00110112 CITY OF CUI'ECONTRACTOR INFORMATION:
nuu.ntrvs DIVISION
st°ry PERMIT
HUII.DmcauDRESS: PERMITNOOI 10 11 i
LIZ1358 LEOLA CT
(OWNER'S NAME. AI'PLICATIT JSVrLZ,11V 20L71O
isSHENDY—,7A7h1, RITf� -
1'HONE: SANITARY NO. CONTROI.NO.
C ne zARCHI'I'ECTIENGINIJIR: ' BUILDING VERMIT INFO
OO 1{LDG ELECT PLUMB MECH
W
Ni W I
2a,
any in LICENSED CON'IRACIOR S IWCLARAI'[ON
y Iherehyafrothin lantlicensedamlmprwwwa,orChapter uaommen,i.1g Job Description
0�1-� with Section 7IXvp of Division 3of the Bu.inews and PofcaJon.Cute.and my licence
FWATERHEATER AND GAS LINE
is In full fora anti effect.
C 6 L Icm o,Clo, I.ic,e
O a ODate Comms
3 h ARCIIn'RCI'S DECLARATION
tLL g I tmdmmand my pian, UH be u'al a,public record.
in
i i p himnneJ 1'n,l'maianal /
o OWNER-BUILDERanIamv,cIn DECLARATION
I nanny mfina mm I mo eanmt o-om the t...mw Cos LiAn,c Law o I„r me
following reason, amaii In 703i5Constr It.MICLs amt improve.
darmh cr,sle:Any cin or county
x O which rfgaires n permit h,airehum,sire,nt for at demolish,or repair any xwmure
pram t I: y p applicant for suchpc 11iesignal.ttmfm
(com 1 with n m p Id t t si 'ss 1 '(atter) Sq. Ft. Floor Area �tIU Ii
(commencing w'th Smi t n 900))r I Division T of the Business and Professions Cndcl
or that he is exempt therefrom unit the basin lin the alleged exemption.Any violation
oI section 7131,5 by any applicant Ihr v permit subjects the apl,Ilcam W a civil paualn
of nog more thin five hundred dollars SNXL. APN Number Occupancy Type
❑Las uwncroflhc property,or nnemployee.w with wages as their sole compemadon. -
will do me work,and the mmcmre is not intended or ottered for,Ode(Sec.7(94.
Business ofand
hopers l'Who Wilds
erThe C11es thfm,n'iceme and who doe such wow does nor rk ihimself 106 — SEWE�yu�fec�i tyEefl�':�io ns
or owner rough his own cnrployces.provided than inch Lnpon,fords are n I intended or
aadrfd Iorale.It,however,me Inlding or unprova—m is nom within one year of 202 -- UNDERFLOOR PLUMBING
completion.the owner-Wilda will have the burden of proving that he did not build or ^�1 — ROUGH PLUMBING
improve far Pm xwv of.u1c.), J
ld�a.owncroltheIt pro,so,ss,Iuivlyamhon,ingwidtlicensed camrunor„o 302 — TUB' & OR SHOWER
nstruct the project(sec.70n4.Ba.hresn and Prot s,ims Code:)The Comman 502 — FINAL F'LUMB I NG ENERGY
License Law down not apply to an owner of property who build,or improve, eo
thern.
:rod who contract, or such pro;ats wait a counacmn>a Iirenncd poounm to the
- 506 — GAS TEST
Centricmrs I.iccase Law.
❑I min exaapt untar SSeee,.. ,H k P C for this reason 507 — FINAL PLUMBING
Ower_ _W= Date
1
WORKER'S CO,MPENSNOON DECLARA'I ION
I hereby affou under pnudty of perjury one ol'the following declarations:
I have and will maintain a Cenificam of Consent to self-irwre for W kat',
a,rl,pen,minn, a, pravidcd for by Section 3700 of he Laho, Cale, rot the
pmt o.nuuu.of work Ibrwhich thin per uiI is u.u'd
01 have and will maintain Worker's Compensation Insurance,m required by Section
37(X)e,1 the Labor Cn 1,for the par nature of the work for which this pania is
sued,My Warkas's Coinpenwtien Insurunoe caner mm Policy number arc:
Caries: Policy Ne.:
CERTIIICAIION OF EXFMI'I'[ON FROM W(IRKERS' -
COMPENSAIIVNINSURANCE
1'Ihissection need not be completed if the permit is lin one hundred dollars
($11X1)11r leas,) -
1 emir mal mire penom,anec of the work for which this permit is i...al.I
rhull.1111 employ any parson is any ou mlia m a.to I,umnne oh,,,b,the Worker,'
C11mlwo,mion laws or California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cmilicme of Iixcmplion,you should
berme,tm al ,,tlm Work-i'.O...t,mesion Pmvixinn.ul the Ltm Code.yonmust
QO forthwith comply wait och novision,oohs, non, hall lx defnaJ revoked.
Vl CONS'IRUCrioN LENDING AGENCY
CL 5I hfmny atnrm that there is a co Wroc.ian lending apcney for me parTunntmcc
of the work for which this pemrit Is issued(See.YN7,Civ.C.)
0. ❑ Louie,',Name
7 7 Lender'.,Address
V Q 1 cenily mal I have nail aprurnio.and.me mat the.1mve information i.
4. E. correct.I agree a,comply with alt city and county ordinances and stale laws relating
C) O to huilAing eon.ouuloµmt hereby unthorim rprm'enmdvu.ur miw'ny h,anter upon
;„ 14 the aMw.e.mcmioned pmpcny for it,pection purposes.
F-, p, (WeO,ree to sane indemnify and keep he arless tnc City of Cu,mdro xgarrel
Vi j
Ihtbiliticw,judgca
namtn,cos and cw
xpcn .which min .,,.cin tiny way amc agrin.,t said
en
U Z cin in isn",oOVce of ore....n of mi,periost. ,Z
pPLICARCE REGVLATIhNT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
Signature of Almhcm,✓conraclor Date Re-roofs
HAZARDOUS MA'ILRIALS DISCLOSURE
Will the applicant or future Wildingo,,u,am store or handle moatJoas material Type of Roof
a,I,mcd by me Cup,dnn manifi,w Coda Chapta 11.12.and the rla,dth nod safety
Cole,Smion 25532(x)' .
0 Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
WBld,ctmpuant or mtare,huBdingyccurvutl a.c cgaim„onto,d,,,c, lu,h If a roof is installed without first obtaining an inspection, I agree to remove
� t woodous air communants as defined by the Bay Ams Air Ouulay Ma...anvin
isfdct7 all new materials for inspection. Applicant understands and will comply with
❑Yc' 0 N all non-point source regulations.
I base mai the h w.olm,materiel,na,mra era under Chapter 695 of the
California Henhh k Safety Code,Salons 25505,25533 and 255)4.1 understand her
iI the WilAir,doe,nm cart auIs buve a mmmt,that 11 In toy ssponGbil fly W ool1,the
occupant of the mgnimntents which must be mel prior In issuance of a Cenilicme of
Occupancy.
ndR�— Signature ol'Applicant Date
rlmmoranmoaafdagfnl Date All roof coverings to be Class "B” or better
OFFICE