02090119 CITY ofcDEsONO
IViiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
10111 PHAR LAP DR ACTION TEAM INC 020901,19
9fURn JAMES D JR AND MARIETT 1278 ALMA CT APPLIc09%18/2002
PHONE: (408) 629-'4433 SANITARY NO. CONTROL NO.
O O ARCHITECD/ENGINEER: a BUILDING PERMIT INFO
BLDG ELECT PLUMB MEEK
Z wt =1 —I =1 L_D
tt-- LICENSED CONTRACTOR'S DECLARATION
OZ y o I hereby aRnn the,I am licensed under provisions of Chapter 9(commencing Job DBscriptlOn
F=tw with Section 70110)of Division 3o! Business end Professions Cade,and my licetwe GAS LINE FROM METER TO STOVE TOP
Y f is in full(area and effecLC C 3 Z
OU License,Cl s Lic.g
Dote Contractor
a te0�+' ARCH CT'S DECLARA IO
h—rn 5 I understand my plans shall he used as public mco
p O Licensed Professional
,I6 OWNER-BUILDER DECLARATION
s �� 1 hereby armor Om I am exempt from Or Commebe's License Law for the $2500
T
< followinguires a.(Section]onsmBusiness
mpr Professions Code.Any city or county
D tali r t requires n permu r consumer,ah improve,demolish, repair any nmcmrt
Ma:3 Q -Pot s vine.also requires,he applicant for such permit file a signed statement, _ _ .. ....... ..... . ..
that be ii Odoir4
pursuant.6 the tmvido f the Commcmfs License Low(Chapter 9 32' ,4• D �oR�C(ea,� ,• ,, ,,, Valuation
( mm napg with S a 7000)of Di 3 of the Busmen padPofessions Code) �+1�)ls t { lTe"k/1\ 1c51`s V'1Y
a tM1 I h i5'ezempt th 'f m and to basis for the alleged eamnptlov.Any violation -
-of Section 9031.5 by any applicant fora permit subjects the applicant to a civil penalty-
tar
enalty-
taromarethan1fivehomregdogars($5m) 202 ApN[T11bPJ11RFLOOR PLU BING Occupancy Type
❑L as owner ort.ad be .tam'r,is ameetendedth or offered theirsaleto(Simt 70,14. 301 ROUGHPLUMBING
�va
70,14.-
(Business
inaTrk,-and,hCoils: re'i Communist's
License
Low doe sa.,apply
to
- 502 - FINAL PL>),�4jA�r pn iRd3Yf'
�BuxinesYond�Professians Coils:The Comrtc,or's License Law does not apply to an
owner of property Who builds or improves,hemon,and who does such work himself 506 - GAS TEST
or through his n employees provided Oat such improvemenis are int intended or
_,_,..,,_..__. ._ —fl-A',
._ _.._ _. .. .._.. ..._
-o ircilit.IC howcbcr',he buildm rimrovement Is'sld wi,nnone year of -'
completion,the owner Wilm r will have she burden of proving that h did not a dd or
50 7 - FINAL -PLUMBING .�''.I ,,.. .,
improve for purpose of sate.)
__._----—----.--_._________.__
A lies mvner,of,he pmpeny,am exclusively contracting with licensed contractors to B:"T lit•;r'.'"rj,•.Ir! 1\n r
construct the project(Sec.71194,Business and Professions Code:)The Contractor's , Ct,
c' ' License Law does not apply,o an owner of property who builds or improves thereon, -
...and who conuects far sh P.jactr with a.contrachads)licensed.pursuant.to Ne.......... ..,.. ..____.._. . .._.___._._ _._.... . _ _ __,__._.._.. .
C1a. e.pt Liw.
! ❑lam a<mpt d S ' ' "st sBt&PCfo this reason
O or-t ' •t.Data .
WORKTRSCOMPCNSATION DECLARATION01, 1 FEB 8
'• ;hereby effumcode r_prnahymin ofperjueyoftNwwm
e.follgdo.clabdona 2003
❑ 1 he rad will mairitlint C sent oto self insure for Worker's
Citanpon,almir asp dad-far by Section 3700 of,he Labor Code. for she BUILDING
pert anon a of the k for which this Francis sed: ),
I]I have And will aminniiiin Workee.,63m,mration In.mince, requo,redbySec,nm
. 1700 or the Labor Code,f the tlb nc of the sork f which this "t s
i s d My l rkews.q pe ' , n l i ce c r d P l y 'M, - � n
Cartmr 1l r d Policy ��h-� A2C'70� V.r .y ' ,t my nl.y-n A`
[ V'11 Ur 1,')µi '
1l rhl ICERTTFI ATI OF EXEMPTION FROM I�O KERIt 5.` M_.''f,i i 4u�El, ].tj {, i .9` 1d�r,I yp ION;
COMPENSATION INSURANCE
n"I' fThnxem on nee ;
d ,bccumpleted hhc Permit is for one hundred dollars /'\, '� 11 .a't '..1t pi;',CRI ll t,"�t,'.
I$[bid)or m%s.l „
.�s ' J'cnfy-that
--
a he performance of the vdrkfrhl lith peimnis slued 1Cam 1
n II' t mplay any per bra m any'ma r as in become suhj ct to the Workers L -
PPI rcrm Laws Af C I t n.Dai t
beiri TO APPLICANT,IL after making this Cenilichte'ofExemption,you i should,
becdme subj&t io the Worker,Compcnsaion prn4isi66s of the Labor Calc,yod must
ZZ .
O (dnhwith comply with ivah'pmvisions or this permit shall he deemed revoked.
.. _._. _ _ ... _ _____.._.. ........ ...._._...__....__ ._ ._ _. _.
'113 , .CCTfONLENDINGAGENCY D:ILI 1"x ' t.. :^FO
11 retry air,.not
them li tthe ant Cu ti lenJin�gg'ug ny(' ,he peLfn n.,. '.(., .t tl. -If
rn of the work for which this permit isted(Sec 3097'C C I
Gs Le deri Address" — �• -
77
I comfy Oat I have mad this application and state that he above information is
'Rtr[r c I'I agree to comply with all city and county,ordinances and state laws no arm,
I�cV 1.
to budding cnnstmcuon,and hereby amnmwertpiesentanves of M'icty rat enter upon
yi:W phe above-mentioned property for
Os (We)agree`,o savCiMemmi(y and on pumsetEls.eh _ rps'nnd'vQ-a_i
nneirC
'(n liabilities,judgments,costs and reponse,which may,In any way ac a against said
�,) Z City consequence of graining of pe t ��" '-
'APPLIC' NT UNDF TANDS AN ILLCOMPLY�WITHALL.NOri-PON7
C)I RPGv G :'s e Issued by; Date
,n asnUcc,uracwr0l`n14;1`;;i:. 't"''L' ,,pate Re-roofs
HAZA
DOUS
a def nod by,he CupntnRA1 rose MATERIALS eR1Af.g DIS91O5URE `
Wdby three pbconfirm urruci ddCoce,Chapter
handle Health
met rad Type.Of
pa p 2 end the Health end Safety,
Cod Section 25532(al 4 '•'' ..� - . 1 t ? 'Fa •x's. li •`❑
ItOvi ' -' tt 'iC Nb 111 Int fairsiy9;J.ro,
All roofs shall be poor to any_ ofing material being installed._--_,._„_._
o. taill hermus applicant rBoomas dedmg byt p , equipmentito devices which' of an newmatedfor Without
__a __ _. P Y _.
obtaining is an ms ecudn 'I`a roe Ore-move
emit h nutl uta c m nam as d B N by,h Bay Area An Quality Management P g
Di'mcl IIApp13c rat understands and will com 1 with
t Q Yes q' .. .„ '-_ _ .,
ky , r, t oN : all'non-point source regulations,.;,,);
.l h ve readthis ho.ohms amon.1s rc u1161mi u de Chapmr.6.95 of toe.
Calf 'mHehl,h&Sfty Gide Sections25505.25533 and 25534.1.understund,hm, _
'i9h.b. of gtloes not currently have an „hits my respomiblayt ratify rAe - �' _ - ” '- s s
- boo6occa f h requ arears which a N,mm pn m issuance of nit I e of
r t �' Z _- Signature of Applicant Date-
--
at m
r
ono doge t , me All roof coverings to be Class B' or, etter
..-. L
- --- ----OFFICE.