02080164 CITY G DONPERT
IPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7655 DUMAS DR 02080164
oMIYUNdE. UB DATE
in PAUL W AND TERRY N APPLICATIONS
08/228/8/
2002
im PHONE: SANITARY NO. CONTROL NO,
1
Cat ARCHITECT/ENGINEER: BUILDING PERMIT INFO
.2 BLDG ELECT' PLUMB MECH
�Qw fU O CI CJ
LICENSED CONTRACTOR'S DECLARATION
z8uz R'
I hereby anthm l am licensed com
under provisions of Chapter 9( mencing Job Description
°y=w lfinwith Section 7")of Division 3oftheBusiness and ProossiormCede,and mylicense GAS LINE TO COOKTOP (''DOWN DRAFT)
<yE< Licensllforceand effect FIIyALE®
K 0 z a License Clens Lic.tr 7 tl
a'o U Date Ar
F g O✓n ARCHITECT'SSDECLDECLARATION
so
< I understand my plans shall be used as public records MAY O 7
2002 w °o Licensed Professional
OWNER-BUILDER DECLARATION
o�
vi y I herebynaso affirm that 1 1. exempt from the Contractor's Any c Law for the
G following reason.(Section construct,
Business and Professions Code:Any city or county BUILDINGO 0 0
which y permit t o Int p < demolish. p any structure
prior to its issuance.alsorcq ¢s the applisaint fa such permit or rile a signed statement
n. that he s licensid,mmuset to the provision.pmvi%ion,s of the Crd for License La (Chapter9 -_- -� - - -
(do me<ngwi!hS«uo 70101 fDivision3 ofshe B .nea dProfessions Code)', :'( ?•' '�35 F},0 44St�F a -t,�.�.-If}. Valuation
or that hen is ciFmpt therifthi anil the hu.is for the alleged exemption.Any violation "
-of S«tion 7031.5 by any appli<am bass permit subjects the applicant m a civil penalty
rof,mn mmenwn five hundred dollars($500), 106A �FJRIPSR & WATER ''F``^" Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation.
-will:eo the sick and theCriic:Tstructure is not intendedistLow foes alenot appSeely
to ai-
Susi 3 01 - ROUGH PIRIIP}ii ENTrispections' ,`
t will d s the sick and Calc:The is nttaor offered law dors not apply to an owner -
of property Who wilds or improves Nenan,and who dues such work himself', 302 - TUB & OR SHOWER_
or through his own employees.provide)that such improvements are not intended on;
_—_. _
o c or sae.I,hovicverJ w wavethe improaffirm ng that he
not Wild of 502 ---FINAli 'PLUMBING ENERGY' '>'�! "
Improvdon,the owner-builder will have the wmen o(pmving that he did not wild or
improv<rnrnarpasenrsala). 506 - GAS TEST
ias , tin property.ten es<w:vdy<nmmctingwithu«nsee<nntia<trt 507_.-.._FINAL- PLUMBING_.._ :TI.: . 1 .,. ..)
c t s t th p ) t(Sm.7p 1 Business and Pmfessions Code)The Contract FLC: .... ..t 4..
Lice se law does not apply to an owner of property who builds or mproves themoo, '
_and.whocontmets for.such.projea'ts.with.a.mnvactor(s).licensed pursuant.to.the. ._-_.....__._____._..._......_._.. . ------_---------.._...._._.-__._.-._..._.... _-___..__.
Comomes License Law.i"f.•r":`r,K';na•I;."C':.` - \
❑_Tame e,Pt oder ak B&PCT this mason .1 r,,j;
r ny
yet\. PENSA b�0 Z'
W1O KER S C MPENSATI DECL RATION
c• ". < .1 hcrtbY aflitt unJertpe, ty of Pcijar otic of the following JMamtionx:
❑ 1 Wave'and'will"maimain'a'Cenifiess,of'Cansent`m self-ireare for Worker's
_ Compensation-es-provided for by-Section-37110-of the Labor Code, for the
performanceof the work for which this permit u isaucd, ,
37 T h k lid- Wr C m orthe is Crmlpcn t I auranifor requirtd by permit
is
3700. the Lihoi Cone,for the performance of the wdrk for which this permlf is
'ittued.My Workes Compensation lnsuranca conie(arW Polic number art:
y
_ Cone (4i '.1 re F 'f :s't�Pol cY No J
It
1 )s CERTIFICATION'OF EXEMPTION FROM WORKERS - a.,•,' :x I it ]Y +, it<w_Jl ft i`�i iLy Y7: 1 1
I v ` COMPENSATION INSURANCE' " °".
:)N r
(Thosection`neednot W complded if the permit is for one hundred dollars
r .v ``\f (1' ', _
)
IS101)or lcx.� - - -
-
,ap ,n._ ............................rt.-.,-,.-,...�.,- _ _ _
.v1 ylcn[yth tin 'onin nee°(th kfwhichth parent sissued:l -
Ci n c out ploy y,pe on in n d y�t�oeuatntC hl t m th W ke .� J „ tf,l•. ..
'Cu pest 1 Calif rtIN PS,2�� L
APPppI t�n -- -
swyrflCETOA IC\ Tie mak d¢ nlfct fExemption.- -should
Q 'Z' fonhm th cbJ s en the W 'C M SY
nail th LaborCsd you t
Q ply with p � ns o th t shall W deemed restaked.
'h �' "CONSTRUCTION LENDING AGENCY - ) tli�'•
..a � `O1 ' 1 h by Ifrtn thanh mwa I nd'ng abs cY f th perform• 'e .c
t 3.: t:r
Q 'of the work for wh¢h th pc t s Issued(Sec]097'Civ.C) -
U.O t - _
I n fy th t l ha d th pplicat d sate that th b e f inn'is
fs F' corn« 1 g t cornplY N II a ty.and ty oM'nn« d.t to II relating
Q V Ito bu Id g .w<hon d he by uMo p ten'cs f th ly t emet pan
,7s'[s7 the bo t cJ p pony f 'ptt' p qo -
tid (We)agree7o sena mtlemmfy and keep harmless the-C ty fCpn' o3ganm
W ImbJmes,juJgrrcnts,costs and expenses wM1ic�may,in any xay accrue against said j
V i City n co seq ce of th gr nfn f N '
X SOLRC
'OURr ANT UNDERSTAN KA.�DWILLCOMPLY WITH dLL\ \ OIN o'
Rq uI:\TIo. ;IdT, I o Issued bye Date
t ppl aWW m ao r t
BOGUS I AIS DISCLOSURE 1 Re-roofs
,I Wllth p'l'an rf m t cepa t t.ao handle'haiaN matenat --Type Of Roof �� __._:.. ....._
azdf dby the CupertinoM nc al Cod Chapte 912 nJ thaH IN atMS fty - ` - -' "
Cage Sminm 255321x1 xtil, Ys + • '\'' '+tt 1 '> \ %I '
�11M1le
tj4 _ _All roofs shall be mspectei prtorao.any roofing.material be' g installed _
wn N vpl pn t rfvwrcw Id ng <p t y p t e <s which If a roof is installed without first obtaining an Ins ectlon;4 a fee to.femove
^em t h x a e t t. it f cd by N Bdy A A utility M1I gem t -_ g P $ .. .-
D's 'oY N _ all new materials for inspection. Applicant understands and will comply,,With II , all non-point souEeregulahons. .$ )
,1 hivx ieatl'the h b mmirial - airemenu bndit,Chapter 6.95 of,Ne '
'California Health&Softy Code.Sections 25505,25533 and 25535.I•undemand at
'fim buildingdoes,not correctly have ate Y
. Y nIe that it is my to notify the' - ' --- -
qa t f th -luireme ts which must w met poo to issua ce f a Ceviticme of0, Pit - - '
"' bSignature natuleant Date
f o � .oZ: __ .re of A PP. -
:.. Owner or owhonm a8ct s t . I , ;Die; .;
All roof coverings B or.better ,.
n s to be Class