02010130 (2) CITY
t BUIL DING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10175 SWAN OAK LA ALLSTAR PLUMBING 9q sy 02010130
DSCHLICHTING JAMES L AND ARDS 656 N KING RD A01G/30/ 2002
I•PHONE: (408) 251-6040 SANITARY NO. CONTROL NO,
u�s z ARCHITECDENGINEER: BUILDING PERMIT INFO
-WE O BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION 1 herebyffirm that I am licensed under fcha ter 9(commencingJob Description
Omfn a andiaianao ve COPPER RE-PIPE
FW with Section]000) fDivisionJof Ne Busi¢ess dProfessians Code.and my license
�m2� is in fullf rt<ande t x —7�A ll
c z 6 License C _ Lid.. \
o SL �,te z Cammdma a_L S n z L r...er
'q u O ARCHITECT'S DECIXRATION
t:Ef 1 1 understand my plans shall W used as public me Aids
w p p Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Commerce's License Law for the
F Z< fallowing reason.(Section 7031,5.Business and Professions Cade:Any city or county, $6000
do i3C which squires a permit to construct,alter,improve.demolish,or repair any suuaum
m poor to its issuance,also requires the applicant for such permittofileasignedsmtemem V1 I
thalha is licensed pursuant m the provisions of the Conm odes License Law(Chapter 9 P a .'s„ s",r •" a LLa 100
(cummcricing with Smion.71)00)of Division Jof the Business and Pmfeaions Code) �'1��:',•)3�93 '1 °9.,f116.t; "r' t I;,•
or that he is exempt theafrorrm and the basis for the alleged exemption.Any violation "r'""' - •s _.. .
of Section 7031-.5 by any applicant for a permit subjects the applicant to a civil penalty
Iof man mom than five hundred dollars($503). 202APN RFLOOR PL BING'- Occupancy Type
❑1,as owner of the pmpi m my employees with wages as their sole compensation. 301
will do the work and he aronurc is-not intended'or offered for sale(Sec'76t4' --— - -- ----- -- - - -- — -
Business ane Pmress ons Cale Tom Contractor.L icen.e Law does not apply to an 502 - FINAL PIIAdi�IHEMSpEdd1EiRG-Y •"'
owner of property Who builds or improves thereon,and who does such work himself 507 - FINAL PLUMBING
orr through his own employeesprovided that such improvements is sol are not intended ar or
"offered far sale lL however,the WildinBor improvemem is sold within'dda Yeei of -"" "'---"" "_. -__..__ ._ ..._. -_.__ _..... . ..... ......_... ....- .. ..._. .,- _ _ -. . .
ompletion.the owner-Wilder will have the burden of proving that he did not Wild or '
improve for purpou of sale..
._co_I,._a.sowner
..o-f_the_P .n_a.m._ex.clusively.. p_P._o .i_..w_i.th_l_censedocm.rs. o.to.
constructIh project(Se784a Bone and Professions CW )The Contractors
ntm trs
License,la d at pt..n nownermpresart,
ah.W Id,cori.proveschenum.
std who contractsfor such
\ F ,_
P ulc e w m a comactiond.ficensed.purs amt lnc. _„_. . ...-._.. ._.. . ._ .....
Contractoex License W
0 am exempt undert ' Ii&�P C fdrdi,rcason
Owner Date
WORKER'S COMPENSATION DECLARATION 5�
IM1crtby offirn under penalty of perjury one of We following delamrions:
-j•O 1 have and will maintain a Certificate of Concern to self-insure for Worker's
Campcnsmian, As provided for by.Senion 3700 of he Labor Codc.'for the
- •performance ofthe work for which Ibis emall is issued,
❑1 have and will o6immor Workcr's Com vneation Insumnce,as squiri by Section
q. 37W of the LaWr Cole,for the performance of the work for'which this permit is
issued,t1�6q .C^j. pc t IA'suiande carter and Policy number arc.
�(JQ�szAc AMtL,ee dy T�WC. 0171;2'DD r ' 1 .
eS-:NRTIFICATION OF EXEMPT�FROh1 WORKERS+ s �J '.lf.- .t � is' i 'rl 't" �- If I
' '-' COMPENSATION INSURANCE!'; *"�
' 'I T(tL s act c n need not be completed if the permit is for one hundred dollars
(51001 or less.
'I certify That in the f mince r f the,wau'rforh his-,count-i-s
Rn employ any person in any manner so a.s to become subject to Ne WrrkeriComFeI California.
1 -
Laws of C I I nice:Das
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ill
NOTICE TO APP after Compensation
this Certificate cthe Exemption:odYooumust
bttvmnehcosubject m the Workers Colons of tan penv s an:of the Labor Cod,I must
provisions O O forthwith comply with such provisions or this permit shall W Deemed revoke.. '
'Ln " ' 'CONSTRUCTION LENDING AGENCY'
1 hereby affirm that them is i construction lending agency for the perfomtance t '
'If the work for which thik pe mit is issued(Sec.L' 31YO Cis,C.)
der.Le N a _ ........ . . .. .. ...... .. ....... ._ - _ ..._ /^//(f,V../Q�..- . . .. .
D.z Leader As
UO
1 st fy th ' a t l hreactions Application d state that th boe Information
'mscdct I agree
to comply with all city and d Io rordinancesand state laws , i a
O"V the one-mensoucmomand hoar inspection
sm spresenmi mere o[thisry)o cnmrurym
the abo(We)agme orned propcny for inspc d lk,p,harnic .-,
F_f4 es dgree m sang inJ reify and keep Wrmlcsn he City of Cupeni against
snn
.�. liabilities,judgn Is,pasts; expenses,which may in uny way adcme against said I
Cit Y in con n e grime P ntin8 ohhis permit
^
APR IR)F STA D$AND WILL COMPLY N'ITH•AL.NON 'DINT' ! lllfff
se L F•E ui nory yam- I 3a oL Issued by: Da
- tgna re ieanyan�mnar Date' .. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE.
IINapplicantort r building sap r.r m h dl haavd us material Type of Roof.
del tied by the Cupen no tic aI C N Ch pter 9 12 d th H Ith a d S f ty,
Cod Set 25532(x) _ - s rr S _,.1' • :.In d Y•i ,
dv f N ( ± All roofs shall be Inspected prwr to_any,roofing material,being installed _ ,. .
Will the,ppb fit future n bling occupant use equipment or devices which If a roof is installed without first obtaining an inspection; I agree'to remove
u'tit d regm' we all new materials for inspection Applicant understands and will comply with
col Jf dbylh ByA aArQ Quality Management: _ - _ _ _ ..:
11 Yes "all non poi source regulations , „
California Health&Surer Code,'Sectionv25505,25533 and 25534.1 u rder,and that.
1 time read th haemdoa,materials cements u der Cha 6.95 of im
Y ... ...._. -.. .. _ .... ._ .. .._ .. ..- __... . ...... . .._..
Sam
iftheatoft gird mhic,he osnantmetprirmyssuancsiofa'mnmify th -
occupam oft r quire ms x�hich�moa he,mct prior issuance ar a Ccni¢a f
Gdda Signatureof. Datepp
licant
: sem to All roof coverings to be Class `B" or better
.. .P .C... . . _ ..... . .. .... .OFFICE ...