02030013 OF
TINO
CI BUILD NG DIIVIISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
KOPELS DAVID N AND BARBARA S 03/04/2002
qqq PHONE: SANITARY NO. CONTROL NO,
p+0 0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
<& py BLDG ELECT PLUMB MECH
�,a6 u
z m 3 LICENSED CONTRACTOR'S DECLARATION
Job Description
a_ I hereby affirm that I am licensed under provisions of Chapter 9(commencing
y with Section 7")ofDivision 3ofthe Business and ProfendersCode.and mylicense UPSTAIRS REPIPE .
x f j Is in full force and eHeri.
e 6 License Class Lic.p
Dale Cammnor
ARCHITECT'S DECLARATION
O 1 undersand my plans shall he used as public records t
Y
as Licensed Professiowl
t . roc exempt
DECLARATION f at
wreby.(film Iwl I am exempt tram the Commnor's Lie use L¢w for,the
Z C
following rtes (Section]OJI 3 Bui ss and Prcfessio y oil t
which requires a peon t 1 mown cher,Improve,do sh. trust c „ $1500
u°1 prronon i u also req ue'di p 11 h 1 eassg
all= 4(Co he 141<e9s'ed pu c iq tq Iliap he rsL se C er OOI•Are .d.ppf i Valuation
(co enc ppBwlhS Ilan]000)or Dl lonJofN 'r rue on{ e t_�1. v`i I Vl ltv.t r!..5
or the,he I4 exempt IhertfMm'alld Ina basis far the a ale a.Any vie n 1 214 0'2 6 (T(�
af5ectionmBE5-byanyappficautfonaponind jccl l plic as civil y-;of not bane Inas five hundred dollars $( APN Number l:r.,;r1!7,•, Occupancy Type
0I,nsowr'.1'lne a matte rte ease wit sec 106 - SEWER & WATER ,
may... I
P pe y y y w s soecompereation,
--will-do Ihe'wolk,arW'the swnure'is - ,i offered for sale(Sec.-7014: -'-- ------ ---' - - -
Busineis and-Professions Cade:The Ca _' a License Law does mol apply to an e�t�� peC (ODS Ir°'.�•y "=
owner of progeny Who builds or improves thereon,and who docs such work himself 301 — ROUGH P iWffy
or through his own employees.provided Nat such improvements arc not intended or --.. ..._3 02. TUB--& GR- SHOWER- --
-:ollcm fair-rale:1L howeve.lbe building or Ilnpm4"emcm ii said within one ycer of '--"
'celnpledon.the owner Wilder will have the burden of proving that he did not wild or 502 — FINAL PLUMBING (ENERGY
improve far purpose of sale.).
__e; _ GAS.._TEST___,.. -
❑1eoownerofthe ecprogenyamBus ly t esi uhb n de nvemroto ;I ,)
ronswa the pro3tt1 is ]044 Ra{ e a Professions CMa:)me c n,mctar{ 507 — FINAL PLUMBING
License Isw does not apply to an owner of property who w Ids m Improves Ihemao,
end wh wets for. h.p Jens wishacommcwpl,licensed Persona to.the. ._...._-... _ _..__ ... _.. ___.--. ..._. .._. __ .__t ._-_. __ ._._
nwc r e Law
lean at I $//// this
caner am
W I O ENSAT104ECLARATIt � _
1 hereby eRlm under penelLy of perjury one of the following dedunsions: �Q� ��0
❑ 1 have and will maintain a Cerlificam of Consent to self-insure for Worker's V 1C� • 1)
410
as provided for by Section 37W of the Labor Code, for the !
perfni mile,of the we for which This permit is issued.
❑1 have and will meiniain Worker c Compenenn I
ioniumnce:ai required by section
37W of the Lawr Code,for the,performance of the;work'for which this permit is
'� isiued.My Worker's Compensation Insurance cir ter and Policy number are: '
I,. - i .. ....0
Came } I i, Jr , y..:PolmYNo.'
f r ICERTIFICATION OF EXEMPTION FRPM,WORNERS
COMPENSATION INSURA CE
frb s se6inn need not he completed If the permit is for one hundred dollen
`(S100)o let
p'�r l c o f din lh o lbe crk f' hie lin l' sec
scall mol amp f a as to M1 t t the Wa k n
Compenssl -
—_e pYw pc Prov so .. p yyshould
eraking-flusAho Id
Anpu t
NOTE APPLI m C nlfare of ti l ton o
bat bled t (fie W rker Com nsel o I ni of Ih Lebo Cod au moat
00 forth M c m I iN such v s a or Ino rte t shell w deemed ked. ._ _- - _ - --
f� I' s'`CONSTRUCq]ON LENDING AGENCY
�'� I h rcny arm thin the a conswn on lending g y f r the p rformunce . .. i.
W of Ina ark fa hi[n Ihl{pefmlL Ia IS(led($C JB9] r.'I r.') - ,
-Z
yy Ixdtler d'Addrtss'
0 1 eeni(y mel l have reatl this application and slam Ihm the above informmi..is
tr+'Est corral.I egravo comply with ell city end county,ordinances entl sloe laws reining
V la wilding conslrunion,and hereby ev0loriu reprcxmetives of lhii airy to en ter upon
��yx,W the ewvcmemionW property for inspection gurposes, ,
•' 5,4,y ( ')eglde so'savq'indenPnifys1at keep harmless Ih'c Ciij'of Copenils aseinal
Fes+ Vi liubili's.l greens{,costs wM expcnus whi h meyin any_ey accrue against said
U-r� City cons ucnca•e agla-' W a '
HPP AN S A WI PLY NIITH ALL NOI N
s N Issued roofs Date
� arvre o p I can ova r.- „ ,I,es, i Re-roofs
- HAZAR abed ERIAIS DISCLO$FIRE
Will;beappbcsm rflrvre w'Idm¢xcugant stole or haMle hexerdous mlnil .Type of.ROof_ _.._ .. _ ..
as defrcd by the Cupenig Munlc Pl Code Chapter 9 12 and rho Health d Safety
-
cadr sttl 55321.)',`0.111.fgg,,��;; �f,e� r ` 11''b`17:: ": )Ir . ,;e 1{z��tEi x
�Y' .All_roofs,shall be ms acted riot to an roofn material,beim installed_
— _ P"__. .P Y_ _. g. g
I'.t �Will the applicant or'future buddingoccupantuse equipment ordevices which If a roof is initalled'without first obtaining an:inspeetioni I agree to remove
emit narord...air contaminants e£'deflied by the B.y'Ares Air Quality Man.gefncnl
rinrocs' all new materials far inspection. Applicant understands and will comply with.
°Ye I :'..: all non-point source regulations.' _
nth ave lead the'h i odous,malenals requirements'under Ctiaute+6.95b(the
cahf n He th At Safety Cade,Scott da 25505.5533 and 25534.1 understand that
Itth gdasnol currcntlY haveei ant,Ihel it is mY rcspansibiliryl notify the.
de o the ie hich'm be urn or m issuadce o(a niflciuc of \'
I
Signature of Applicant Date
l'-' Owner oreuthoriz sgeni,- fate All roof coverings to be Class `Br'or better'
j�' • , ., . ., .
OFFICE
a