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011200401/ esz �oFC YUl v~i¢n -5v 33CC ca T 3�OC I-za ad d, c a3e CITY DIEOo • CONTRACTOR INFORMATION: SIN' PERMIT BUff O yyL,ppI�NNCO; qp TASTINE AV THOMAS PLUMBING INC PERMIT NO. 01120040 0"ET565i1c1TA TONCEE IPHONE: 15250 BOWDEN CT "Pr1L A%ibS/n���I (408)736-3050 SANITARY NO. CONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMI1 INFO ELECT PLUMB MECH rii LI I_=7 I..._I LICENSED CONTRACTOR'S DECLARATION I hereby afli%mlhal l am licensed under provisions of Chapter 9 (mmmencing �1o1,.� REPLACE 40 GALLOl�.esk HEATER with Section 7000) cf Division 3 of 0e Business and Pufosi°m Code, and it, bceme in full force and ef{1���c'�pp /u,/ Liexin Claa}rss�;�r—l.J * 5 O-( U Lica_ Date �l,VI V' Contractor ARCHITECT'S DECLARATION 1 be D� understand any plans shall used as public mcoNs Y F' p V, A L E Licensed Ymfessionol OWNER -BUILDER DECLARATION 1 hereby affirm that Iain exempt from the Comraanr's License Laxhim, C 9002 FEB O following reaeon. (Section 7031.5. Business and Pm es ser, Code: Any city or coumy L J $500 which requirea permit t° con o- ct, ahca improve, demolish, or repair any mature prior to its' I reports chile 's dstatement ..... .._. _. .. ... _._ Valuation prapplicantf is L that he licensedp u n thep of the Contractor's L la ode)A(���® Sof the Business a Professions cme) (commencingis a mpt the mom f he basis or that is exempt therefrom and the bus for the allege) exempt on. Any violation ®rGLa io of am me ]03L4ny any hundred 11 rnra permit subjects the applicant a civil penalty , of am merchant Bre nandreadnnara asoo). 502♦PN NilMdtL PLUMBIING ENERG`Dccupancy Type 01,.,—anoflhepmpeny,°r my amphora, wins wngea as feticide eompenaadnn. 506 — GAS TEST will do the work. and the sounure is not intended or offered for sale (Sec. ]814;_ bU/'pectlonS Business and Professions Code: The ConlroduCs License Law does not apply' to an awns r of p,,,,oy Who mild, or improves thereon, and who does such nark himself . or through his own employees. provided Inns mets such improvenart net intended of "of&rcdfor sale, If. howcixr.lhe building�-` tis sold within aria f"'"' or impmvcmcn year o _......__.._....._..__.._ ...............__... _._..._... ____......-_...__ .. c fthe owner -builder will M1uvc the harden of proving that he did not mild or impprove for rove pumosc of sale J. ❑ L sr ownernrjes property, am aclmlvela withodenxd commmon ra - ' one wen the project (Sec. ]tea Business and Professions Cme'J The Contractor's d Professions law docs not apply no.j owner °f property who builds Linand '' -• h and who ontracts fLess proleazainh a conuactmfs),IicenseJ pursuant to nhe ..improves to the . _.. .._ _ .. _..... ... . .. Cunoamr's License Lax. . ... .... .. .... ......... . __ __.._. . - ❑IamexemptunderSec. ,B@P C for this reason „ , Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations. ❑ 1 have and will maintain a Cenificane of Consent to self -insure for Workers Comptorelm, us provided for by Section 37W m the Labor Code, for the performance of the work for which this .if is issued.. . 711 have and will maintain V.'orker'a Comennuaou lnsnrance, as requited by Section 3700 of the Lilet Code, for the performance of the work' for which this permit is Izsoed Mppyy W ker s Comllif !an on Insure c c and Policy number aLre/ � _. ..:. _ .. .. .. Cart 9t' C:T/I , Policy N ©o1.9. f -f - I .. .. . _... d +CERTIFICATION E%EMF COM INSURAOM'N'ORKERS', ,,, � , ,• ;COMPENSATION INSURANCE'"- (11,inpunini need nal be completed If the permit is for one hundred dollars ' ISI001 ml,".) ' I cert ry Ih n n Ifi xidimmem& f Ine k f h eh perm t - - "' •. . - _..., . _ . _. ,. . ,. shall nal employ any pe an e son n y manner in as to become subject to the Workers' ( : V. cmm,maadnn Lowa dreabrortiia. nate. Applicant ., -, .... NOTICE TO APPLICANT: It, after making this Cenifca¢or Exemption. you mould forthwithcomplyMittprovisionsor tum Permit ons° be dLabor Coded, must forthwith comply with such provisions or permit shall be deemed revoked. " `'• - m CONSTRUCTION LENDING AGENCY" " 1 hereby affirm that nncrc is a construction lending agency for the perfonnintt 'of N1 work for which this permit is issom Sec. 3Cir. ., Lender's Name .. ::. ......,;... ., : .�_. ._.... ...: _ ..... .. ..._ .._ -. _.... Lender Address' .... ... ..:.. ._.. 1 certify than I have read this application and state than the above information is ' correct I agree 10 comply withall city and count)ordinances mining to building construction. and hereby authorize repressintatives ofshis city to enter upon ,he am mom p,.,M, for inspection p p (We)ago'n s` de d keep hm lesthe C lyof pertai against liabilities. judgments, costs J expenses which y' yway c agm said _ Any in tof the granting of ihi% Permit, /Jaws �state 'ANTI'NDERSTADAD\VIL! COMPLYWim ALL NON-POI Anc� 1 Issued by: Date0C) aRL Stgnuve or Appbcanv ntmcmr .- , .•.. •. . Da�j Re -roofs HAZARDOUS MATERIALS DISCLOSURE will thinpiplicam - remain, Infiddingdocupsaild6reorhandle naam°aa material -p _. Type of Roof as der y 1 C d Chapl 9,12 nJ th hl hh d S f ty . _... . Code Section 255321 7 - 0 Year 0._All. •. 'um -' roofs., shall. be inspected prior to.any roofing material being Installed. K'peal'ant 1 t b lding pat eeaAi I ee swum emit hazardous b te m u defined bribe i B Area At Q mny Management If a roof is installed without first obtaining an inspection, I, agree to.remove °ice'"" _ all new materials for inspection. Applicant understands and will comply with "non all -point source regulations. 1 ha read the h d t •rials y ums and Chapt r 6.95 '`of Be Calif H elth & Safety Cod : Sarum, 25505 5533 and 25534 1 understand that if ebuilding does not currently have a moans that in is my raponsibilinY no notify the re 'psc mon be «rep f the re ut merits x• - h met prior to issuance of a Certificate of oc pa r . — !^' I � U40 0 / Signature of Applicant Dale All roof coverings to be Class "B" or better owns contended agent - "' e '.i.; •� ... .. OFFICE . ... ....