02060128e
CITY
NG DOF IVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
7375 ROLLING DELL DR
TRIPLE A PLUMBING
02060128
OWNER'S NAME:
APPLICATION SUB DATE
WESTERN -SEVEN TREES INVESTORS
1230 PEAR AVE 45
6/20/2002
iPHONE:
SANITARY NO. CONTROL NO.
(650)964-4935
ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
u
I—� u u 1__1
LICENSEDCONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under visions of Chapter 9 (commencing
won seaiop 7poo7 of D'Ivii neBe,l. �d P.2,0 na code. dory license
mmnr nn effect �1 SS3(� � �
GAS LINE REPAIR
C Licenu C Lid. R
p_ c [�._ Contmnur
D
`7 lArU `ARCHITECT'S DE
j 1 understand my plans sM1all be used as pallid ry rd.
jLicensed Professional
OWNER BUILDER DECLA ION
1 hereby action that 1 am exempt from the Contractor s License Law for the
z following reason. (Section 7031.5. Business and Pmfessions Code Any city or county
I which require, a permit to construct, alter, improve, demolish, or repair any strucere-
$850
..pn t v " alrequiresthef suchpermit t fl signed statement.
- -
- 'lart lea ii,licensed Dominant 1the p _ 'io of the C t t L La (Chapter9
'.,%'th
�Q( p pOOr p{ea ,p -g-v -
Valuation
(co Set VINIB) of Division \ of be ¢slneand Profession,Code)
("4,)'V':359 3t5s1 t_00`l 1: 5:.f .td 4e).d•
-
or that he i4 exempt therefrmi and the ba„ for the alleged exempt im Any violation
-of Section 7031.5 by any applicant for a parent subjects the applicanto, a civil penalty
of not more mon five hemred doll..,($500).
APN 1.����n� r . , Occupancy Type
106 - SEWE & WATER t
❑ I, o mr employees w ion,
work, for lecompe
and the s intendeded 7
d or offered
' wJl do the k J the .'rut '" t ' t d d 'offereJ for sole (Sec.'7044,"
'Bn e% a'd -P r „ Code The Contrachah License Law doe, not apply to an
- - " -- - - - - - "-
it nspections • '
owner cfpropeny Who builds 0 . itherceir and who does such work himself
3 01 - ROUGH PL
or hpaghIn ply p ddthat .ach'appocorecome am notintended or
OR. SHOWER_' ..
—off 'd f s le: If,'however, th b 'Id B improvement . W t s 'tti on. year of
_....302._.= _TUB.& 1
ompletion the ownerbu lder will have the burden (if prong that he did not bold or
502 - FINAL PLUMBING ENERGY"
improve for propose if at,.).
506- GAS .,, TEST __ t
_ � - ----�� �
p1 of the propetty, am exdus IYcontracting with licensed contract
'%
i
507 - FINAL PLUMBING
nmaNet the project (See "1044 Businessand Prem%%en, Cele) The Comment,
p.eir,.0
.Lr, tit
- License Law docs not apply to an owner of property who builds or thereon.
seilnpmvcs
with.$ contrucmrts).licensed pursuam to We
' .and who comicense
.._.. __ _.. _. _...._.. .... ........_ .. _...__.. ._ ..... .'_...__....._ ..__ ..._.._ ._ .__.. _.__.. _.-. ..
Lawch.projec¢.
01 a. esea m code Law.
❑lam extmpl undgSec. "'"t - .B&PCfonhis aa,on
Owner' Dare - -
- WORKER'S COMPENSATION DECLARATION
h Ihereby import end,, R ItY,ofpej y no fey folleang declarations:
If ❑ 1 have and ill thernod n a C di ficam of Considel to self'nsum for Workers
Compensation, as provided f by Sprimp 37W of the Labor Code for the
r'�r
per f the k f h'ch this permit s issued.
V /�� q
❑ I have mid will mointnin Worker s Compersation'Insurxnce, as required by Seetinn
,(. 4 90OZ
P00'af me Libor Code, for the pedoremove of the work for which this peonii i,
1,7 c,
C .
d My w_rker, C mpnn� f l u c r antl Pol pcJ rnruJJmb1cr nru
L�.C] 1
I
w'/ ..,:.............,...
Carrier {pry 161:'are,N1_l-l� tQ.
s C[RTIFICATIONUFEXEMPTROM
,.v 1
j:, Or
' CO. PGNSATIONI
----------
.(This
(Th seciiun rli dd not be cempleted if the permit is for one hundred dollars
($IW)or lea,.) -
1' t fy Ih t th fe ( of the work for which ere ptnnn', , d 1
•.ihall
, : L . s " • 1' .:
not employ any p ,,on in any rear er,o a, ,, be ca me ,object m the Worker,
l.aw% WCalifornia: Data
Applicant
NOTcant
ICE' 10 APPLICAN"f If, did, making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
" forthwith comply with such provisions or this permit sI nll be deemed revoked.
i" ' ' ' CONSTRUC7HON LENDING AGENCY
:
1 hereby a firm mat here i, a connrmenam leading agemq far the 'cheapened
or the workf which this perarit is Noted (Sec. 3097 Cit C)
'.
... ..... . ..
Leader Name -
Lvcdrr, Address
_ ..... . .. .. ._. .... .. .. .. ..
I that d this application andstate to b f at is
r
ct I .red to comply with all dopey ordinances and slaty laws plating
to buildingcon dhereby unmoor Pmnaho(thlet t poo
aop
'h b -pi 1, Yf PpT:
-
Js W�) agree t e'Je fy andkeep hu I th Cry atm ll gv'nid
D li b i t 1 Jb us t xpsns which ay t mY Y c ab'(n t ,a A
i
C C'y 1 'ace hh I' hof th p
r•
AGLI C\N4 UND' R9 N5 ND WILL COMPLY WITH \LI SON-P11NT
Issued by: Date �%p1�/
ICI--- : 6 o1i
Re -roofs
Iga reed( ApplkanVContraaor.:.- n'c ..
HAZARDOUS NATLRI \I S DISCLOSURE
Rll the applicarror.frour,lrila p u store or handle b .udus material
_.Type of Root _ ... _. .. .. ,...,. .... .:: ,,. _,., .... .
a, def Iby th Cpn M ICJ Chapter 91 and Health and Safety
C d See f 25513(1
{ $r; i s t l r s f
ore. " o N ( -
q Mfr i rl: [1 _ J x
All roofs sFiall be mspec[ed pnor.to.any roofing,ma[enal.being installed., _
well m ppl t Ibt e b g p ' >v yq v t devices which
[f a roof Is installed without firs[ obtaining an inspection; I agree to remove
e ' h Jou, air c ' efn d by the9 y.Arc� 1 Quality Management
D t ct -
all new materials for inspection. Applicant understands and will comply with
71 ° le
I �.
-
all hon -porn o6rce regulations.
1 h read theh do s materialsrequirements under Chapter 695 of the
'
California H - Ith & Safety Code Sections n. 25505 25533 d 25534 1 anders'end that
1?"/, ........... ..a
i� _ . L (,2�A)
if the bo la ng dads not eptly have a tenant that'' is my responsibility to notify the
V
'o p 1 f the rglu t. which,mu. t be t prior to < I a Cenitlemo of
° p " Y (� r2p7i
nature of Applicant
ss�
All roof coverings to be Class "B" or better
tltndd:ea B tit he