02030145 OF
CI BUILDING
u D NG DIIVIIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1133 STAFFORD DR WATER CLARITY PLUMBING 02030145
OWNER'S NAME: APPLICATION SUB DATE
JEN LAI 193 BARNARD AVE 03/26/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 275-9300
77 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w O BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
v Y I thereby aRnn that 1 am licensed under provisions of Chapter 9(Commencing Job Description
in t: GAS LINE EXTENSION.
is
f, with 5ecilon]8001 of DivisionJof the Basin nd Professions Cale, ad liana
in II tpp:i unrliliCGt
o u u Latera a CI L:22� L"'a 7QO
13 a.it., �-�N-�i Comm
ARCHITECT$DECCLAARATION
gI untlersmnJ my plmrs shall he useJ as public«cards
IE:p, Licensed Professional
OWNER-BUILDER DECLARATION
w 1 hereby oM.thin 1 am esempt from the Contractor's License Law for the
C?a following tenon.(Section 7031.5.Business and Professions Code:Any city or county $1200
E F C which requires a permit m concoct,alter,improve,demolish,or repair any structure
„th6i w i i c Iso y d pions of or Con p tr to icon k ted na.pt e,9
(commencing
f e pdp Section
the pro sion3o theBvsnorsLiccnutswonsCrar9 $,e s��ss7IOppI pp��gga sy a. Valuation
(comment 8„ thSm ]000)of On ion3af,hc Busncsp and Proles tonsCMd �kf.` L 136L(�15(7;1`4::;�lTVg3.„1IC1i A. ^
or Shot be is 335 b,,Shcrtfrom and the basin fonhe alleged exempuan Any violnaon
-of but mo 703E5 iv any hundred
d ll for a permit subjects the applicant too civil penalty
or rwt more th.n B.emamrea aml,rs(55W). 106APN li4� & WATER r"( r-r. Occupancy Type
01,as owner of the property,or my employees with wages as their sole compcnsmlon,
will do the work:and,he structure is not inteided or'offered'for sale ser:76f4,'
'Business and Professions Cade no Contractors License law does na,apply,o. 301 - ROUGH P24411&j[Mspections l" _,.1
owner of property Who builds or improves tremor,and who does such work himself
atered nhis own however.tpropdinmatearn v,om a.solaarehinoneMapr 302 - TUB & OR SHOWER'
-bEcrid�r"vlc.IL nmvevm,the a,ndm __. tis ante wimih�oa�-ca er - ._. ..-_. ._... ...... ....__. __... _.. .. :..._.
I, builder will have the burden of proving that he did not Wild or 502 - FINAL PLUMBING ENERGY .t;�l ` '
ompc n,,he owner
improve
completion,
_ _506 - GAS TEST
,
-f]i,osuwnerrojec property.am Business
Professions
CWe;;) h Contractor's
onor otsm 51)7.. .-...FINAL PLUMBING _....___ ._...._.____..._.... _. -------
construct the presto(Sec.]I?L1.Business and Professions CMe:I mThep.Centre nor's
andwho
Law docs nm apply,o an owner of property who milds m improlat Merton,
and who conoaas for sProjects with a.commea(s)licensed pursuant m the. . .._ .. _. _..__ .._.__.... .__.....__.. .... ._ ._._
' - �-
Contractor's License Lou.la .
❑Ium exempt under Sec:' , ., _ b `,B&P C for this reason
Owner- ” Date l
WORKER'S COMPENSATION DECLARATION
I hereby M.under penalty of perjury one of the following declarations. F 1 1 aA) L E D
Js ° I have and will maintain a Certificate of Consent to self-insure for Worker's PMAR /� 1 2002
v` Compensation, as provided for by Section W of the Labor Code. for the
perom uncc of the work for which this permit is issued. L
01 have and will mainmin Worker's Compensation Insuranre.as required by Section
J]W of the Labor Code,for the performance of the work%,which this permit is BUILDING
issued My Workers Comone in.Insurance carrier and Policy number sm
i,y NoP29-OZ f�L28417 f._,.r ' t t , • e„.1j l,Sit
;f^ .CERTIFI ATIONOFEXE MON OMi !. e.l h. \ ..r
COMPENSATION INSURAaCE .'..;'•n :”
(Ths sectmn teed net ho coinpined ti the permit is for one hundred dollars ''i'�' °•,.v _--—_ — ---- ----1-_ _
(S 100)cr less.)
I certify matin me n in a once of the work fnr whieh this'permit c isaed.I J d"
shall not employ any person in any manner so as to become iubjcn m'�he Workers' '
Comicaion Laws of California. teiDate
NOTIC
beeomeETOAPP6ICAN WormrLalmrmnsing xatkm is Cesionsocam ofE alkarron.you se.younould . R;..
z Qbecome s compl p id Workers visom nation Amit&hoof the labor CMc,you mus,
fonhwiN comply with ouch provisiona or this permit anal)be domed revoked.
Ir - `CONSTRUCItON LENDING AGENCY t
F 1
battery rifiturch.,these is a construction lending agen y flutist perfmarmde
W'.> of,trc o k for which th permit_ s issued(Se JW]C C) r - '
I
QLcndcrs Namc',.. .. .._. ._. .. _ ....... .. . ..... __. __. . . ..
n' Loider's Address"'•... 11
11
V • I certify that I have read this application and state that above information is
tiered: I agree to comply with all city and county ordinances and nam laws relating
O: to building construction.and hereby authorize ck'presemative>ofmis city to enter upon
,.ythe above-mentioned property for inspection purposes. .
(We)'gree,to save,indemnify and keep harmless the City of Cupenini4itunst
-y liabilities, uu,Q(8gmens,coxa and expenses which may m any way accrue against said
V City int slquente of the rigg (this pecan. .' . ' ... _ " r
APPLI T UNDER ND WILD COMPLY WITH ACL NON DINT
S D s _ f Issued by: Date
O
rt PPI;an to T :'^. i gate - ';' Re roofs
is a s�o the tar«ni rebepal pdeCnapte9.13 aMtneH hn ndStJty _ Type of Roof..... ..
HA2 DOUS MATERIALS DISCLOSURE
g pant stow handle haraN s m .... .. ..
,r 'i.... '.'d' . .� I�t, it+t{:t}s '1 •'1: ) .. .
°Ye` N. "'�, All roofs shall be Inspected-prrorj-any_roofing material being,installed.--,_, _, _
corm pplica t r t bu 'ng occupant equipment or devices whim If a roof is installed without first obtaining an inspecttoh;I agree torremove
emit hoz d cont i s nM by he Biiy Area Air Crain,Management
D':mtr- all new materials for inspection. Applicant understands and will+comply with
A °Y03 ���"'***"��� - . • 1 all noir-point sorce regulations. • ),
�k -1'h read
Nv2e Trdons material qui«ments'under Ch pmr 6.95 of the
Cilifomia Health&Safdy CMB,Sec,i s 25505,25533 and 25534.1 understand that
ifthebuildin oesnmeurrtmly ve nam,hatitismyrtsponsibili....inotify the
act,
- ce,ofa Cc ircar,of "
upy t of a rtyuircmen t be mt ry of m Isp
Oct. a " . - u "
Signature of Applicant_ _ Date
o ncrpraa a agent ane All roof coverings to be Class"B"or better
..n '. 1. .. .OFFICE