02050064 CIBUILDING DPvSONO
iiPERMIT CONTRACTOR INFORMATION:
BuHU"M&BYSHIRE DR ABLE SEPTIC PERMIT No. 02050064
oM`&'kHECHFE 949 OLD OAKLAND RD Ap5`5'7T'bsyY®$2
(408) 377-9990
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PHONE: SANITARY NO. CONTROL NO.
In O O ARCHITECI]ENGINEF.R: BUILDING PERMIT INFO
w F BLDG ELECT PLUMB MECH
a`uhf CJ
Sv LICENSED CONTRACTOR'S DECLARATION
vi I hereby affirm mai I am licensed under sof Cha ter 9lcmarnma in Job Description
sy-� Panic t, SEWER C/O
—tw with Eenion](g0) fDivihon3ofine Busi¢csy nd PmfcssionsCWe.antl mylicrnse
' , i.m run rh a n errert /Y'
i rc a Licen3c CI /—/�2 Lis.p 7
%OaG Co
i 3 ti y ARCHITECT'S D¢tQARATIDI
''=y�C S 1 uneeremnJ my plans shall be usetl as piblic rtcoNs
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to
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Licensed Professional
O
w o 2lo,OWNERBUILDERDECLARATION
1 hereby affirm that 1 am exempt form the Contractor's License Law for the
tza- following reason.(Section]031.5.Business and Protmons,Code:Any city orcounty 1000
s which requires a perant ns cnmwct,slue,,improJ,demolish,or.,.it any structure
i3m
ptiorro itsIs qi the applicant for such permino file a signed statement -
- dutneslicensed p imam to the Provisions ofine CommnohLeense Law(Chapter 9 .36`A r�.�y Valuation
(com gwwith Sect 70011) fD' .ton 3ofthe Butmessmad P(Ofai,ons Cod,) E :°+, s Il y s t -
of that he is exempt ihnerefroand the basis for the alleged exemption.Any violation - '' '' s t +' IN
'' '
ur Out
]031.5 by am hundred
dollars
ll ror a permit sunien.me apphtant ro a tint]penaltr 10 GAPN T18$F$DR & WATER
:ornntmnrtthanfi+�enanarcaammrstssao. " Occupancy Type
❑Lasownernnnepnpny,�rmy,mpiny swim agaaameirmleenm n+aJnn. 202 - UNDERFLOOR PLUMBING
will Jn the work,and the structure'is not intended or Offered far sale(Sec.7844;-
Business and Professions Code:The Contractor's License Law does not apply to an 301 _ ROUGH pectlons '
owner of property WE.build,or imirrm-es mere.,and won dues such work himself 507 — FINAL PL B I NG
or through his own employees.provided the[such improvement%are not intended of
..offered foisale.If,however,me loadingo ..._ ..._..--..__ ._...-._..__..-._..._...- -. .-_ __. _..... .._ _....._
e burderddmem n sold within and year or
opove for th rmse of
will have the burden of proving that he did not build or
improve for pntpose of sole.),
Q I f the property. m I lycontracting sld t cors m
n wctProfession,
ua P 1 t(S c ]041 B .' tl Proffsi Co ns Cod.)ThC t noes "
i. License L one, t-pply Ina minor of property who torlds or unprov.thereon,`
he cocis f i inch P injects with t aor(s).licensed p uanrt are . . _ ..,. .. _..... . _.
Coo connote.
i LicenseL /Q --
01 ame pr underSee '. ',B&PCfi mix re son
0.
want
WORKERS COMPENSATION DECLARATION
1 hereb fRrm under h f'
y a pepa, r u pefiun',on,of the rmmw:ng amlamtmns:
❑ 1 have ai d'will mountain Ceniflcme'of Consent to self-insum for Worker's
1 Comparmoon, as;provided for by Section 37W of the Labor Code, for the
perfommnce ofine work fur which this permit is issued.
❑1 have End will maintain Workers Compensation Insurance,as required by Sermon
3700 of the Labor Code.ror the performance of theworkfor which this permit is
issued:My Workers Compensation Insurance carrier and Policy number arc:
po
IFICATION OF EXEMPTIO ROM WORKERS 1.'' ?'.
\ .
...,,.,+�-r._ ... COMPENSATION IN URANCE_+•,"'_., .._ :.... ... .. ........._._—_..._..__..______._.._.___-. _....._....--___.-,_.....__. ._ .__.._-....
^.':'• o or lis union need not he rnmplemL if the permit is for one hundred dollars • .. lit
IF 100 W1 or eza)
- -._ ._.
I n ft'mar ,
shall m e ply any Person in say a to berome Iduoul amdoe Wmke s
Compensation Lama of Californ a Date,
_NOTIC t
N come su O AP,the T If. R making thisCertificate f Exemption,Yo Would'
bedo e s o n th N k s C pc t pro t dud] a lobo Cad y "must -' -
0 fonnwnh comply will it ch prow•ions or this permit shall M deemed revoked.
F N 'CONSTRUCTI°NLENDING AGENCY
a.,; 1 hkfor which thin there' sued on lending agency for the performance
k7- of the k fwhichth pe t ix's cd(Sec 3097 CO,C) - '-
Q Libbl Na .. _ - ._ _ .. . ....... ... . . . _ _. _.. ..
bodkill',Addres,
U -
t: I rtf loan reed th'city
mint,dot thbo information g
A [..t correct.I g t comply fir he b ry d ire ordinances' f d state laws enter
'U aobuJdingronhrvctconstruction. for
bumhnae ar,woes. Lofthucity menmr upon
>e Loa the abo m ro ed save:
y f and k p mar,woes.
[•. L eWed g tom' tactically dkeepha ss the City f e p . against
h
liabilities judgment,Of
e t d pe ses which Y in any y tt g Inst said ra V V
-U Z CityConsequence fthg f gof this pennt
'AIPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON P01•YI' 1
Sr RCFREC AEONS Issued by: Date
�._
V.Iam of Appucanvcnmmemr :; -t - ,,4, ate Re-roofs
„- - HAZARDOUS'MATE RIALS DISCLOSURE - '
: -
Will the apphtant of from,'1xildiiswanpant store or handle haeardauamamnal _.. Type.ofRoof_. .
its act ed by,th Ontar M 'c pad Cod CM1 pt 9 12 d'he H lth a d Safety '"
Code Section 25538a1
E]Tax
All roofs shall be inspected prior[o any roofing,material being,installed.
Will the pprc oil o future building g crecby
p t use ex Air t delimit;'e met If a roof Is installed''without first obtaining an inspection;-1 agree to remove
emit iall us air coma ¢as dcfned by me B y Alex A Quality Managemrnt g p g
Dixn toY_ - all new materials for inspection, Applicant understands and will comply with
\ �1 '`. °;_ ,i: `.:�',; all`non-p'ointsourceregulahons. -
�s I h r,ad the ham d s ar¢rialsrequirements rind Chapter 6.95 of ice
'Califom a Health&Safety Code Sections 25505:25533 and 25534.-1 underhand that
" � mdo Y mon,Chit it is my msponsibiliy to notify the --
t the aobuildingdoes nes commonly have a m
occupy "cqumcmenm which mustbe met prior to issuance ore Cenifcate of �Z C/9gl Y7J L/
Occupancy. t ., . ., .
:2�P.c/� ,// yyeiK )V L Signature of Applicant Date
. ._ r . . . _
own n thp ma agent D m All roof coverings to be Class "B" or better
u,.
OFFICE . .. _ - ....-.