02030098 OF
CI BUILDI G DIVIiSiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10451 FINCH AVENUE ABLE SEPTIC 02030098
OWNER'S NAME: APPLICATION SUB DATE
Adlki ALLAN, KEN 949 OLD OAKLAND RD 03/20/2002
PHONE: (408) 377-9990 SANITARY NO. CONTROL NO.
'
O C ARCHITECTIENGINEER: BUILDING PERMIT INFO
n:r- BLDG ELECT PLUMB MECH
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?i LICENSED CONTRACTOR'S DECLARATION Job Description
e 1 herby affirm that 1 am liccnud ander provisions of Chapoer 9(commencing P
t-Z, wi,h Scnion7000)ol Division 3of the BusipCss and Profession Code.andmylimmvu SEWER REPAIR
in fill f e and effect. N
e w u Linens Z_r - d Z Lic.s 6 77'd 75
i LL u.y Darc cam r
r ARCHITECTED ARA1HN
O I understand Or,plans shall M used as public rands
Y
i a e,or Licensed Profcssiowl \/
u��,a OWNERaIam BUILDER DECLARATION C
I hereby affirm that I nm exempt from 0e Contractor's e:Any
Law for the
h¢M following massa(Section Aonstr Business and Pve.de o demolish,
Code:Any city or county �$:2 5 5
Y O which requires a permit to comma,alit,improve,demolish,or repair any structure
poor to'nIsom, the Pplt tf h 't tocense gawGsmrmet - _.___ ....-._ _.. ..._._ ..__- ...._
thinh sl led pp v0m7o the p , n of the Contractor License Law(Chapter 9 p� _
(ram a th Sect om an fD i 3 f0 l i es.and Professors Cod)
Col e'ti31 _ 'F'-. T '-rt Valuation
or that hero exempt and the basis for the aIle ed chem t'on.An �����' "'�'�-�CLi r.'.� 1,
p G p Any md,
of Section 70315 by any apPlicvnt for a permit subjma Ne appliam to a dull penalty
;of no,more than rvehundred douaa(s5oo). N�106PR & WATE IT V; Occupancy Type
❑L as owner of tie property,or my employees with wages a,their sole compensation. _
_wlll dd the work.and'the structure is not intended or offered for sale'Sor:70ii, -- --- -- -
Bhsiness and Paoressions Cade:The Convector's License Law does not apply to an
ownersu3 01 - ROUGH P$@9Mi�I1I$Q3Pections
of propm
property who builds or improves theon,and who does such work himself
or through his own employees.provided that ch improvements are no,intended or3 0 -2 TUB & OR SHOWER
'olfrred ror.ale:If:nowem.die buildiM1B or ithP.dvement is sold aithhdnd yea,or .-._.._..-. ___.._._ ... .._ _ __ -_-
minipletlon,the w,ure,mider will have the burden of proving that he did no,build or 502 - FINAL PLUMBING .ENERGY .w•
improve for propose of sae). 5 0 6 - GAS TEST
Lownegofthe withliccnud Contractor's ro --'-'---""""' -'-- -'
- propertr.mnearwsivelrconweting 507--- FINAli-PLUMBING.•_._
License
construct the does
no(set.7044.Business and Professions ills or Theimproves
Contractor's
License Law does hat apply man owner of property who builds m improves thereon, _
.: _and who c .far.such Dmlens with n convanor(s).licensed.pursuer la.the.. ... __-. ..__ _. _
._. _.___._.............. .........
" .- ConContractor'sor's LiermLicenu Law. __._._ ._ ..._._..._._._____.___......._-_._._._._. _._._....._.__
❑lameamaotinder Sec :•' ';B'kP C fonhis mason
ownrJ)e 0. g, at a, —Zo
- Dn i
WORKER'S COMPENSATION DECLARATION
l hemby affmm under penalty of perju y on,of the following de<lartions:--
�•❑ i hive mid will maintain u Ccdifc,ne if Consent�m self-insure for Worker's
Compensation, as provided for by Section 3700 of the labor Cotler for the
performance of the work for,which this permit is issued.
-- ❑I have and will'oami;in Worker's Compensation Insurance,as mquirm by section
37W Of the Labor Code.for the iscdoimham,of the work'for which this permit is
ssued MyW k -Co pe non uih cam dPoliryn mbe
`� ..FF .......,._._....maw -_._ .. _..... ...•..
ypm ].5/LR7,C �OrOFEXlicy .._-
J' L CERTIFICATION OF E TION IN N FRAM WORKERSS L t.D•�:j . i. . 'c4 i. f i. c. .1 .3 +;.
COMPENSATIONINSURANCE l :
(Thnaeaion aced not be'complfted if the permit is for one hundred dollars t' : id;l'"':"" '•pr: {I;y'LD7:i'i:\' ' .:1C
HIM)or leas.) � _ -
enpl N t n th ped n cn.Of he o or be hieh u perm t- saved,' - - - -shall not mploy any pc 'n any manner so as to become subject to the Workers `
Compensation Laws of California,Date"
Applicant.. ., :,. ... .. - ..
NOTICE TO APPLICANT:If,after makin th Cem � _
6 mama empuooe,you moo, "- -'--------- --
Z becomesubjectto ya,u Workers prCdion,or this provisions of the Labor Cade,you must
C
fonhwitn comply with such provisions n this permit shall be deemed rooked.
�'; � iCONSTRUCTION LENDING AGENCY -" - -- ""-
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a 7 'I h by iri-',hat Ne donswn o le dine egcnry Tor We ped minnce
Lend 'Nm .. ..• ._. ._ .._ __._ .
Lenders
7
V'0cenify thai lheve mead thiso lication and smm that the about information is
Q�+ [-t cgtrcn:1 agree,o,comply with elPcity and county ordinances and star laws relining
,L1 to building conwciion:antl hereby authodidrcprcunrtiva of tali cirymemer upon
}.til the abort-mcmioned pmpcnY for inspection purpous. i
ogre to'sa've,indemnify and kup harmless the Ciiy of Ctipenino'egamst
h liabilities,judgments,coats ane eapcnus which.may,in any way accme against said
C�,y Ciry in conuquence of the Granting of this permit.'"`' "' "' `^"•
APPLICANT ILYDERSTANDS AND wlLL'COMPLY wITH'ALLNON:POtIdf ' i .
' " :_ so RceEeutiAnoNs 1 :•• -,. . Issued by: Date
w pawC tet •J`'`Dam' Re-roofs
\ m defined b the Co "ZAMOn Spat Cg examfMATERIA S DIS9 Lto l :'•
will the ppl cant r rte w la g crap t aur Halal naffiddux material Type of Roof_
Y a p the Health and Safe,,
Code S cto 25532( ) _
'P , - _
, 't�, 4 t All roofs shall be inspected not[o any roofin _
wn the tanto rut rb tan «r ,u -.. . . P __P _. g.materlal being installed_. ..........
w s p q'AcQ t dee when If a roof is installed•without first obtaining atrinspection{ I'agree'-[o remove
mil h aardo s air co tam t as defined by J Bay A' 'Ai Q ry M'nagemrnt
all new materials for inspection..Applicant understands and will comply with_
- L7Y T ._ o.. q p . .._ .ill
all nor=pont[source regulations
` 1 ha red,the heti .do,S t cels 5 a rem ¢'under Cha mr cram f the
CalifonaHealthso,moC'a)c.ave ahs255(15it
and25534. undenotif that
Pa Y Lipo iblrym notify th
if the buildingd«s nate dy have s,tenant.that t sin res
O co t of the equhem nu du h m sr be to t pn , ,x a e of a Cerci fchd f
Occupancy
Y _
Signature of Applicant Date
- -
owner a too tido age, , . Date„, All roof coverings to be Class"B” or better -
..OFFICE --.