvements are not intended or
-aRcfed'for sale.lChowever,tha wilding or impmvcmem Is sold within one Year of ------------- ---- ----'� - --- ---------- -- --
'completion,the owner-wilder will have the widen of proving that he did not build or
improve for puTou of sale.).
tors-_
_.__-_._—_..__.toot-.__.-toot_-___.._.-.--- ____..._.__-_.-_...__.-.-.
cokes owner probe pmpny.am BIt usinissad Pron,ngwithoce:)neonvazmrsto n'ILt'":;
License
construct the project(Sec.7044,Business and Pr ywhons Cadea The vemm thereon. g�; ci fir" ^ ,, •.
Liccnm Law docs not apply toancts of.,co nit what),Iic or improves thereon,
' -arM who.conlmcu[m.su h p leas.with ntmaorts)IcemeJy uant.m.N
Cormorcmns License W
T - Z ❑I am exempt order s LIC I- 'I'' t ` B&PCT this P G�Lat
WORKERS COMPENSATION DECLARATION
SEP J 9 LOoOq
-1 heresy affirm under e e
penally of fsriliiy linof th
following declamriar.s �k1 L
1/ 0 I h J II' tan C riff t f C u
at to rete msurt for Worker's BUILDING
Compensator.
a. p Jed f by Section 37W f the Labor Code, for the
_ performarabof the work 5r\whmIt the fir
is ed. ,.
❑1 h 4 aad'will ma lar Worker s Ca p mai Insurer'e,as required by Section
of .. ci . . Pe
= J]tgl oPthe'Lawi Cale,far the forrwnce of the armcfor which tris rmii'is
c cd MyW kisC Pens io Islta crandP ley
annihilate
n 1,19,06" .. . .. _._ ..,...._......_......
c e11l�UC. OIlm11L•1polayry ria „ � r X.
(CERTIFICATION OF EXIT IO OM WORKERS ;/ 4e
.. COMPENSATION INS URA NCP '!. r,I,�_, .. toot.- :+.— _._--_ -., _. .--.,......-....
,If;; w(Th s ua tin nee]not completed if the permit is for one hundred dollars I) ' P:
IS b8 or lcss.l
.'� I'ttn IY fhafi th perform mannerhsu as leo be'h A th leer lib the Workers
ivmp mics s J l 1. I -ti m } L.,•'I
r 4fiall nut,empiny'ony Perwn to anyn' sub -
omc
Corm rsution Ww1 of Cal f m .n re
..Apple i. " :,` .. . ._-._-_. __ _.. _-__..___. _.._._. _._.....-. -._-_.- -
:N, ICETOAPPLICAN pIL'aftsr maklgth<Cnficate of Exempton,you should
mine b3ea 1.rhe Wo key Com n u o must
0 funs m ply- lh h pro,istim,or chi,Isamit hall
-CONSTRUCTON LENDINGAGE CYeemeJ revoked.
FI hertby affirm Nanherc is ekonnm<unn lending reg ncY f rhe perfmnnunce
of the hf whichN Pe t ssu d(See l09] C C)
Z Lcod r Ada' ..
I cagey that I have read allityapplicationdstamth that w' 'nf muton is
lea.U inbuilt naercc w comply hh all city and countyordinances,of
.vont taws enter
upon \/
Q.iV tin he cllNngca,smlap fan,far
iepreiemauves of NivcirY to enter upon
>„ (y lyse w me t mcJp pnYf -pat P T 9 :-
t. IWe)dgrcVdfyandlee phvay s they tit fC primoagmmttrid
yblt . ) dpf1A hes yin nit ygainsr saidvrTuowu h `vIPLyKItxAuIssued by; Date
Lir Aptar ;., ,..f' '.;Date '',: Re-roofs
HAZARDOUS MATERIALS DISCLOSURE i.
i l Il the PPIi more t -wlldi grccupnl aorta harMle hared mate at Type.of Roof
a d fn d by the Cupen o At pl Cod Chapter9 12 d theHealth and Safety - , s l'I I::I)d
l 1,
'Code Sea o �5532(a) , tY h 11 F11 1,T-j R I,s{'V r 5 .- e,,.
❑Ye,-""`_ s 1 All.roofs.shall be inspected poor to.any_roofing.matenal.being installed.-.-_._.. -_
- I 11 - fir .` , . nil .:
Will theppl<anw (u rc building g P 1 use equipment a<Tres nab If a roof is installed'without first obtaining an mspec[ton Ilagree•to remove
emit M1 N t t df g cu Bay A Quality Management:
D Ina � all new materials for inspection.,Applicant understands and will comply with-
^t"9 'all non-point source regulations; .
1 h'aw read the hdtaraoui m dte'rws requirements.under Chapter,6,95,of the, '
Cdlifornia Health y e.Sections 25505,25533 and 25534.1 understand that
rf Ne wlld'ng s not By have a tenant charts my Spon ibilay to or little
- "' - - _ -- - •--
'acup t of 9u n which mu t hae r p a 10 i$an e of,,CeatBeare of
Q" P // Signature of Applicant „ . Date .
pr. In'. agent
s,:
i Dale All roof coverings to be Class B" or Setter'
..,
„.
h.. . . - - -' OFFICE. .- ... __... -..- -
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