02050161z
z:
CITY aDI G DIVISION PERMIT
CONTRACTOR INFORMATION:
TlJLEW00D DR
RUDD STEPHEN S AND BARBA
l 02050161
clti1blffAlTEPHEN S AND BARBARA 0
Ae5lrTOU2
PHONE:
SANITARY NO. CONTROL NO.
J ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
' IWei sfoorthat Iamlicensed under provisionsofChapter 9(commencing
COUNTER & ENCLOt@bP9ctVtoWATER HEATER
5 with Section ]000)of Division 3ofthe Businessind Professions Code. and my license
it in full fore, and effect.
( License Class Lie. a
Date ContractoSDECLA
ARCHITECT" DECLARATION
IL0�pAL EE®
17— N `�
e
1 undemand my Plans shall he used as public records
SEP 7 2002
L LiccnttdProfcssional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law far the
following rtawn. (Station 7031.5. Business Pfessi Cede:
$200
Z and roons Any city Or county
which requires a permit to cma,,m t, alter, Improve, demolish, or repair any smrcture
$ Prior to itsalso y- the applicant for such permit file a signedonament
RI III mKiIi
" tbut hit e 1 dp-rp rtothepfD an the Ce B.,iar Lc La C r9
(commencing with Sed ])00)oTD"s on3of the Bus rte. tWProfessions Code)
R a'. Valuation
:k nw ! a..., �•t: ),!
or that he is exempt therefrom and the W,is for the alleged exemption. Any violation
r'•!at„•.. t'
of Sedimt 7031.5 by any applicant for a permit subject the applicant to s civil Penalty
Of not mor, than five hundred dollars (s503)
APNt3UiL,UiN...... • Occupancy Type
❑ h as owner or the property, or my employees with wages as their sole compensation,
will do the work, and the swcture is not intended or offered for sale (Sec. 7044;
Business and Professions Cade: The Commcmr's License law does not apply to an
Required Inspections
Owner of prepeny Who Wilds or improves thereon, and who does such wart, himself
br through his awn <mploytcs. provided that such ial,werram, are not immu or
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off d for sale. If, hoi the building p is sold within one year of
... .. -... _._.. _. ..._ _. _. _. _..” .. ...
m 1 t mi the owner builder will have the burden of
a p proving that he did not build or
' -
improve for purpose of xakJ.
p apc. lust elY i ...t g nh I'c d onrract- m
-
7
truce the P olttt (S ]044 B . iness d P f si ons Cad ) The Contractor's
s
m se Law does
L' not apply m an owner of propcny who Wilds or'repmms thereon.
t
_ane who contract, for such prujeds..with.a connotations). licensed. pursuant to thin,
Contractor License Law.
exempt ode Stt. ' � ' " ` - B A P C for mason
Own& 0 Date ..
- „
O KER'S COMPENSATION DECLARATION
1 hereby affirm under penalty nfperjury one of the following declarations
❑ I Ww'and will ram mom a Certificate of Consent to mlf-insure for worker's
Compcnamion, as provided for by Section 3700 of the Labor Coda rot the
performance afore work far which mit permit is issued.
O 1 have and will maintain Worker's Compriimtlori Imomm". as rtquiiM by Seem.3]00
of the Labor Cade; fur the performance of me xork for which his permit is
sued My Worker's Compensation homence crime, ad Policy number are:
Came '!t f l l.`•' Pal yN'
' CERTIFICXTIONOFCXE
RAMC w'ORKERS'(,
i y., a .�. .., r•,: .. ..ns. ,.
v. �) ': 1. „•l �" „ter qs t„I �Y 's ,�, � ' ,. ,
ATION INS
„�,; •__,:„..c, _. COMPENSATION INSURANCE' .'.";i-
' 'Crhis xdibn�need not be completed if the permit is for one hundred! dollars
' 0-; i ':: 4 t - " -
(5100) or less.)
I em fY hm in pern any the work for th s period,,tote tamed, I
- .. .. -. -
person rn r
shill t ploy any pc any manner so as to become sub3en to the Workeri
.are
- r.l
Comon Laws of California
ia Do
Applicant i „r.. .,..
..
-
after Exemption,
iod,y should
NOTICE TOctno
this Cismnsof
gCix.ml
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become the
he Wink,', Comm�swoon
mm ti the
ft Co - ode, you must
foe Labor
comply such
fnnhwilh'comply with such provisions or this permit shall W deemed revoked.
”' " "' CONSTRUCTION LENDING AGENCY
lending agency for the performance
I hereby affirm that there ti acsued
blthe work for which this permit ifissueJ (Sec. 3097; Civ. C.)
(Sec.
Name..... -.. • . .:.-..,..."" v.v..�n._.. .�..."_.: .::..
_ .. ._... _ _ ....._
luma:x
Lendei sAddress' ` •
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I certify that I have read this application and state that the above information is
cq,
orned: I agree to comply with all city and county ordinances and state laws relating
m building construction, and hereby auhorice relarlap miwis of this city to enter upon
he above-mentioned property far inspection purposes
(W) ill"a m sauOinderroify ad keep harm) ss the City of Clipmorm against
liabilities judgments. c is..ad 0 parties which may in any y a gain,, said
City qu m of th Bra I g. f this Permit.,/-
APPLICANTUhDE NOSA A'ILLCOMPLYW HALL'NON�POIN/T'
5 RCE RE )NS
I
Issued by: 5 — Z y
�d0
Date �C
signature ac r ale'
'
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE' " '-
�". WIIh pplmnat fat Wla g gam Swee or hand le duration mormal
defined
Type Of Roof
as by theCpen Municipal Code Ch p¢912 ad got Health and Safety
Cod S t
WYes
r..
Will
_ All, roofs shall be inspected.prwr to,any roofing material being installed.
dth pplanto future bull d gat a nt ea Ai to a e: e
emit ha d scontaminantsas defined by IM1<B y A A Qat ty Management
If a roof is installed without first obtaining an inspection;'I agree to'remove
°i" '0Ytt - MN.
- all new materials for inspection. Applicant understands and will comply with
-1 �
all non point source regulations.. - - - - - -
(-,
I have d the baza d s mamlld quvemem, tine Chapter 6.95 of the
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Califnmm Hcalh & Safdy Code, Seminars 25505,25533 and 25534 1 understand that
if the butingds not currentlyhw a rant that I reinvariability 1nobly the
eva p i f thet which st be t p xsu f C rtfate of
�•�/�
Signature of Applicant .. Date
All roof coverings to be Class "B" or better
ronmereturn onaee ag , _ ,
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�. ... .. .. .OFFICE ..