02060001 CITY
t BBUILLDIIN DIIVC1ISSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10154 DENISON AV WATER SYSTEMS PLUMBING 02060001
fOWNER'S NAME: APPLICATION SUB DATE
SRICHARD KAIDA 3844 HEPPNER LN 06/03/2002
PHONE: SANITARY NO. CONTROL N0.
(408) 266-8222
G O zp ARCHITECT/ENGINEER: BUILDING PERMIT INFO
to BLDG ELECT PLUMB MECH
Z' LICENSED CONTRACTOR'S DECLARATION
C 5 N I hemb firm that 1 am licensed under, Job Description
Oz"•0 ya prp visions of Chaprcr9lcommennng
H"aa with Section 7o00)of Division]of she Basin,
Profsssions Code.and my license RE-PIPE MAIN LINE .
�§st E-a is in full f` p d effec 9 ,//'
ttpwu License Cl
n G Lica �D
it
HITECr'S DECL RAT'
} 1 anderuand my plans shall be used as public records
a'n o 0 Licensed Professional
OWNER BUILDER DECLARATION
m to 1 hereby affirm that 1 am exempt from the Comranor's License Law for the
C?< following reason.(Section 703 I.S.Business and Professions Cade:Any city or county' $6000
Exp which requires a permit to construct. wrt
.alter,improve,demolish,or repair any scsu
63�of
-trim Laos issuance,also req ' theapplicantfor suchpmiu
erofile asigned ssamment
_
that be i.slimnsed pursuant to th provisions of the Contractor s License Law(Chapter 9 5 � F,1QOr�rEa Valuation
(commencin with Scctian7 of Division J of the Business and Ymfessions Coda ;`i.k, F L UUU f"• ' �,-i'. .
or TheNo is exempt durelosid and the basis for the irkied exemption.Any violation
- of Section 7031.5 by any applican{for a permit subjects the audivam to at civil penalty N,,mt,e�
mm
f no, omflun Ove hundred dollar,(SSW) 202APN UNUr•KFLOOR PL BING " Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation.
-
will'do the work:and the structure is'not intended or offered for salt'(Sec.-7044: - --- - - ROUGH PLUMBING
----- -- - --------- ------._--
Busine sand Pedfossions Code:The Contractor.License Law does not apply to an 502 - FINAL PLI RgtATA EIslFF&RrY , ..
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements are not intended or 50 7__-_,.F INALPLUMB ING ._._. _..- _._..._
',pficmd for le If hoe thebuilding p s s s.Id wuh n one year of -- -—"- _. - - ''- --- --
coinpl f n,the owner-builder will have the burden of proving that be did not build or '• '- `
Improve for purpose of salt.).
01,
aiownerp the progeny am exclusivelycontractingi ,ithocenxde Contractor
in s p p� - r
nevem the does
n (sec 7044,Business der f. s endo)The venther o z �� f�t3� �,• ••
License Law d«<not apply m an owner f p openy who builds or reproves therethe.
_and who co murb for such pmlecrt with .contmear s)Lcensed pursuant m the. _ _ .-_-._.. __ _._ --_.____.
Conoamor's License Law.
❑l amenempt under Sec.""� .B&P C for this reason �P11� '.y: 0,;0L G
00')
Owner.- .':.},...Dme .. . ..'..t'
WORKER'S COMPENSATION DECLARATION
�: ,.'e thereby urfirm under,penalty or perjury one of,the rollowing dcelarations:� BUILDING
❑ 1 have and'siollmo itemn'a'Cenifica t of'Consem to self-insure for Worker's
Compensation,-as provided for by Section 37W of the Labor Code,-for the
Performance of the work for which this permit is issued.
❑1 have and will numbLin H'oiker's Comptniationlmforrou Ss required by Section
- - 3700 at the Labor Cade,fur the performance of the w6rk for which this permit is
', is! d MyW k 'eC pe ton lobo' c rtie dPul y robe are' '
�5�� � __ ...._. ...�..,.,..�.ori...........,�
,./ .0 .POI CYPZ y`— i \' r•a taws { r-.0 vT•,1Se3
\✓`f {I 1 IR17FICATIOMOF EXF.M ION f WORK RS I:. � f t p�.
' ' ' COhIPENSATION INSURANCE s"^� " • ' v •
nlhis Lee"tion'need nm be completed if the permit is for one hundred dollars '-kf s' , , ,I, t.__,,,'t,., l_•." ""'-«' «..
(8100)or Inst
.I cert fy th n'n die 6tfvsWceis
z '
.
r, work hick dpermit
ss Ithan t mploy any incision n nriorw'as m tiecnme object rothe Workers
CompsnsaionLawsofCalirdm.Doe
Apl¢
NOCaEnTOAPPLICAYT 'Tffimak 8thCertificate Eon you should
Eec tt t b) a he Wokii C us , p ofh Labb,Cod you most
. th ply eh ch p __ permit hall be doomed revoked.
;:Z_ "• Ht t I"I'CONSTRUCTION LENDIYG•AGEYCY '�'" ' � --
C:> I hk fin whir.[this permit is issued(Sec.
k1 Civgency for th6 t+rfurmance' ,.!`:.f ' r
.., Leib okm tichthsp its ed f5 e'lC9i Civ,C)
y,C Lend',Name-�.su , . . ,.: . .. v.,.;.., - ......__. ... _ _...__.
=:Z IindersAddreaa ,....,- ... _ __. ....
V 0 1 certify that I h d this m d n that the above information is
f�F. cur t 1 agree fit comply with all any nJ my d' rt r, testing
Q:V rob Id g construction:still h by arulbmizm represcomtises ofthis ct to enter upon
the bo e e t a ed propsny,r r inspection purposes.
hat
�.L (N ) g eiu'sa d m fy and kttph nan Cty '.0 peal o3g Laid
V
Cityleah, co l dg ems, t d pens h h Y in ^Y Y c against said
9 h 8
APPLICAY" S O - .D LL COMPLY WITWALL nD>'POI T y- �+ TT /
gol'RCP_+ Issued by: Date
,,train n p icanr/C m r f„' am O'
HAZ\RUOUS MATE S DISCLOSURE ” Re-roofs
w n m ppr na, r tore, lane ectapanincre or h free has iii,mated.[ _ Type of Roof....
�J f dbyth C pen M n p{Code CM1 pr 91Zt drh H lth ndS f tY "- - .., .... ,, T.............. m.
Cod 5 t 2551(al - x• - 1 i
❑Y f a•k, t � - ! 'i' fk f •.i .r,..�t ;{Y \ • ..
_All roofs shall be mspec[ed.prior_to any-roofing,material being Installed.
W n In uirc ;rot r t b ming c y t seaequipment ate c.em n If a roof is instal ;without first obtaining an inspection; Pagree to remove
errinh and 'd Area Quality Management
°iii- N _all new mat ria for.inspe on. Applicant understands and will comply with
i qu', _ .. _ .. .__._. ._
m v c the A all ❑On- [ nrCe Ce OHS'
(
❑Y Y Y
I h d the biz donsmammaal requirements under Chrpt 'ti of the _California H hh&Sff ry Cale S coons 5505 288]3 and 255iJ de to d this
f thcb Id %does no- dYh a,-thus Yrcspon bl'tyt tfy,he - - �" - - /� Pings
fOscoelaeniate; (7 tp - Z, Applic nt Date
ale All roc coso be Class "B" or better
�. .., , . .. .,. _... .�.... . . .... . ...OFFICE.