01060120 li
CIBuy DING DP DIVISION
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
21201 CANYON OAK WAY. CREATIVE ENVIRONMENTS 01060120
qq y
o2? EWALTER & HEADLAND 5021 UNIT lA BLUM RD. A06G/20/2001
HONE: (925) 837-2715 SANITARY NO. CONTROL NO.
4� .
pZO ARCHITECT/ENOINEER: 11 � BUILDING PERMIT INFO
kL'kL"' BLDG ELECT PLUMB MECH
y i LICENSED CONTRACTOR'S DECLARATION
•5„ Job Description
jel_ IMrtby B.f .111a3liftedundoprovPromofChapter9lcommencing SWIMMING POOL.
mC withSec fore000)af Divisi Sof Ne Businessand Rotes ions Code, d ,Beer.
mm m in ran rhe aTrcTy �Q�
1 C Liana Clq,f p1Lic.N lar
a a KKE
Data._L✓t1S—_ Commcmr
13ati ARC TCu'SDECLARA WALE®
I understand my plans shell M n records used public records
7 a<p O Licensed pode"iaW •.
OWNER-BUILDER DECLARATION
62un 2 1 hereby affirm but 1 not exempt from she Contractor's Llceme law for the FEB 2 5 2003
K .5.Entrains s and Professions Code:Any city or worry $35000
which G (commenun s nth Section]M0 e4 alter,improve,demolish,ore a sig any suucmm
C < following season.(Section]031
-poor mits 1eAYantt.tll6n requires the applicant Antioch PEIIIIIImfIIa BaIgMd NamaMntr _._ .-�._.. .._.........._ —... .. . ..........
iii shat be hi licensed'putruhnttotheprovvdim thl,Contractors License Law(Ch epmr9 �., rra$(�arT *'♦�`' , Valuation
' gwa )p[Division JofsheBminessandRpfessiomCoda)
i_t,!,•,j_;�;.�,,,', _ �. •._ ,fys,1!Tr'4"I�t�Jti'
or Nat M is exempt thertfiom'end the basis fee the,alleged skinquioa.Any violation
of Session 7031.5 by any.pplicmn for a permit subjan rhe applinm e c cMI pnalry
,of or mom than five hawed doll.(S500). I(). 10 3APN r OccuP aneY x7 P e
❑l;n owner of the pmpcny,or my employees with wages as their sole compensation, 104 — REBAR t
will do the work,and the museum is or intended or offered for sale(See.]04q i�T] a
'Business and Professions Code:The Contractor's License Law does not apply to an 107 — POOL BO3Q d Inspectlonsl'
owner of Property Who builds or improves Hereon,and who does such work himself 301 - ROUGH PLUMBING I
or through his own employees.provided that 3 0 4at such Improvements an not intended or _ _ _3
offered for sale.If:fimmi.the Wilding or improvement is sold within one year of - ROUGH ELECTRICAL- +" -
completion,the owner-builder will have the burden of proving that M did nor build or ds',,`
improvermpmpneenfaale.). 502 - FINAL PLUMBING ENERGY
°1;as owner of the property,am exclusively contracting with licensed contractors to
503 = ' FINAL -MECHANICAL—ENERGYr,- ..,t
construct the project(Sec.7144,Business and Professions Cade:)The Connectors 506 — GAS TEST
I.
and wh law dos nm apply man ower of property who halide fir improve to
the
r%
and who eanrmcrs for such projects with a comrnma(s)licensed pursuant to the ... -53 0 - FINAL -PLANNING
Cofactors License law.
❑Iem exempt urWes Sec: " B APCfmthismenon 511 - FINAL POOLt'
= owo
Er wan516 - FINAL BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby affnm under,penalty of perjury one of the following declarations:
❑ 1 have ind will maiamm'e Crmficdm of Consent,to self-insure for Wmker'a
Compensation, as provided for by Section 37M of the Labor Code, for the
performance of the work to which thin permit is issued.,
°1 have avd will mtinmin tPohcr's Compenurioai h%auance,as required by Section
37011 o"IC2RUTIFICATID� menca of the work for which this permit's
issued e tt urieraM Policy number tie:
CamyrICY N. OCi ?`j, aerv,f�s; gf {I�: •51-A'l R.li�l�'y,;: PI[IL'h,'
MPnON FROM\ORKERS'%
COMPENSATION INSURANCE•.• !'"• . .____ __.._.__..____
a . ,_-.
]`rrbn veld.need nor be completed if de permit is for on husMnd dollenj';1•.-
(31M)or IcuJ
'
•
certifythat nN1which lhia penal aimed.]Ca employ anyromote any mummer 6 is to becoe subject m Na Wprken'ompensation Laws ofCalifome. `
me Dere
NOTICE object
APPLICANTer'sC mpensiti this ovisio s-6fthate Exemption;you should
lissome
c ikitsu comply the Workers Compensation provisionsll she labor Cade;you moot
Q O fonliwith comply with such provisions m this permit dull M deemed revoked.
Za7-�
CONSTRUCTION!ENDING AGENCY, ..l ` .., __..
I hereby affirm that then is a contraction Ieialing agave;far Ne perform nce -.
of the work for which thsPan rs is nsue4(Sic 301 Cb.C)
Under',Name
z LcndcrsAdd s OOn
1 certify that 1 have read this application and nate the the above information is
ta+'tr'. cement.l agree to comply with all city aha county ordinances and stem laws mlming
Q U in W ldangc unction andhereby asithomize representatives of thiscny to enter upon
y tgt tMabase menuonW,property fed inspect purposes. -
[�-•, ps; e) gotokaa nadmmdfy swl keep hatmlessdie Cary of Cupenanoagainst
fA lieb 1 r )dgmen%,cos%end eapenus which may i.any way acerae agues said
City .sequence of the granting of Nib permit
qPP
' ANT AND WILL COMPLY'V✓ITH ALL NON:POR•IT"
so 1 0 Issued by: ate
D
Re-roofs
- HAZARDOUS MATERIALS DISCLOSURE "
a• sed the ippliant m These ip Il Ce aavpant atsx or hutlk Health a matenal Type Of Roof
u defined by the,Cupenano Mumnpel Code Chaptm 9 12,and Jae HnIN end Safety
5324) r n •'• :': ": .f Y 'i '.... .f1IL �p+ �'Se.J..: 1{,a... d`.,,;Va-e 1..._• _a _ _
Cede Section 75 + i
-All-roofs shall.be.inspected,prior to any roofing,material.being installed.
-, Will the applicant orPanama building acupant um equipment ordeviccewhich If a roof is installed'without firstobtainiri an insecti6n;Pli'-eebiYemove
emit thermal en contaminants n defined bythe Bay Area Aar Quality Management g P
Dismn] all new materials for inspection. Applicant-understands and will comply with,
°Ye `(0 v all non-point source regulations..:.
I hi 'cad ' Was'miierials sequireanrn%trader Chapter 6.93 of the, r
CaliPdmie 61N& eta Cdde,'Satiom 33503,35333 and 33334.1 understand that _
Bric Wild i gd c no tenant:that it is my responsibility to notify she - - - - -
fir o N must M mss Prior to issuance of Certificate of
p. ._ cc nay
_Signature of Applicant Date ,.
owner. nee m .' o.e All roof coverings to be Class"B"or better
•. I in OFFICE