02080016 OF
CI BUILDINGUDIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
10281 N BLANEY AV 02080016
OWNER'S NAME: APPLICATION SUB DATE
An CONLY DONALD E AND JO A 08/06/2002
PHONE: SANITARY NO. CONTROL NO.
to to tc ARCHITEC'UENGINEER: BUILDING PERMIT INFO
be w{O BLDGELECT PLUMB MECH
El a C= r--I L_LJ I--1
O1 LICENSED CONTRACTOR'S DECLARATION Job Description
O z=o I hereby affirm Nal I em liernud under provisions of Chapter 9(commencing
rest. wiyth�9Section 7")of Division 3ofmc Buyd Professions Code.and my license RE P I PE
Yms9
FB NA L�l�
sev
1-OLLOU ✓\ ARCHITECT"$DECto TION ,/ AUG 19 2002
se
sn g I understand my plans shall he used as hire records
dE!y T
"p0 LicenxdProf<ssiorul BUILDING
o,o Oat I am exempt
from
DECLARATION
u�=' 1 hereby affirm that 1 am exempt from the Goons, o License taw co ms
F a following mason(Semon 7031.5,Business and Professions Cade:Any city or county
$2000
F F c which requires a permit m construct,alter,improve,demolish,or repair any structure
3 _priono its ixsmncc,also requires the appliwm for sucM1 pemu,,o Ble o signed summate.
Wahl intingwdh SRtii�to me pm Division do Business
usineLievue Lawns Carl Valuation
(c that he ingwi!h Sation.7inanof dlne basisoof the teallejldemand braProfessions Cadet f_ [fsyi'P'31C7f3:5O1C/-.i;C1`CI•k•;jns,_a}l`i,jf >�.
of mai Ire is exempt Iany apli and the basis for the subjects
they a pliant to Any l Pennon. t
-of Sertien4071:$by any applicant for a permit subjects Ina applicant To a civil penalty
,of no,mote than five hundred dollars($500). 202AP_Nt4Ml§eYFLOOR PL MB' TNG' Occupancy Type
❑1,as owner of the property.or on,employ.,with wages m their sole ampere.ion. I
will-do me work:of and Professions
stm:The is nm Contractor
sintended or aofferedLaw for sale(Sec )bed; '---- - -' - -
Bane, and P oyes,ons endo The Contmcmr s License taw docs not apply m an 502 - FINAL PIIBIItq�ideN�Is �Y
owner of property Who builds or improves memnn and ve e s such work himself 507 — FINAL PLUMBING t
or through his own employers.provided Nat such improvements within
not intended m
or see - m WildingtimprovementfProv s sola wuh n note year of )
•improve for
the owner-builder will have me hurdrn of proving But he did not Wild or -"
improve for purpose of sale.). '
171 of the property,7 am Business
sly Tracing wird Imrnud mnuacmrs m
construct n a project(Sec ]bed,Bums,and Profess ore Code,)The vthereon,Commission's
Lid who
taw does not apply,o of own.th property who builds or improves thereon,
L _Coil ittees Livens lonsuch,projers wim.a.conuacmrts).li<ensed pursuant m.,he.Committees am axe pt under
S
❑lam exempt unJerSc • B&PCfor.this reams
WORKER'S C ..
- - " OMPENSATION DECLARATION
I hereby M.undtar pe alt,of ponj rY me of the fall wir,declaraions:..
❑ 1 have urd will inturtim'a Ceni(cat f Cause.1 to self-itume self-itfor Worker's
Compensation. as provided f by Section 77M of the tab Code, for the
perfearr,unce'of the work for which this permit is issued.
❑1 base and will meimaln Workers Comprnsation Insurance,as squired by Steelton
97M of the Labor Cush,for the performance of the'wbrk for which mis'atmiu is
limed My W lo 's Companuiders Insurance carrier and Pol ry.mrmber arc:
�'�1" Co Poi
I,TCE FICATfON OF
EXEZ, FROM WORKERS 't �`0� l ,t. .� ' itI i�fl�.'•'r.IP I'').viil,ll
COMPENSATION INSURANCE a.g E '
(This eecnod need not be completed d the pemTiT is for me hundred dollars
($1001 or less.) ,
I
'I cimilothat i a perms nhM1 work for which this pe , issueda ,' t , t ',t,11?tl
shall i rept Los"
person m any man r as,o become subject to the Workers' l '" 'Wripers'
_ ro
Applcantt1 Lodi fCalifornia.i 9 -
NOTICETOAr'MUANTIt. ❑ making th
Contractile
Crr t bfExemption.-you u Id
o uhf uo the W kf Confirmation Provisions theWho Code you inm
0frth Th c py with hp 'i ,o re permit hll W decried revoked.
Z
.._ .. _ ... . .. . ......—. .. .. . .. .._...._ _ ._....
mCONSTRUCTION LENDING AGENCY an -
�,' I laucrk fm iffirmWhdCh that dicFm conmNCT n leading0agency f the performance
•oath work for wNah Tit spcl ti ,issued(S .tW],Cv:C)
L D ..Lo de 5N'me ._...a.. -.t':'_,r _ ;.. ..a. _..-.. .. ..._._._ .-__._.._ ..... .... ..... ..
U O . .
I certify that I hbout this city
application and tT, ban he information is
agree W F eo a 1 g T comply with 11 i,y a d count ordinances e anddstate I laws relating
� V theta ld g construction.andrtyfmaavm ertp move fm cry, m upon
IM1c bo ani nil art f
}.W e property Y Peet on Pa..
_
[.., IY (%r) geioser e d rena and ketpwhich
hamay in Jia CroyofC pea againm
rn Cit Ii judgments, a and pe u h ch --n any Y e geiat said
V Z AiryconsequenceDER the granting D m pc t - - r
AP t'IrERJ UNDERSTANDS nS'ANO WILL CObIPLY WITH ALL J-O`1T
1,L '�6r���lhs l r ' `_1„ Issued by: Date
axil fn dl mpCupv RMmc pili ndRIChSDISoe or Jm<N Health Re LOOTS
Igo tum YA I caulCo t t D Ie,
RE
Wllih t,Capam Mfuturt Wilipso injCo e,Chapt store or h d and
Earl Type.of .,......_..__„,___..._ / .......
Y. p serf ty I '"""` ••
Cotl OY 12557,1)11 YI
I r...t Cc j1t I_m r 1i F i i�_snVt
All roofs shall be respected pnoi to.any.roofing material be' g Installed
mums anii,ca , oilfimb im.,oc,,Pon, q Ipart de.i.,which If a roof Is installed wi[bout first obtainingan ins echos 1 a ee t6 remove
1 have read le'haurdwsmaterialsrequirements under Chapter b age [ p
Di' ' n all new materials for inspection, Applicant understands and will comply with
rpYes 9u n p .. . _ . . .._.. .
m, ucot Tasdefned byre Bay Area AuQ Quality
all non point source regulations
r' I
95 of me
CaliforniaeWlHeal,,&Safety Coda have
Sections 25505 t itis and s,pr l un to atif maT,
ftnebuildingdpesnot ernems dv have a,enant,Natnrsmy mspom,btuty,er nnmry mc' - _.._- .. -_ ._ ... _ ... ._ _. _ .. .. ............ . . ..
Kb—part of the requirements which mum he met primo issuance ofd Certifies of
r_ a cy' .. . . ..
Signature of Applicant Date
T�
_ _..
�mI'sq.q erg or p to All roof coverings to be Class B"or better
. .- ---.... OFFICE--