01100151 TY OF
CI
BUILDING DPERTONNO PERMIT CONTRACTOR INFORMATION:
'
BUILDING ADDRESS: PERMIT NO.
7496 TIPTOE LA ROBIDART CHARLES M JR AND MARY 01100151
OWNER'S NAME: APPLICATION SyB DATE.
AM ROBIDART CHARLES M JR AND MARY 10/ 30/2001
PHONE: SANITARY NO. CONTROL NO.
o z ARCHITECT/ENGINEER: BUILDING PERMIT TO
POO BLDG ELECT PLU MECH
L"U O -_J ILJ
LICENSED CONTRACTOR'S DECLARATION
Z.
z 1 hereby affirm ohm I am licarctl under fCha ¢r 9lcommencin Job Description
j Z_ Y a prod Professions
o P 8
mtw 7001 on3oftbeBusinessandPmfessionsCode.antlmylicenu INSTALL GAS LINE
9, -1 iainrmlrar<eaneefiem. FOR GAS RANGE TOP .
s License Class Li,.g
c 3 n y Dae Contmnnr
ARCHITECT'S DECLARATION
I understand my plans shall be used as public meads
so
[ �I
Licensed Professional
OWNER-BUILDER DECLARATION
vl^_ I herebymasa affirm that 1am 1. .Busin from the Contractor's o License Law Tonto
t_z G following reason.(Section i ]031.5,Business and se.Protections Code:Any city orcounty
D
which9 Permit ......n to p d permit
rep' anYscat re
�3m pct«mu l req .m applicant a«n Permian signed statement -
Nanesl epraan map : nn c t nor:L< uLasionsCode) S F[ Floor-Area-a , Valuation
tea mg wtm sect ]teat)of a basis 3 or e a BPp«ak.nil P�rAny si cna<7 [:1's'\ . t -. 9 3,} § til._t
or that he is cxcmpi thciefrom and the basin for the allage8 dempub My violation t
of Section)O3 P.5vanydred chin furaSW). nubjemsthe apPlimm macivil Penalty' ,
arnntmarcN.nf�enanarcaaanamasoo). APN Number I ... � Occupancy Type
❑Lasownerofthe propeny,army employees with wages is oheir.solecompeaction, 106 SEWER & WATER
will'do the work,and the stmctu ,is not intended or onemd-for aale(See ]Dw, 202 - UNDERFL//��// pp�� iii TTi]�,��(�'.�
Business md'Pmfessinns Code:The Conaacmr'n License Law d«a not apply to an 4Qfj IrG L&TWI1y1g8
owner or property was mrdan ar improves Nercnn,arta was a«a a«n wmk mmelr
301 - ROUGH PLUMBING
or through his own employees.provided that such improvements am not intended or - _ __
.offered for sale.IL however,the building or improvement n sold within one year of 302 - TUB & -OR- SHOWER;. .t. -: -- -
amplaion,th wberWilder will have the burden of proving shut he did not buildm
improve pnrpnsearanle.). 502 - FINAL PLUMBING ENERGY
Las caner Lf The pmpeny,u i�l�aibdy contracting with iiav«d camannra in 506 - -GAS TEST. -.. -h-_- - -___. r,:__,_1
wet the project(Sec.]f W,Business and Professions Code:)The Cantaao,a 5 0 7 - FINAL PLUM ''A'�E` " is
License Law does not apply to an owner of property who builds or improves thermn, s
J. andwho contracts for such projects with a.commetor(s)licensed pursuant to the _
01 m axe Licenu Law; r p 1 Q
❑lam exempt under Sec. ' � � B&PCfm Nis reason I` "'r ED"Q 4 20UL
- Q n - .. . —
Le
WOR SCOMPENSATIONDECLARATION
I hereby affirm under penalty of perjury one nr the following declarroma: BUILDING
❑ 1 lave and will maintain a Certificate of Camara-so self-insure Por Worker.
Compensation,as provided for by Section 3700 of the Labor Code. for the
-- performance of the work for which this permit is issued
L3 lvve'ard will mainmin Worker's Compensation insurance,as required by Section
3700'm the lalwr Circle.for the performance of use work for which this permit is
isiu d.MyWorker's C p :foo l sura c nil Polt y bar m:,
d. _-
ou," T I aJ' :1. I,' !�t j'ai, N . C r.ys - e. �,,t .v� :
w. .3 CERTIFICATION Oq EXEMPTION FROM WORKERS'j s Ot t t K .r...E�,1. _-`*`f :-'•.. %A 51...
COMPENSATION INSURANCE;
'(ITr section need vat be completed ifte hpermit is for one hurdred d.11.0510 p)m btsv)
1<emplothat tri person
performancenn r,work for Zomc u parand,e issued,l
shall nos employ any fC.Inf in any manner soros to become sub)en to the Worker.
ApplicatCompensation.Laws of Celifomia:Date:
Applicant
becoNOTme
the WoT:1L a0ermakutg this Certificate of Labor odyou u as.
becomeimbjecty the Worker's post
Compcnsr Prov stonell the Labor cod'.you must
z 0 fanhwiN comply with such provisions nr Nis permit shell be deemed revoked.
:CONSTRUCTION LENDING AGENCY,
ae7 I" ]hereby affirrin this Permit
is issued ce. lending agency for the performance
'' •
i.y of Lethe work for which this permr is issue)(Sec.309],Civ.Cd:
fztg� lender's Name .,,..._ ....• ...... . .... .... _: .: .- .. - .. .. _ _._.. - .. .. _...
)milers Add.. `
•Ur 1 certify that 1 have read this application and state that the above information is
W E., cored.I agree to comply with all city and county ordinances and state laws relating
QJ;) to buildingconnrucoian.and hereby Authorize rrpresetnativea of this city to enter upon
sr1], he abase menoaned.property for inspection pastimes...,
:0., (We)agree io save,indemnify and keep harmless the City of Nfxitino against
y liabilities,judgr«ms,casks and sapennes which',may in any way acme against said
t"7C� City in quem of the gaming of chis permit.`- Al
APPU .ANT UNDERSTANDS AND WILL COMPLYWITH'ALLNQN-POINT JSSUed by: ale
SOT' CE REOI31,A710 S e /
na sere on. HAA RDOU ""Y "'r" Dam Ito-TOOTS
� HAZARDOUS MATERIALS DISCLOSURE
. teIIapplicant futurewildingv tt rhmiama¢ral Type ofRoof
as deflated bythoCupen Municipal Code.Chapter 9.12,coal she Health od --
Safety _
Crile Sectin25532(a) , o " v is •�,�. -! .. S •4 t-laf♦ >•• ) iC�*r.
Duca t .oNo•;Ir All,roofs_shall be inspected rior.to an .roofin .material beim
P P Y g g.installed...__._
wntheapprc t future ndming cupintuse equipment ordevices which If a roof is installed'ivithout first obtaining an inspection;Fagree to remove
emit taaraous air contaminants as defined by the Bay Area Air Quality Management
Districn all new materials for inspection., Applicant understands and will comply with
;,.': °Y"' „'° -No all non-point source regulations.
I have read the miankme'mrial
aies'm,.0 emenu'under Chapter 6.95 of He
Califomia Health&'Safety Code,Sections 25505,25533 and 25530.1 undersandNn
'irthebuilding d«s not currently have a tenon,that it is my responsibility to,notify the - '-
tacdPSat f the requirements which muss be met prior to issuance of a Cer ifeate of
o41. "" '`y''":'' Signature of Applicant _ _ Date
,. ! Date All roof coverings to be Class "B" or better
amhar , agent ' -
OFFICE - '