02090178 CI BUILDING N f UOPERTPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7544 DUMAS DR TARN' S CONSTRUCTION 020901y�E78
08XE�MEHUI 43 STILL BEACH CT APPLIcO9�UB D
26A/ 2002
1 PHONE: SANITARY NO. CONTROL NO.
(916) 392-3262
o re0 ZO ARCHITEC iENGINEER: BUILDING PERMIT INFO
<W— BLDG ELECT PLUMB MECH
u u u u
Hi LICENSED CONTRACTOR'S DECLARATION
se=`—'0 1hoss 70by affirm ivihat in3 ofilhe B�s,.;vinlons ofos Co!c (commencing CLEAN OUT Job-DeySRrSp[ n��
FwM_w wi S«ion7000)ofDtvision3ofthcBusi undPro(csionsCodeanJmylicenu IlU'CIA
y y is i u (area and ef(e _/
Obe
w u Lic Class Lic.p
w3LL S °r OCT 1 0 2002
ARCHITECT'S DECLARA N
O 1 understand my plans shall be used m public records
r
w6p0 Licensed Professiowl ��'�®���
u I hereby affirm that I am OWNER-wimp Efrom the omDECLARAmccttor's License Law for the
Z< following rcamn.(Section 7031.5.Business and Professions Code:Any city or county $1500
Sd w which requires a permit to conswet,alter,improve,demolish,or repair any structure
i 3 pn m u c also q the applicant for such psmn to Blc a s 9
indiumnam, — ❑ p�
that hp sc^ seJ puisuvni in the provisions ofthe Contractors V«nu law lCh p< 9 - ..s35ii]t0'I.I�YA�a t,iq ,l`�t,l:;, Valuation
( gwith Seca gt%p)of Divison 3of,hb Business and Prafessons Code) `(!:'ti•I
or that he is exem t therefrom and the bass for the aIle ed clam ren.AnY
Pk p viola on
of Section 7031:5 by any applicant for o pe.it sobj«a the applicanrto a civil pendft
ry
lot am me ban five hundreddollara(s500). 106ARN$'P?G0IJ!�R & WATER r�-a>,1�;•., Occupancy Type
❑Lasioneprofthempeny.ormyemployees 202 - UNDERFLOOR PL BING
-will do he work; the'swaurc is of intended or-offered for saki(Sec.-703y- - 3 01 - ROUGH P
'Business unit Professions Cade:The Contractor-a License law docs not apply to an tl A(Fnspections'" ``1t t""
of property Who builds or improves thereon,and who docs such work himself 3 0 2 - TUB & OR HOWER
owner
or through his own employees, buiMid nonsuch improvements me not intended yes or j
offered sele"IEhoweveCthe tiaildin ��—mtis abld�-ith(-o- �-�- —"--"�-��- -'---- "- .._...._.._-. _ __-..-._.____.__.,.._.
seri pmol pro w ne year or 502- - FINAL PLUMBING"--ENERGY,
en'rostma,the me.d.1c.)rwJlhavemenamenarpmvmgthatheaidnotbandor 506 - GAS TEST
impmvc for puryose of sale).
exclusively
and Professions
h licensed The ntmwctort a
n ❑I' MN ppy•anecunerofprperty hobuiidsoriprs�„"eo h� _ 507_- _FINAli PLUMBING _7 —
consw i the p )n(S«.7llaf,B 1 1 L t'
License L" d ofa 1 to
._Co whore License
(ar.auch
- •, _. ❑lam exempt mide,Set, . %,B&PCfor this reawn
D. ..: .L._
-' WORKER'S COa
" h1PENSATION DECLARATION
I hereby affirm under penalty of perjmy ime of the following dMamd er s:
'�• ❑ 1 have and will in intain Cenificate of CorscnYm self-insutc for Workers
Campcnsatloo,-as provided for by Section 3700 of the Libor Code, for the
_ - perromunce of that work for which this Permit is issued.,Ir„
❑1 have and wJl ma t Work ,Con Den t I umnce na required by Sinidn
37W'of Me labor Cci for the peAormance of the work for which this pe,nd,is
i s d My W k rs C a' t 1 tar nc« 'an>�Pol cy 'be arc
' a( ; ,IFI ATI NOF E% PTION FROM WORKERS - I 1_y+)` i .'1-, l7. ds 'hs p't,ist.,7s, .?I {4_};+,;, r-lit "' '1❑
' COMPENSATION INSURANCE i`' ' ' � t
ar.. D.
(Tht7 sect nn neeJ not be compineJ f the pesmn is for one hundred dollars 't' 't ',)('•'...'� i.y t ''�;
($100)or less.)
r. .. ...:.:� .. .........
nc
1 ri fy.thm in Oaf c me, wok( which this permit 3 s kers t,,h," ,, r•t E
's
hall of<mploy any ,.n'in any manner so as m become wh)ea to'he Workers t.l... C.: t ti i,.s .. ...
Co pe. r LuWs ofC ltd I Use.- _ "
:NOTICETO APPLICAYf If Rrmak ng th Cnfct fE pt n nhnulJ
Z fiecome sub3enmthe Wa ker C 'p sit p sons of ih Labo Cade you man. mss" "t' ,
zQ fonhwM comply Wnh ch pins s ons nr sh s not shall be dee ned revoked.
_....
'" IherctiY ffrm tits th c st tool nd g gc Yf ih',prf "e � 1'._
bfm ark( M1tch muR nae"d(Sec 10970 C) '-
y ❑ "Lender N . _�. �.. . _. .. __ __._. _. .__ .. ... ... ........ __...__._
-
1 ti fY th t i h J th ppl' s o O t t th I th ba o f don is
Is''F 'otrcp 1 8 m omplY th IIcryasWc tY b c J.mmI Q crng C.7 tab Id- g c t mon a d h robY a Ji ze rep se (t s ftA c'tY t t r u upon
Ur Izt the bo" t d (o t .p tion - /,�
�'l�q iia It W)�rce saem ren fy and keeph red . theCry (Capco reg"Inst d
I pts.. d o genus h ch y in any y ace ngamst said
U z Citpp t cg meg of thi Dc t
APpLIG ( N TA�Q,S ASId WILL OMPLY WITH ALL hr N:POI\Tt-
solm Ns .n , ,, Issued bye D [ Z
"' fApP "' '° one Re roofs
HAZARDOUS MATERIALS DISCLOSURE
t Wil the appl cent or f t ddld' g c w t i- ochandle hatmolims mancHal T e Of Roof.
"a dd f d by theCupertino M c Pxl Cal Clutter 9.12. d the Health d Safety YP 1 - ...
Cod E)Yes.;553(o) s1 N k' 1 -•
'v,*s t d' 4 sk Y n i( i. it :Ir, S•Ift
All roofs SIT 11.be inspected prior_to.any roofmg.matenal being installed. _ _
t... MdltheanPucu tarObiexde nee ireBay®eaAi mot ManaV ichant If a roof is install& ' ithbut first obtainin an'ins ection;'Ii gree'to'remove
mnh Wilt sair cvea ants asturm uildiadby dt ByArcaArQuality Mnagc o ,g p
°L1 c7 't all new materials for.inspection. Applicant.understands and will comply
.
-, o�") all non-poi t source regulations,,, ,
I vc reatl the h u d serials y m ments.and Chap '695 of the
Cis i(m Heahb&Safe ode, tines 25505,25533 and 25534,1 understand that
fifth bu ding down mnslY ve amn t,th t t m ripombhry ton dfy the j"- _-- "' .- .._ _- __. ..--... ._ _
-._ .. .-.
entin the m. M1 moss he mst,pr or w v nee f,a Centfscatc of. — r.
°C s a
Occ paneY. ,. w
'. .:._ " .._ ._.:.'- _ _ ._Signature-of Applicant _. ._._ .. ._ ._ . ... Date
-, Praa ate,:.. All roof coverings to be Class, B'or better
-OFFICE-- ------
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