02010123 OF
CI BUILDING DIVISION
NO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO. -
20219 CAMARDA CT KOPELS DAVID N AND BARBAIA S 02010123
OWNER'S NAME: APPLICATION SUB DATE
KOPELS DAVID N AND BARBARA S 01/30/2002
• PHONE: SANITARY NO. CONTROL NO.
S O O ARCHITE=NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i r—I LJ LJ 1__1
Z y affirm 2 LICENSED CONTRACTOR'S DECLARATION lob Description
O Z_G 1 hereby arm that 1 am licensed under provisions of Chapter 9(commencing
pH�w wish Section 7")of Division 3 of the Bmaners,ad Profession,Code.a ad my license REPLACE WATER MAIN.
be be is in full force and effect.
S rep a< LicenseClass Lic,p
S m l-
Data ContractorARCHITECT'S DECLARATION
t_a O 4 1 understand my plans shall be,used as public records
w a
p O Licensed Professional
o a OWNER-BUILDER DECLARATION
uai.2 to 1 hereby affirm that 1 am exempt from the Contractor's License law for the
F Z a following reason.(Section 7031.5.Business and Professions Code:Any city or county $1500
M which requires a Permit to construct.alter,improve,demolish,or repair any svuctum
be
i3 priono ns issuance,also rtquves Nc applicant for such From fileasigned smmanm-
thmbeis-hes sed pundonUoihpp pryv{sioru of sne Contractors Liccnx law(Chapmr9 -
(cmnmencin with
thS Iian;]G0D (Dlvisimn3or the Business and Pruri ons Code) "r 'er'3'1 4VLO.. UY1� r Valuation
8..i,.�a �o em a\ 1 or a l� SrT
m that It i,exempt iso mrom'and ar basis far the cts the athimat to Any violmion x't' T i °• `- 1 a .. s. ., „!Rl. S:-..i 2�
--of Stttion4031,5 by any applicant for a permit-subjects the applicanuo v civil penvlry-
o rat more than eve hundred dollar,fselw). 10 3 APN rUpLztker Occupancy Type
111 owner f me poo,stry,or my employees with wages as their sole compensation.
will-do the work v ad do,swcturc'ts not'intended or offered for sale(Sec.7IH4; - -- - -- ------ -- --- - ---- - -- --------- - - -- ---___ ..
•B 'e: and Professions CMc:The Contractor's Lmamsa Law does not apply to an 507 - FINAL PLR241EIfN&spectlons t. ''-'j`+(.''1:
owner of property who builds or improves thereon,and who Jscs such work himself
or through his own employees.provided that such improvements are tintended or 1
',.ITCeidf salathe fi '- to Wilda,aec de of prav . .ha the one year of _. _ .. .._..-...__ __...__..... . .......___._. _ __...
dompleuon,the owner-Wilder will have Nc burden of n that he did not build or - ^ ^`s
provr g `"
rmpro e for purpose of isle)
colas ow (the propertyam Bullis ly voctng withhcenxtle Contractor
onti ototoconstruct arta project f5 c ]641 Business and Promotions CW r ThCo chane s
L la rices not pply t wnar th a.comy who) ice proves thereon, r p Q C •2002 v
..a d Contractors
kens. cseeh.p leets wnh a comrnaor(s)Ieensed pursuam m.Na r D LI D
Commnors Li<ena Law. ._ _._.__._._. ._... .. ._._ _.__...__ :.__.. __.. _ ._.
--. . .
❑lam cxemp"under Scci'- „+ ,B&P C for this reason
_ D Date: . BUILDING
WORKER S COMPENSATION DECLARATION
• ..t a. (hereby aPorm under,pc- of a ., of the followin dmlaretiom:
y perj ry Win g
❑ 1 nave and will'mmntain'a Cetlifcac of Consenttu self-insure for Worker's
Compensation. aa-provided for by-Section 37W of the labor Codc. for the
performance of rho work for which this permit is issued:,,
❑I have'and will maidoidid Worker's Co pe vtin�losumnc 'iequireE by Section
3700'of the Wb r Code;for Ne pnihoraance of the work,fmrwhich this'pernit is
issued.My Worker's Compensation lnsuiance'carrier and Policy number are:"="r`
:.;./p 1' No...
r - :gCERTIFICATIOY OF EXEMPTION FROM WORKERS a �+' i,,, - ', ,., j r r,_, d ib i. t.'- ,X....1L'Sl,1•..t L3,
INSURANCE.v,;i
;m (iii .- ton dnor be mmplaed if tM1e permit tnf tone hundred dollars V'_~~..��,_,.• a�ss __ _._.___.�_.._ _ t-.� .I _ V I. lh ;ly`- � �• ._
r ri 1 n fy th t 0 port ce f
sM1 lin to pl ype on 'ymath - le k for 1 � the'whn ..
�. i..t t Y' -rt i"A
C pc i of o D t V F-.
NGTIC A P NT f fie Air, ata fEx pt you h it
- -
hve .emd0 th Hok PasCompensation a L C J you musi i
Z Q fonhwuM1 somply'with such prowns
v ° or ti'slsin °ftow permit shall be deemed revoked. a
F st I .
+ CONSTRUCTION LENDING AGENCY". -
�:� '1 hereby Pone thin to ie . nswaron Icntlmg ag -y fo dm perfoim -'e , r v
,.., ofth- rk fo M1i<h th. pcsmt srssu d(S J09]'Cv C) - '- `'
,
:L -.. _.__.-. __.. . .. _ . .._.._. '__. ._
ri
I comfy that 1 have rcaJ this application and setae th t th w information is
fir.=.[.., cortectrl agree m comply with all city and rounry okinan<es and stem laws relating -
_ O::(J io,builJing cnnstridtion,;and h2reby atvhoiize represenmtives of this city to enterupon
' }Y W, the awvonsemioned property fur inspection purposes.
- y:4 IW'e7 agree eixme.'indemnify aril keep hamiless the Oiv BFCupertiho against
V] Iiabilities.juJgments.caste and expenses which may in any waynaccme agaiast said
UCz City in cov: uerme of tie(g{ ming of thispcnnit "'
APPCIGA T 'NUER$TAN0.. 1'L CO LY WITH ALC NON-P5INT' Issued by: Dale
SignuturepfAppl¢aMContmaor,,.; "':: ,Dare. ,( Re-roofs /
r. HAZARDOUS MATERIALS IALSDISCLOSURE s
and a the appl cat f m' h Idiog e. p t store or n dl h Health
,material ----Type.Of Roof_.......
des d py the 32 M pal Cade Chapter9.12.and she H hh- d Safety. -
CM Seto 2p5P17 ,t,? t -.s.. r I Fr ' S - .Ir' s,.l a� j s. aYfe , .I ,. ....._ ,_
OY r All roofs shall be n5pected to
prior .any roofing,material being installed
WEth mph t o 1 t b;ltl g p - cq p t V es h' h If a roof is In$talled without first obtaining anrinspecticn,I-agree Io remove
anth d cot ant dfn dbyth ByAnaiA QallyMmag t
.all new materials for inspection.-A_pplicant understands and will comply with
oY °N° - all non-point source regulations -
I haves read the haves do maerial. mal-immen¢m de Chapt r 6.95 of the
California Health&SafeajCode.Sections 25505,25533 and 25534.1 understand that
- i6 the building dxsvo,curemlynave a tenant, t it is my responsibility to notify the
oc< P m c,requi is wh'ch must b p' of a Cen rani f; -- - -
onto is e
c _ Signature o_f Applicant _ Date _
'i :owneror,autnodzedagent . ;, ° All roof coverings to be Class"B"o'r Better
'
—OFFICE . . - ..._.. . _.-_
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