02060175 OF
ci BUILD NG C, O
DIVISION PERMIT
ION CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7681 RAINBOW DR ALL VALLEY PLUMBING 02060175
OWNER'S NAME:
APPLICATION SUB DATE
URINDA BHALE 170 BRANNON DR 06/26/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 376-4816
GOO ARCHITEC IENGR EER: BUILDING PERMIT INFO
m BLDG ELECT PLU R MECH
I-7 GJ L J LJ
Z y z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_0 1 hereby affirm rho I am licenmd under ,provisions of Chapter 9 mmannesism,
pyl__ wimSection 1000)orDivision3ofth,BusinessandPmfellammCndeand mylicense REPLACE WATER HEATER
is awl raa a an
c < �icen.e q y_re� Lie.. 74 •S9D
° 3 LL y Dalt_(Q[a(�µ,/Q� C.....! /area'
ARCHIIIaLl h DECLARATION (1
C a.�j 1 understand my plans shall be used as public recants
ca O Licensed Professional
W
OWNER-BUILDER DECLARATION
�'e 1 hereby aM.tom 1 am exempt from the Conlimmr's License Law for the
Y?< following on.(Section 703 L5.Business and Professions Code:Any city or county 6 650
C o which requires a pert to construct,alter,improve,demolish.or repair any structure. Y
ism prior minissuance.ulsoreau smeapplicaat fursuchpernnluofleasigrmdstmemem_
ors License Law 9 [ 1 r a .- Valuation
that hat ivlicenvdpursuant to the pmvrnonsof o Contmm - -'ram�z [6'qo p�
(cam eu'in cicilat the fminand the bisionlofthr eaBjed viand Pryfesys i Code) (;ul?e; i'3, �3,01�°e� .;i._,I_:.jat;:5
or marhe ii exempt Iheiefrom and the basis for rbc subjects
the exempting.Any violation
al Sminn'/OJ h5 by nny applicant for a permit rubjcau the applicant to a civil Penalty pptltl RR++ttaarr��
of not mmethan live.hundred dollar,S50)). 502 APN PILYFIZ PLUMBIN ENERGY Occupancy Type
01,as owner ofthe progeny,or my employees with wages as their sole compensation,
will do the work.-and the structure is not intended or offered for sale(Sec.7(olt, - - --- - - - -- ---
Business gad Prbfiession.Code:The Camraetar.Llceme naw char tan apply to an 507 - FINAL PLMQORM-fspectiohs+
ow
net ar progeny Who builds m improves daemon.aad who does such work himself
or dardu h his own emplorees, building
that such imp ravemenu am not intended or
.
offered�;a31e:Ir,ndweva:the building or imcwement is aoldwhnid one year or. ..... .. . ...
nidplolian,the owrar.mildor will nave the nardea of,owing mal he dud no,build or I' • , .
improve far pry r I ).
-01 -ciumater oftipanapeatyRimseli iamou-nglh Tcnscd i,satractomto
comaracttM1 p j t(Sec.]BW Business- and Professions Cede:)ThContractor's
License Law does nol apply la an owneref,rolFarty who buildsor improverthereon, '' t
end h contracts for SUCh,PMjMtS with 2 contmcmr(s)licensed puant rothe
Cant cr License Law. O
01 e`empl under Ser. ,B&P C for this reason ��C• �) "r
Owner Doc 1 2009
WORKER'S COMPENSATION DECLARATION /�' <
I hereby affirm under penally of,,jury one of the following declarations ( 44
i �• 0 1 have and will maintain a Cur ifcale of Cement m self-imam for Worker's
\ Compensation, as provided for by Section 37M of the Izbor Cade, for me
per ciarmice orthe'work for which this permit is issued.
bave and will maintain Workers Compensation Insurance,as required by Section
r 9]00 of the Labor Cade,for the performance of the work far which this permit is
issued.My Workers Com at an Insurance carrier and Policy number are
���.LA774D 'Puhcy Na /6539 =0/.. _. _. . .__'
,t CERTIFICATIONOFEXEMPnON FROM WORKERS';' a e f,° f �\ ns,r.i]
COMPENSATION INSURANCE '" '°'
�tThu secrinh mica l nor be m,inpleted it the pmnit Is far am hundred Jull.¢s
(3100)or less)
I c it fy mm in the rformance of the xorh for wh¢h thispermit is issued,1 -- _ - -
slwll t y nny p nny manner sa as to become bl t 1 the Workers'
Con pe . f nl .D
m
Applies
NOT"..
PLICANTIf ft kig' th Cnfam of Esempton,you houd
Qhe heW k C ,.tarsprovisions of the Labor Cole you must
C) forth Eply wiihsuch p or thiss t:hall W deemed revoked
.. .. .- . .. . _. . . — ._ _ _.. ..... ... . .. ........ _... _.__ ---
J)
te " ' ' CONSTRUCTION LENDING AGENCY
a'7 - I hereby'alfirm that more is a construction lending agency for the performance r
fs1l� bf the work for whiten this parnit is issued(Sec,309],Civ.C.1 _ _ ._.._ ...... _ .. .__ ...... ... ..
O. Leaders Name. •. - ._.. ..., .. ... ._. _ ., _.,
Leaders Addm,,
I.,memat1have rend thisapplicationand natethatthe abovei law,mono
b*+'U to m.i agree tr cmnply with nil city and county ordinances dhi nate laws erming
V taoWilding construction, dh by action representatives fth city to enter upon
the above mentioned save,
e,property f inspection purposes,
'fin.tl
(We)agree t;so costs
and and keep hm may
in a n City f C pen o against
.rn Cit
liabilities.1 , t, e Jexpenses which y ,arty Y'«me against said
V Z City- ms q enc r tit b f mi perm 1
APVLICAST.VP'DERSTARSTASD$ASD\\'ILL COMPLY WITH ALL NON-POINT d b
SOURCE [SSUe
REGULATIONS. y Date
signam¢af ApplicHAZARaamr .. ;Date Re-roofs
HAZARDOUS b1ding comport
DISCLOSURE
iredbyll hceppheartbrrmumi,dCBecChapteure,or 9.12.aamllehvarduus Safety ..Type of Roof.. . _._.-_'.-.... _....... .. . ..._.. , ....-.., -.. _ _
Cdde,nW by the 4upenino Municipal CnJe.Chapter 9.11,and me Ileahh and Safety
as def ,1
seedan 25532fm'y ;,. v:, •a I".a ° [. " ..-a, yw.n..r,.I,t,.,,l `;'),,.' '
OYe 1 ` All roofs shall lie inspected prior to any roofing material being installed. _
pptiaa t future building occupant use egti p t o device'which If a roof is installed without first obtaining an inspection, [ agree to'remove
e
m t M1' d s tat 1. d fine by th Bay.Area\rQbmility hWnagc aunt
Dina' rOYN all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
1 have read the hazardous materials mquirements under Chapter 6.95 of the
California Health&Safety Cola Seaters 25505,25533 and 25534.1 underrmn l that
ir�olfnl'l
,t curently hmeatenanl.Nat it is my responsibiliry ro ntify theimmeme.which man M met prior m issuance of a C nifcam of
Or, 1
G Y/f Signature of Applicant _ _ Dale _
Owr�epyr i thar;:ed agent _ Data All roof coverings to be Class"B" or better .
._ ... . . . . _.. ... . OFFICE
.. .. .. .. - 'L