02010075 c►BUIL DING1DPE[tOONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10225 ANTHONY PL ALL VALLEY PLUMBING 02010075
OWNER'S NAME: APPLICATION SUB DATE
DORIS CHEN 170 BRANNAN DR 01/17/2002
(' HONE: (510) 376-4588 SANITARY NO. CONTROL NO.
1
MOO ARCHITEC AENGINEER: BUILDING PERMIT INFO
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-,uu BLDG ELECT PLUMB MECH
a I_J I_I L _1 1___I
S i LICENSED CONTRACTOR'S DECLARATION Job Description
w
I hereby affirm mmm
at 1 am licensed under provisions of Chapter 9(coencing -
Hu, with Scniun1001ry of Diriaion3of me Business and Rafcssions Code.and mylicense WATER HEATER REPLACEMENT
x E- n con force nna err y.
ad i U teener Clas Lia.p
3 ac,�„ Date Contain,
n O a CHITECT'S DECLARATION
:� _ I undemm�d my plan<shall he used as puhlic recoMs l
Y
ne O Licensed Professional
cf i OWNER-BUILDER DECLARATION
L:_ 1 hereby amnn mm 1 con exempt from she Conaz,C 1_iAay,Law Tor the
L:z following«awn.lstan t 1031.5, t,alien and Professions Cade:Any city st county $600
5 F C which requires n permit be enre,the alien improve,demolhporain 1 file
repair any structure
i3mPrimmits hecinncnalsost to thstMvisiono for suchpermis LGleasiaw(Cha mem
d161 he ening xd puisu5nl m she provisions of me the inside License taw nary Cor,) -
Icommmeikexehsmdnnatio)othebamnoormelegedosapim,An,violatm t)'+...?:t3,°�� �t � �}.:!��:; Valuation
or that io ii exempt mem applicant
the basis for the alleged cxfmpnit to Any violation 'rq i't {f
of Section 703 1.5 by any applicam for a permit subjects the applicant to a civil Penalty
-
ornot mmethan Evebuound!c,llara65d)L 502ApNSI L PLUMBI G ENERGVccupancy Type
❑1,as owner of me property,or my employees with wages as their sole compensation, 506 - CA q TEST
-will do the work.and the"stratum,is nm'intended or offered for sale(Sec.701
Business and Protesdom Code:The Commcmr's License law does not apply to an 507 - FINAL PRk4ditt igpectiohs-" -
owner of prnpeny Who builds or improves thereon,and who does such work himself
or through B. rpt ) .provided mut such impro%cinents ate not intended or
offend fosale.'If,h.vitivu, he
milds m� trrld lh'd�ane "- _. ""-.. ... __.. _.. _.
ge proof pro year of
impletion me owner sale.) will have me burden of proving that he did not build or
improve for purpose of coley `o 1
- r ❑1,ex owner of me pmpeny nm emlosivcly commming win licenud commaorsm
Lieense,the project(Sec. o an Bus and Professions ills or The improves
Contractor -'
License Law doer not apply suc man owner of property who builds or therms. -
:. .- ,.and.wctor., VeeseL such.projects.with aconnncmr(z)linnud.pursuam to.me ._ ... __._...._._ OZ
- - -JAN"3-1-20 '- ----_.. -
Comucmra License Law. ..
❑lam enempt under Sec '' ' ' ;B&PCfor mit reason - .._.,.''I;
_ -= Owner Dare • • BUILDING
WORKER'S COMPENSATION DECLARATION
I hereby affirm order penalty of perjury no,of the following declarations:
•7 I have and will maimnin n Cenificme of Consent to self-moms for Worker's
Compenuion, as provided for by Section 3700 of the Labor Code, for the
performancc of me'work for which this Permit is issued.
❑1 have and will moment Worker's Compnaoriun Insurance,as required by Section
37W of the�LLa)_borrr Coode.for thea pp�errforrmann(pce o`f tthe workfafar wwh�icch this pcmvt is
issueCanna My Tk� 's.uJL var _M^Puo alicy No,7[I /�u7 J/��re Q� - _
EMPTIO FROMWORKERS - . t ' 1 S} 1 'tL ' K;\'v t s ' .B .
tc `CCRTIFICA O FSA ION INSURANCE,'
�,,,, ; CO PENSAT
'
(ThI t need'not ire con leled if thePermit - - _-
15100)os Ices 7 p rs for ane hundred dollars "'� (. ,:L(�
I I employ
mar me mu 'ni the irk f which cors tout rs naued I t 1,, - _.•• ." - ', „
shall t n in any Pe .y m n ro become subject
to the Woderi •-,1 --
Compensation Laws of California.Dale
Applicant
NOTICE TO APPLICANT If.after making th C n f m f Ex pion y _ - . .._. _ .,. _ _. .. .... ..
n1 old
Z foci subject me W k iv penmh P ns of the Lbo Cod you me i
O
forthwith comply win such pro .'o s air d pe r hall be d coed resolved
z ..
,F W
CONSTRUCTION AGENCY
heaffirm
a ' i shyhick that pe d(See
S 'lend ng vC.)agency f m'pe fnmrance'
afthe k f which thispeons r :¢ued(S c 10911 Civ.CJ
L � "Lend., .Nam .-...." -...._`. _.. . -
D'Z Lendcr'x Address
V „I certify that I haw mad mit city
nation and stare re the d slid laws inion is
kat [.. cones.I ague tr comply with all city and d repo i dinances°ntl state laws enter
uponto buil.ingcroswedo nanny reby5°urnmoerr o,e nmrives of his city to enmr upon
IAS the ebo(We)agree to Ae:irdforify ad onpurposes.
r-L IWe)agreem_wve.inouacpmns which
meway acrueniainst snm
V] liabilities,.eq. m¢,costs and expenses which may in any wry,erne against said
V.z co in conzequeree of me ting of oris pe Tao n /
P Nf
ONE
DER. ,•DS•AND F IL COMPLY WITH ALL NO -Pot' •" Izho-2
on :cu Issued by: Date
gram c o p ImnUCunna,or •-Dm r'„ RC-TOOTS /
" HAZARDOUS MATERIALS DISCLOSURE
ll me applicant or fire build'
aaaef edn m c g«mpanr m 12.. h Health ma
mal --Type of Roof.
y pen n htun c p 1 Cale Chair 9 12 d rh Health and S fny - - - .-
Code See on 2553 1a)?
0 ye, No
' ` _.All.roofs shall be Inspected prior to any,roofing material,being installed. _
Will the applicant or future b 'Id', g weapon,use tocstiproem or devices which If a roof is installed'without first obtaining ani ms ectlon I'agiee'to remove
emit h ardea contaminantsrefined by theBoyA Air Quality Management g p
all new materials,for inspection. Applicant understands and will con I with
Yes t I all non point source regulations. r - - - p'y
I have read the he.,do s,materials requionfents'under Chapin 6.95 or the
Califo a Health&Safety Code S tions 25505,25533 ad 25514 f underlain!that
ifinebultlngdtas not only have.hmaimr't . yrespo-.bi1, dfY the
acupant ,ng
the requ to which. un be t p' or'issuance of"Candi m of
Ocnn, , ..
Q.Z, Signature of Applicant _ Date
ant°rare agent, All roof coverings to be Class "B"or better '
_ ... . . OFFICE _.. .. .. . . . .. .