00100198 cI RUILDI GuPVIRONNo PERMIT CONTRACTOR INFOR iktI ;
MATION:
BUILD]NG A DDRESS: n , PERM]I'NO. "
DD"I b0'l70 ..
OWNER-SNAki APPLICAn00Qt Q01.98 -
HONE: 10297 5 DE ANZA BLU SANITARINQtO/,�,pf4tlL7f f0y,
z Y ARCHITECT?E- GINI31ik:
O O ' (408) a83-0618 dU11.1y1NG PERMIT INFO
tlLW ELECT PLUMB MIiCH
7 tun
LICENSED CONI RACTOR'S DECLARATION
o�=9 1 h -br union m T 1 need I p ":I I Cha t t sort„• :_ - Job Description- .. ,
wimb I 7000b.1D 1 tlhe Hu” dP h �
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g I understand my pl em W noes .p nr cord. WATER MAIN .
�'o Letnwd rmreash,nm - - r.� , .. .
o OWNIiR-BUILDERDECLARA'1']ON - a
1 hereby stunt that 1.,It ever",from the Conlmdnr's Licence Law for the -
t Z a following farm.(Sac,ion 703 L5,Haziness anA Ismfasiom Calc:AnY city nr nonry
O which requires a permit to construe,,alar,improve,demolish or tapir any structure
pnorm its issuance.also requires the applicant for such permitto rile a signed smmmenl --
hat heis mcmalpursuant
nnnmdmpmvmmoneormeContractor's License Law(Chapter p Sq. Fl:Floor Area Valuation
with Semon 70(Ko of Division?of the Hartness and Prefessloas Code)
or]hal he is exempt meretioread the basis Iia the alleged e.emryion.Any violation _
of Section 71131.5 by any applicant for a Permit.subjects lime applicant In a civil penalty
of nm more man five hundred dollars($50(). APN Number Occupancy Type
❑1.as owner of ee properly,or my employees with wages as their sole compemation, $1200
will do the work,and,he structure is of imendcd or offered in,aide(Sri.7044.
Badness and Profession.Cod.:'IheContmcmr's Lieanm Law does m( ppI....rotRequired Inspections
o� r nl'p,a,ny Who buiId,int impmsee thereon,and suIt.dosuch'wmk himself - ,
through nit ramemployee..Pss Provided mat such improvements are not intended n' , y ,,.>561.7067. 00-
offered for sale.If,however,the Wilding or improvement is sold within one year of
completion,the owner-builder will have the burden of proving that he did no,Wild or m
improve far purpose of sale.).
502 -. FINAL PLUMBING. ENERGY,
off,aet the onhc"(Sec 7144.Business
yd mm cdttion,0eetl+see Contractor 506 .GAS TEST 'License
taw "rosea(Sec "1.1 onsets ane am whom Calaa'Um Conuocmr's - '
amere Lawdoes naapply man ownerof acanderwino Wadsorimp mveathereon. 507 — FINAL PLUMBING .
and who connotes,Licefor zuedm projects with n commmoge)licemnl pmm�anl m,he
Qlbl attars License LBW.
Alam exempt under Sec. ,❑&PC fnr this reran - '
Owner "nate
• WORKER'S COMPENSA'I ION DECLARATION
]hereby talion under penalty of pe,jmy one nl the following declarations /
7 1 have and will maintain a Ceniicme of Comment to self-ineam for Worker's
mpensminn, as provided for by,Section 370() of the Labor Code, for ,he jO
pedonnunce of the work Far which lhis'pennit 6'issuat. - ,
r O❑1 have and will C,Aa.n Worker's omecn,uCompensation Insurance,r required by Seddon
issue of iy W kFr Cniar for me,perfomdeec nl'Inc wad for which tis permit ix r
issued My Workers Cnmpem:nibn lnsamancc carrierrand
'Policy number,are:
Cartier�x a'Nwri`. Policy ITO: _I Y
CEHTIPICA'I[ON FF.Policy o- h OM W( t
COM]'1NSA'fION INSURANCE
(ITis xaion need not W completed if The panni,is for one hundred dollars
(sIf0)ur less.) '
I randy dent in the performance of the work for which this permit is issued,1
shall no,ant to any son in an so its in become subject r me Workers'
P Y Y per y manner:
1
•Compensation Luws nl'Culilbmiit.Dote s -
Applicant
NOTICE TO ct to the ANI�Work rs after makeg to,Certificatesof of Labor io de,younuls,
became subject to the such
Cnmpsnsmlon provisionsofine Labor Cade,you mn.n
zforthwith comply with such provisions onM1in permit shall W JeenmJ revoked. - _ -
CONSTRUCTION LENDING AGENCY -
' a ' I hereby Minn pan Ihmx Is a ooanrcdnn lending agency for the perfommnco - -
W of,he work finnr which this penal,Is issued(Sea?Uu'!.Civ.C.) '
0. Q Lcneer's Numc s
U Z Lender's Address -
U 0 I certify that l have,read This applicatimt and state that[tic above information is
I'st F carter.1 agree ,,comply with all city and«mumy orrinaaces dad slate tows relating -
'Q U ,R,buidng corora,,ion,and hreby uuffienue rcpmexmadves of 0"'c,i,y,to enter open
y r� ,he alovaen..dioned properly or inepeclion pumoene. _
,(••t' 6 . (We)agree to save,indemnity and keep hmmles,the City of Cmenino against
h liabilities,judgments,cons and represses which ivy in any way:ucme.gains,said
City inconsequence of,M1egmming ofthis l,rmi,.
,SOURCEAPPIACAbT`UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINET REGULATIONS. Issued by: (� Date.` 0 .-,? d_r/lJ
Stgmnnraof ApplitamA0an1rmlor - - - Date, Re-roofs - - - -
HA7.AHDOUSMATERIALS DISCLOSURE - ,
Will the applicant or future Wildogneattpum smreur handle haremdous material Type of Roof,
as defined by the CUPcninu Mmucipal Code,Chapar ti.12.ane be Health and Safety
Code.Section 35532(x)?
WY" 0N All roofs shall be inspected prior to any roofing material being installed. '
will The upplicotn nr l'umrc building bycapam rase nlulpnwnt nr dcvius whitM1 If a roof is installed without first obtainin r all inspection, I agree tosremove
aril hhimdnux tarronlantivndx na Jetinee by the Ray Area Air Quality Menagemem In P g
Di%ennO va> •p No
all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
1 have read he hazardous nuar als'rcyuimnmens under Chapter 6S5 of the -
California 11"Ith&SafetyCede,Secants 25505,25533 and 25534.1 understand mat '
if the huildin•J�ts nm
'an'
huvaatecou'lhulilkaryresponslhibitylono,ify The '
up o m:mcyui cry w ich snow be mel prior to issuance of a Certificate at .
r tD_•lcj.�,� Signature of Applicant Date
OW,or mahnnocal agent l / Dir t All roof coverings to be Class "B"or better
OFFICE