00110084 cf BUILDINGoFuPtIRTNNo
PERMIT CONTRACTOR INFORMATION:
Bu11.Dwcn]Dll `Er0 RAMPART AV COLLINS WALTER S AND"1"-1fLtN E 1-0011.0084
OWNER'S NAME: APPLICATI � }/ f5
O S B U L
COLLINS WALTER S AND HELEN E T /2000
PIIONB: SANITARY NO. CONTROL NO.
0ARCHrrECUENGINCER: BUILDINGPFRMI I'INFO
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mp BI.DG ELECT PLUMB MECll
NiW I_I CI 1=1 1.1
m LIC,NSIiD CONTRACTOR'S DECLARATION
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ml:onlianwilmalerpnwision.atchartero('aunmocins Job Description
wishScaion7lMMpofDiviriun3oflheIncom,sun 'roNoion.Gde•andmylicen,e SHOWER GAN PLUMBING
Y s is in full Interact]cffem.
0 i U Dian x:CLu laic.k _
ARCH l S DECLARATION RATIONDam
ollumuclor
Innder,mmlahytilos,,nalIncoedav
panne reoom, -
u,'o O Licensed P-d'es' ared
.°:o�y OWNER-Ii IRLDCR UECLARnn(lN
u� 1 heahy all inn thin I um exempt Isom the Convncon s License l.aw for the
F.
following tensile.(Section 7031.5,Duchess and Professions Crdc Any city or county
2Q which fequifcx afheI inoeno,nowt,leer,improve,finalist,or micurany.structure
ce 1– poor l r Ise y d ppl ca t h pv nh 111 g d sarcmrin
mato licensed p romttt he p n, fnneL tmentrsl ml (Chapter9 Sq. Ft. Floor Area JIt��O
(co t ',hSal Tuthill Dexit 3 f he Business dl af.. r,Calc)
or thin he Is evcapt 0untmin and In,Nils for the alleged .,m,mau.Any vininion '
of Section 7031.5 by any applicant for a Permit,uhjecu he applicant In a civil Penalty
of not mar=than Ive W.Wd dollar:5500) A PN Number W 7
upancy Type
r he norm employee,with sees<s lsdteirsole compensation, 36925005. 00
proper y=mp r £ pcnm
le done"work.and the svuaure is not intended ora Low for,Ile(see.76td, Re uired Inspections
-
Wxincs uIW Pral'es.ions Code improve,
rove,bel Lacuna ,d dao nm apply it all q
nigh his ow ho emplyes0rovidod t ha such ad itarweni mnotitendeuch work or `106 — SEWER & WATER
or through his own employees provided that n,an inlprod I, ul art not mended or
completion.then;Ito rewbn have
to Irdent elft:mese within one ail of 202 — UNDERFLOOR PLUMBING
n„reprove for the owner builder will bmm lbs MtNen of Proving that he did oat build or
Pntve for parl.,v=or,al=.). 2,01 — ROUGH PLUMBING
01.a,ownerofinepropertY.artexem.ivelycontracingwihfdensedcommmorto 302 — TUB & OR SHOWER
lconstruct the project(Sec.70u,Business and Prolcssmns Crdc:))tie contractors
icense Law doe,nm apply to an owner of prapeny who build,or hnproves reclean. 502 — FINAL PLUMBING ENERGY
and who contri=te for such protects with a commclor(,) licensed pnraaaut ut the �.
cattmcmr,License l'w. 506 — GAS' TEST
0 l hhmnxe`gtto inrse . .B&P C to,his roman 507 — FINAL PLUMBING
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WU IKER'S :OMPLNSAI'10. IiCLARATION
1 hereby affirm under Penally of perjury one 0f the following dcclaraionr
❑ 1 have and will imam a Cedifian<at Consent tI sell assume for Worker',
Cmnpeomi0n, as prmided for by Section 3901 of the LUG, Cale. Iia Thu
performance of the work for which his Permit is issued.
01 have and will maintain Worker's Cotnpemvsion Insumna=,as required by Satins
391U of the labor Code,for he performance of he work for which his pemdl is
issued,My Worker's complication insurance comer and Policy mummer are:
Carrier Policy No.:
CERTIFICATION OF EXEMPTION FROM WORK17RS'
COMPENSATION INSURANCE
(I his.=sties need not be completed if he Permit is for one hundred dollar
is 100)or loss.)
I unify that in he pcHamancc of h<walk for which his pcmtit is iaued.I
,fall amt Inutility any porno In any nmmmer so m to Weare subject to the Worker'
Compcnsminn Law,of Culil ere Date
Applicant
NOTICH'I0 APPLICANT'.IL olicnnakiny his C=nifcmc of Excngnion,you should -
hansubject w the Worker's Compen,alion provisions al the LUX,Code.you into
Q Oate foraLin comply aim such provisions or his .it hall he deemed necked.
F `
CONS,FOC'I'ION LENDING AG ENCY
CGI hereby aRmt that here is a contrast lending agency for he pedo mane
of he work h,which his foralk i,issued(sec.3017,Civ.C.)
6. Q I,cuder's Name
im) Z Icndei,Addreo
U O 1 codify tae I huvc mud Thi,a,plicatinn soul sato that the aGwe inhvntation is
W F., rosea.1 ngme to comply with all city and county ordinances and slate laws relating
Q U to Wilding construction.and hereby omhoriee representatives of his city to enter upon
r W due Ihovcnnentional pmtieny for inspection purp�wcw.
I„m Q, (Wq agree lo.cavo,indemnity and keep harntics he Ciry of Crietlin I again.a
W I"bilifc,,juJgmems,costs and exPenxs which may in any way amine against crit
UZ City incoatsgoatee the grunting orhi,p nail. q– Szrss
APPLICANT NI .R ' NUS AND WI ,COM WITH ALL NOMI tl ' till �p �J�/
soothes REr rte/ Issued by: Date
s�gnaton mf nppheanucrnt0ams J—��arrw^-��—ante Re-roofs
IIA%sRD(lUS MAFERIAIS DISCL(ISURE
Will the applicamor future buildimgokcup:tnl nu,m or handle h:vardous material Type of Roof '
as def red by the C.,vainu Mmim,al Cot]e.Clutptcr 9.12,unit the I Icalih uud Sale,,
Code.Section 255322(a)7
O Ye, El No All roofs shall be inspected prior to any roofing material being installed.
Will heatiphcantormmre huildingoccupant a,cemloipmant ordev;as which If a roof is installed without first obtaining an inspection, I agree to remove
resit hamrdou,air communities as defined by the Pay Ana Air Quality Managema o
• Direst? all new materials for inspection. Applicant understands and will comply with
O Yes CI No all non-point source regulations.
I huvc read the haeardom inton6alx m,niremem,under Cha,wr 695 of the
Culifnmiu ITealllt&Salary Crdc.Scnio.1,25505.255331 125534,1 uacrsmno
if the building dotes not currently have a tenant,that it is my responsibility breli
Yvtianl of the rcyairr m
)es which mot stet prior to ins c,of n 1am o
Occupancy. ,y`'
qy' ' Signature of Applicant Date
Owtrer All roof coverings to be Class •`B"sor better
or mm�ariu� ugciu i}.nuc
OFFICE