01080048 clBUILDINGOFDPERTONNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10601 N BLANEY AVE ALLSTAR PLUMBING 01080048
OWNER'S NAME: APPLICATION SUB DATE
PENINSULA BIBLE CHURCH INC 656 N KING RD 08/08/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 251-6040
M Had O z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w BLDG ELECT USIB MECH
i i LICENSED CONTRACTOR'S DECLARATION Job Description
O a_ 1 hereby off n Ihas I am licenced under provisions of Chapter 9l commencing
„F•w sedan]aaDl fDmisian3xi cBusiness and Roferms,Caae.add mylice.- INSTALLATION ROUGH LAVY ' S .
6rtyy� Win fullide9a I.
B:..<
c u imnsc CIesS.� Lic.tl L� Iv
Ak
X 3 w t- le Comucmr
t-q C ARCHITECT'S DECLARATION
I understand my plans sholl be used as public records
Y W ilk'
do
d=O Licensed Professional
ca
X co OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the m
t_ a following reason.(Section 7031.5.Business surd Professions Cade:Any city or county,
dms which requires a perto construct.alter,improve,demolish.or repair any Staelure $4204
Ed -'Pri t t e.alquires th pplcant forwch Pernutt fl g dstatementis.
that he isl d pursdart tome Provisionsof Ne Crantructrat's License to (ChapterCoe) 1 1U�f70I Asea-3_s Valuation
(commvm g Ih Sai n]ir'idd he basis Saffair Bged ci tlProfessions Calen ; ,. ,'3
or that he t exempt Iany applicant
the basis for the alleged a exemptioh.Any violation - "
-.of not 7031S by
anydreddollrs 500)),uubjects the appllcannoacivil penally _ �yy �S I;• p,;l, .•i Occupancy Type
m am marc man five nanarea dollars as W). 1O6ApN SE�E12 &' WATER '
❑1,as owner of the Property,or my employees with wages as their sole compensation.
-willdothe wart,and the struode Theure is netintendeda esdLaw see sale
.,it(Sceapply
'1.aa; 3 01 - ROUGH PLI IB Fg(tn p
'owner of
ear Who
Code:The Col stheres License Law Joss not apply m an $ ectlOns'•'''
owner of property Who builds or improves thereon,and who encs such work himself
u nc
or through his own employeesprovided that such improvements are not intended
year of 302 TUB__tic OR SHOWER .
oR2 'for ulL
leho a tar the building or imProvemem c sold withinone Year of -- -�-- - -"- -'- '- '--' _' '_-'-- --- -----
Lcrednor,lefican, he ituac,-Intillder is ill have the burden of proving thathedid notbuldor 502 — FINAL PLUMBING ENERGY' `
improve for purpose of sale.). 506 — GAS TEST
- - - - - ------- --a--- ----- r.._s_ _..— - - — --- _ _ _
❑Las owns of thta (Sec.
7 am
exclusively contracting with licensed contractors I° 5 0 7 — F I NAL PLUMBING 1 :I
- - ----------
construct Inc Projal(Sec.]03a,Business and Professions Code:l The Contractor's '•" "' '
] c
License Law does not apply to an owner of pmpeny who builds or improves thereon. "" "• •�" '
.and who contracts.for such Project with a.contracmr(s)licensd.pursuaut m the.
Contractors License law.
- - - Olam exempt under Sec.'' .,B'&PCfor his¢man
Dal¢n .
_ - - WORKER'S COMPENSATION DECLARATION
1 hereby of.underpenally of perjury one of Inc following dcdaretiuns:
j ❑ 1 have'and'wilhmaintain a'Cenifcao of Consent to self-inure for Worker's
Com�nvtimi-as provided for by Section 3700-af the labor Cade. for the
r!
Paonu of the work for which this permit is issued.''.
❑1 have and'will maintain Worker's Compensation Imumoce,as required by Scc,ma
-_ _ IOW �M1e labor Code:for th<performance of IBe work for whim This pcnnit is
izi d MyW ke(s C 'pewfon In e c m d Pal' '
i Y mberare:
o er�1\t 'Oftt.\ dal y N� C.�sS1 •}. ' 1'a ' +it J...1.,. _'�.
1 tGERTIFICATIDN OF EXEMPTION FROM WORKERS" ' 1; - x.. . . +`.:3, -�,A . i y .
" (This. won decent be campleied if the Permit is for one hundred dollars /''r ' ,T fi.L ..
t($I(X)]orlc.u.l
1 mf That the pert m ork fo ai h th rm t s ss I
shall-not amp 0j'any Person in any mannnr so as m becom b m m the Wa kerker s 't.' .1 1
`
Compensation o t Law.c oft'Cul fomia I I
i
Appl
NOTICE TO APPLICANT:11.atom making This Certificate of Exemption.you should
become subject m the stai pr Compensation provisions of the anted Code,yda'musl
O forthwith comply with such provisions or this pennil shall he dremed mvaked.
Z,r _. -._. ...- ._. ..._. GAGEN
vCONSTRUCTfON LENDING AGENCY'
lieretiYSFrm that tliert is 5 coh,mction loading agency for the perfoimaiice '
,b
sof the work for which this permit is issued(Sao 309].Rv,C.I t•- r
y A Lind .N . .... v _ _..... ........_
-Z Lent is Address 1:-1
U Q I ccnify Our l have mad this appl¢ationlsum that suthat the above mu
in(olion is `
W.t;. 'enkrtn:1 agree as comply with all city and county ordinances and nate laws relming
U pn building conw
sa ioo.and hereby'uu,k.,im ie representative,nf,h,,city enter upon
J }:Lis he above-mentioned propcny for inspection purposes.
[r L IWN agree to saic.indirmaily and keep harml -
the City fC penin against
rn
lobilitics.3udg tants,costs and expenses which may in any way accrue against said
U,Z C'ny,t 'ct y hhc g est g of Thi "
fSOUCE
NT U,t)ESTApO VD WILL COhIP YN'ITH ALL NO POINT ISSUCd b
EGO TI s ,l y: ----DatefAPPhcHA ARDOUS MATERIALS U'- ale- Re-roofs
ISCLOSURE "th appl'cm ftrebuddingoccpant ill haidNouemmrial - Type of.Roof.._--.bylhe Cupcnn as
Code Chap, 9l ,a dtheH in ad Safety _iy-,+. '-" "-` `•, .. - .._ - ..-,.
Code S ton.55lfia) e t r ) u• 'r , .(. }. . .. .. �. .`..t .t
t 'O Yes,
" ❑N 5
,
' roofs shall,be inspected.prior to any roofing material.being_installed. __" 1°tnth ppliamo f t rebu'Idin¢ac p I cqup ata a s„ntn. If a roof is installed without first obtaining antinspectlon;+ag reetto remove
Di _
I h rd s onum t a d toed by th B y A ca A Q al ty hfangemem"r 'oY oN . all new materials for inspection. Applicant understands and will comply with
- all non-p g olnt source re ulations. - -'
1 ha nate the h mudth'i'CH-is eaddrernout,vntle Chapter 6.95 of the
Cal! m a Hcahh&Saf ty Coate Sections 5505 35533 and 5531 I and....ad that'
-'illth Jtxc
nor dyk ams tthtt'.- y spa sHftyt rtythe .. - . ''"- _. .... .,. .
act t Y rcyu rtm c ch nbe tPi 'to'si ce of Certifc sof
O nc __..
Signature of Applicant_ Date _
!oat-neror.aum reacts t. , Dale All roof coverings to be Class "B or better" '
_.
.OFFICE — ..