02010070 CITY DEsoNO
IVttNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20818 GARDEN GATE DR ALLSTAR PLUMBING 02010070
OWNER'S NAME: APPLICATION SUB DATE
DUANA NELSON 656 N KING RD 01/16/2002
ONE: SANITARY NO. CONTROL NO.
(408) 251-6040
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
= LICENSED CONTRACTOR'S DECLARATION
1= I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
,tiL° wimSen..7000)ofDivision3ofthe03iAex.andProfe.aionscwe.andmyrrense INST LL 3 44 GAS LINE
;yy< Liverollf�ry�e�mdre,fe�a�� Jc q F F LED
:0 z a Liale 4c,a
n 0 ii are VTj Commnor _
'a ren ARCHITECT'S DECLA ATION
a I undernand my plans shall he used as public records JAN 2 2 2002
i w O O Licensed Professional
'°' OWNER-BUILDER DECLARATION
1 hereby affirm mat 1 1. exempt from the Cessions Co License Law for the BUILDING $1300
h?< following reason,(Seninn]OILS.Business and Professions Cad,.Any city m county
2HC which requires a pc P P Y -
3m-poorto its issuance.also require,Ilw applicant for such permit to file v signed statement + "a x - - . . '. ._.__,_._._._.__._�___...__-_.._..__. ._
m,rll n.INCI alle,rm rn1[,d[n,0I5n OrR art an
IHmheab nwdpunuauothpm sof@e ContheBmiol,,icensehw(Chapter9 �`�sr,,�slFl(iCq, vi; rr x Valuation
(cin ening with Section7mandfDi .lonor the alleged
o'. ,diner.Any vi Cade y 1 , t 3Lb�V V'J;/,�:v17r1 ,) h
or that he is exempt therefrom and,he bees,s for the alleged exempuon.Any vlolvuon
-of not mo'1thaniv a undreddom for apennil subjcnxthe vpplicennovcivil Permlry dpSOccn anC T e
!Of no,mom then five hundred dollars(E5007. 2OL ��RFLOOR P UMBING' P y YP "
❑(,rte owner of thcprim,",ormyrr,layecs wenn wages as their sole eumpmmtion,. _ RoTlr�H PLUMBING
Burne the work.andmrnmmme isd„TintendedLceneLaw for snr(pry 7� 502 — FINAL PRB .2IM8p(RttMRGY
.brides and work.
aid ns Code:The isContractor',t License Law des no,a to ,
went
r of Im Asmy Who builds or improves tomom and who does such work himself
nr Inroagn his own employees.pros'mrg!nal such impm.emenrs are iter!nRneed n, 506 — GAS TEST
_..offered for sale:IL hdwevcg Ina builein n - ,is sole'wehin nli ._ r .._._... _.. . _ .._-._._._ ____ .._ _
`completion,the owner-builder will have theburJnof cit [flat he didnotb build 507 — FINAL PLUMBING.. :"i•.f•: •" '
proving
improve for purpose of sale.).
01,asowner of the progenyan,exclusivelydProaing With licensed tlo C.nnuo 'a „
comtmn the ods Til(Sec,7044,Business vend eery who
Cotler)improves
ves thencom
License unloosen;
doses nal apply m an owner of o.conty who h.liceld�to.gum es,hereon,
`: _und who commas,Law. projects wiN u.unumctor(s).licenssd.purxuvnl to.ehe. .. . _.. _ ... .-,_ __._.._. ._.......____. ,...
Conwaofa Lirenm Low. .._.._.._.......... .. .. .. _.. .._.... ._...
❑1 am esem it made,Sec. ' _. ,'B'&P C for(hip reason a .. ...••t:t;: -.:I
owner" Date .• .. - .
WORKER'S COMPENSATION DECLARATION '
therebyaffirm under penalty of perjury one of the following declarations:
{7 ] I have end will maintain'u Cenificam of Conan,ni self-iomm for Worker's
'fs�y Cournmouion, as provided for by Section 3700 of Ilm Labor Code, for the
performance of the work,for which thispennit is issued.
❑1 have and will moinmin Worl Comp'ensotion Insurance,ox required by Sordid a
37W of the Lidury Code.for the pe fmmanc,of the work for which this permit'is
'• ' issued My Wo ker's Com,cans.tion Inmrh cc carric,and Pali y nu he '
airier.Art' ERTM/sTI ]OF
`EXE cy No' MOMW. ��l��� r .l ..,Tyr..) , \:.:.. .. .
S , .CERTIFICATIONOFEXEMPTION MOM x'ORKERE'° tL'l". �3.`•I;
r
.•. 'secuni nese not be mmplelON,INSURANCC"" _, IP _.__ ._ _. . ._.... _._. _ _.__._ ... _. . .. _ _,.
COMPCNSATI _
' ITh etl if,hu perm,, s for one hunerctl dallarx '
IE 100)or less'.) ,
,. •...:
1 u,n,(y that iii toe rerfom, c of the work for which this Perrot s issued,l - "^^^ '•___..._... .,..--
shall non employ any Person in any unioner som,lbemsubjI '
Compensation Lovis of Cal forma.Da ' '
NOTICETOAPPLIC •r
PP
ANT If aompens tion sCemfieuteof Exemptmn'you'should
,
Z become subject to with
such pr none or this permit nholl be dLabor revoke . mull
0 C fon. -comply wish tech provision or
Permit shell be Deemed revoked.
z 4 ,�S CONSTRUCTION'LENDING AGENCY. -_" - _-- ~^-
a.� ", I hembY hi that mnivunuin lendingagency£the perrormontt - t
W,Q
Lender's
oro far w', Ihl permit a ssuetl(Sec 1097,Co,CC.)
a. -Lenticr'k Name... .. ...I.,..:. ._... . .... . -
�.z Lender'sA I. ,' ...: .e, r .t
V Q I certify that I have mail this application and slam that the above information is
ti F. rmniCtM agree 90 compiy,wi,h all city and county ordinances and state laws relating
Gm buildingcons,noliomandherebyemhodaereprcumatm.crf,hiscitymente,upon
>s the abo e t ncdpropeny for in%ptclion Purposes.
s costs d m pensee il marina
any wa a cord,a eat aid
4 V1
liabilities.judgments,ceof thed expenses'which Permit.may m any w y a against said ' /
Vlyne q ace gl Ih gram g-f lh LO /6 (�
ERSTA qhD WILL COMPLY WITH ALLLON POINTIssued l3y: Dateg m,of Apprca UCohmaemr 1, .':Y,: .' .D, ,. Re-roofs
' HAZARDOUS MATERIALS DISCLO56RE'1"
as e
by
Cu,isni m Municipal
ode.Chant'nnR o, ndfir h Health
an Safety l „Type Of ROOF ... _ --
- e,Sal by the Cupenmo M c p Cod Chapin 9 12,end the Heahh and Safety
Code.Semon 255321a1' Als I- f •_,
'OYex ❑N l.too s.sliall be,inspectedprior toeny roofing.material.being installed.
_..,...
,,Will doapplubcdorfulumbuildingoccupantuseequipmbnordevice,which Ila roof is installed without first obtaining an inspection;Fagreetto remove
emit hamrdo s eu contaminants as defined by the B y Am At Quality Manegemem
mel all new materials for inspection. Applicant understands and will comply with
]Yes' ❑y '.ivi; all non-point source regulations. ,
I have reed She'harardous m tdnals requirements und r Chapter 695 of
Califomm Health&Safety Cala Sections 25505.25533 and 25.134A understand that
Vlhe building does not currently have aiman;thet it is my responsibility to notify due
occupant of the ieOle anquiremcms width must he mei prior ro issounm of Ccnificate of
Signature of Applicant. .. Date
nn :a agent Da, All roof coverings to be Class "B" or better'
..OFFICE