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CITY OF G
CONTRACTOR INFORMATION:
PE[iOONNO
DIVISION
IPERMIT
BUILDING ADDRESS:
PERMIT NO.
10291 DE ANZA BLVD
THOMAS PLUMBING INC
01060089
OWNER'S NAME:
APPLICATION SUB DATE
ALLARIO ROBERT L AND ILDA TRUS
' PHONE:
321 E WASHINGTON
06/14/2001
SANITARY NO. CONTROL NO.
(408)736-3050
zo ARCHITECfIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB CH
CJ - U _ L=1
z, LICENSED CONTRACTOR'S DECLARATIONJob
Description
escrP
1 hereby.,(firm that I am license undmm
aide, pr..izof Chapter 9 (commencing
da
REPLACE UNDERGROUND S WER.
SithSectos7B0010fDivizion3oftheRadiusssandProfessionsCode.andmyheame in full foie.
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-anP'd- �eaff-�e-c`t�.^
l Lic. Lic. p I L
u License C11;
Te1 sur
< Dae r M I
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ii VVV
ARCHITECT'S DECLARATION
g 1 undemand my plans shall be use as public records
O Licensed Professional
ca OWNER -BUILDER DECLARATION
11 1 hertby affirm ma 1 am eaempt fmm the Contractor's License Law for the
afollowing reason (Section 703 L5, Business and Pme,,inns Code: Any city or county
Q which requires a it to consumer, improve. demolish,
$20000 O
permru alter, or repair any structure
at prior to its issuance, alsorequires theuppheantforsachfx..,nit tofileasimvd warm
_
hash I' SeJp n -nothe P' ions.!Jm Co sons. L' W (Chaptc 9
(ui g lhsect' ]WO)[Uvision3ofthe uaaae .
rid Podc,ont Code)
("JsV�A 3471/VV1 f- PF -s
VaiHallOn
or that he is exempt thciclrom and the basis for the alleged exemption. Any violmion
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of Section ]031.5 by any applicant for a permit subjects the applicant to a evil Penalty
ofOut mmethan five handled d.11...($500),
API
..
Occupancy Type t
�4t & WATER
106
.
0 L as owner of the pmpcny, or my employees with wages as their sole compensation,
WDERFLIDGRPLT-
will do the work, and the swcare is not intended or offered for 'sale '(Sea: 7014;
Basinfv, and Profe..i.n. Code: The Cmamcm;. License Law does not apply in an
301 — ROUGH PLRRg1bT*4spections '.
Owner of progeny Who builds or improves thereon, and who does such work himself
or through his own employees. provide'hot such improvements are not intended or
302 = TUB OR SHOWER:
come for sale. If, hr-hold,-Ihc building tir improvement n sola he did one ycaF of
iample..rime.wrier-W11nerwiubavemen.rden.rpmvingtnaheaian.tWud.r
__ -&
502 —'FINAL PLUMBING ENERGY ,� `
mprove for purpose.ftale.).
506 — GAS TEST
❑oso,al'herofthep(S..7,ameacluaivdy nmtmning witM1 licenuJ cantrecmrs'o
507 - FINAL PLUMBING
ons'mn the project (Sec. ](Wq. Business and Professmns Ceea The Cormetnr i
' License Law docs not apply to an owner of progeny who build, or improves thereon,
"'-
T .antl who comrvc¢, for such projects.witb a contmcne(s) licensed Initiation to.the
.. .... . .... .. . _. _ _ _..... !.
Contractors License Law,❑I
._... .
act vm cxnmpt under Sec, t;B& P C for this reason
it �' ��� (';'�l'',i„
Owner' Dine ' ' .'
WORKERs COMPENSATION DECLARATION
,
I hereby affirm urcerpcnalty of perjurymre of the following dmluatiom:
❑ 1 have end will Inalmmin'a C<nificate'of Consent to self-insnrc for Worker -s
Compensation, as provided for by Section 171 of the WWr Cec, for the
of the work for which this permit iz issued.
�perfortmina
;qI M1uve and will maintain Wmker'i Compensation Immo.<e, as required by Section
.77(10 of the Wbur'Cside. for the
performance of the work for which this permit is
- kaddir My Wmke(aG pe.�do'Y Insurance carer and Policy number are
Ce b. 0Polcy No iyy_77'�N
I. _ ..t. r ..,..., r .... .. ... ...._... _.__.. .... ... ........ ...
RUFICATION OF EXEMPTION FROM W DRKERS.
.. i
.._ .�.. ..' COMPENSATION INSURANCE.: '.'_...:
...". ..... .. __-......._ .. ._
� '1 Rnic &also nccJ nm be cOmPlcied if iM1e permit is for one hundred d.11an
' 1 ` - :j'"' ;: �s'
fS1001 or less.) _,
'
-., 1 cenlfy That n the performance of th k r which this permit-' issued:l
-
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scall Orn enphy my parson n any te ua to W,.ama object to the Workcts
Compcnxaion haws sf California DaeApplica'
.. ..
.._-. .. .. ... ....
NOTICE
ANT
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ter g h. Certificate ld
'bt,mme TO AP,, oumust
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-
he Work rs umpiaki
i3O.(E rCade,
bemwithcoecuOththsuch(s Comn, oomiror pears a'oftM1e LaborCade, must
� fonhwith comply with such provisions or this pcnninhall be deemed rtvokcd.
_
" 'CONSTRUCTIONLENDING AGENCY
s 1 h by Iron that the ' - con lending agency for the perf.nnantt
work for which issued S
permit's sued (Sec. 309], Civ. C.1
Lethe
-
:'-Lender's Ndmc - ... i _..._a.-:. .. - ... .-. ... ✓_..,
.. _ - .... .... _ .. .' _.
Lender's Address I .
_.. ... _..._. .. . _. .. .. .-. .
it
1 ramify that 1 have read this application and state dim the above infomtaion is
met. 1 agree to comply with all city and county onliwnces and state laws relating
to building connn...mm and hrmhy authorize repreAenwtives of this city's .mer upon
the alsovementiorrod property r P^ i purposes.
(W) agreet ode fy ❑ ke p boarrole,, the City of stag. ns
,mer.
ts, r and pe es which y'n any Y c gningt aid
Cliabilities.j c
7V -q ice of the gt ins flh P t
•t' N)I LLCOMPLY O'It'H ALL SOV POIT'
OULAT1Ohs .i
Issued by: ate l/O
O
manoContmct.r.. toss . "G=te t .
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Willmeapplicant or future Wilding«Fapant ame orhandle hisrum ui material.
- Type Of Roof _ ..
os defined by the Cuperi no Municipal Code, Chapter 9.12, and the Health and Safety',
.... ... ..... .._ ..... .,.
Code St 255321' l 1
❑Y. cu
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,•.. • , •, 2 )' ' -
'
- All.roofs shall be inspected.pnorto any roofing materiaLbeing, installed.
the ; applicant " budding oce ' use equipment °which,
monh J. umm t JetdingbyheB ArtaQ Ityevicese t�
If a roof is installed without first obtaining an inspection, Pal ree to remove
P
Drsga
ores- - ❑N,'
a e
-,all new materials for ins ection_, Applicant understands and will comply,With.
all non -point soured Teo lations;. . , i
1 have read the h zafdous moterial regmremems under Chapter 6.95 of
Cabfdmm He-ilh & Safety Code. Sections 25505.25533 and 25531 1 understand that
dth-b Id gd not mtlyhale a' tih tit smYrtP _bliyt -inifY the'
c P' i 1 th equir, nt which lout b t p'o to Ixs c f C niticae of
"' - I I /
I l./ e0
_�'
I
f Applicant Date
Al] roof coverings to be Class "B" or better
a.t r sem Date
OFFICE