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CITBBUILDI
CONTRACTOR INFORMATION:
G DIIVISSIIONNOPERMIT
BUILDING ADDRESS:
PERMIT NO.
10057 STERN AVE.
EFFAT P MOTAMED
02080028
OWNER'S NAME:
EFFAT P MOTAMED
APPLICATION SUB DATE
08/07/2002
PHONE:
SANITARY NO. CONTROL NO.
ARCHITEC rENGINEER:
I
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby affirm that 1 am licensed under provisions of Chapter (commencing
REPAIR SEWER LINE
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with Section 7")of Division 3 of the Business and Professions Code, and my license
is in full force ons eRect.
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1 a U
License Class Lic.X
�p�1`V'A
Dale GnlracA
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ARCHITECT'S DECLARATION
1 Understand my plans shall be used as public records
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AUG 2 4
Licensed Professional
o
2002
OWNER -BUILDER DECLARATION
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1 hereby m affirm that I am exempt from Ne Conn..,', License Law for he
following reason. (Section 7031.5, Business and Professions Code: Any city or county
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which rx,re apermit , .t er. alter, improve,demolish, or repair any structure
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port ts issuance.e oniiiines theapplicant f such permitmfile arignedruteroem
N,hs sfse sed torment wthe pualip n fthe C t urs LicenseLa. (Chapter 9
(co m with Section"7000) fD rs t r the Business and Profusions Coder
e IR(N1r- ppa Valuation
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or that m is exeihpt therefrim• ani the basis far the alleged eximipdcla Any violation I
of Section 7031-.5 by any applicam for a permi+wbjects has, applicant u a civil penally
of he, ommmanfive hundred douar,a5W).
106APNN„,,,yN R & WATER
a"P.:::->:, Occupancy Type
property, Io enwiN wo esaz
D 1. as owner of the n yemp Y 8 P e:
for
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301 - ROUGH PIR�ptBrti$I�spections'"
d or ed sale 7044,
ern lCntras not ctorr', Lima. law does
do and aply to
Bdsiieal Profm,iom CodenThe non apply an
owner of property Who builds or improves thereon, and who does such work himself
5 0 7 - FINAL PLUMBING '
or through his own employees, provided that such improvements arc not intended or
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'lei lL however. N Wilding - p -- m at n stha'w year of.
-comp
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io did noneo,
completion, the owner by Idar will have the buNcn of proving that he did not Wild or
improve for parpax of aale.l.
Ol: as owner of rhe pmpeny, am exclusivelya with convectors to
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d profemg deruN
the Business and Professions mr's
no (Sec. m The Gmaraimproves
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does ills the
License Law does not apply,o an owner
License 1. O property who builds rn improves Merton,.
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_and. whotonwcu.for such.Prolecu with a camta<tor(s) lic<nud pursuam.m.Ne.
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on racwrs License Law., , , `s ,
I amexempt under See. . B R P C for this reason
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WORKER'SCOh ENSAT�•DECLAR�AATION
1 hereby affirm unJ<r penalty or perjury nese of the fnllnwmg dedamtions
O 1 hive'and will'ouiniain'a cirtificam-Of Crossett, to self-morm for Warkds
Compensation, as previdcd for -by -Section 37n of the labor Code, for the
'performance ilie work for which Nis permit is ismd. ,
-
D 1 base mid will mihatim Worker's Compensation Insumnce, ei required by Section
37M of the Labor Cade, for the performance of the work for which this permit is
'.iced My Workers C n pe'. io Insurance `am r andPolicy number are
,
Cinoe 1 I ': -1 4 r,( Pobcy No ,
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[CERTIFICATION OF EXEMPTIONFROryry11 WORKERS!'
` COMPENSATION INSURANCEr • sv a' L
(This rection need rat be «implcxJ if Ne pertnn is for ane hundred dollar
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1 CertifyOut t in the pert' ahh Nf hchm pe it is Issued.,1
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shall not p1 Y Y pc r so t he bl t u N Workers'l
'Co,pe t Lawsofer f _, 9,�e_
'N TOA LIC: Zf alter lookingthis Certificate Of homxxitmYOU should
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Qbe
sublect in the N k 2 C mpcnsa,on pmv s ora ortb lobo Cade, you mum
comply ions N D<J ❑
forthwith with s <h p. or s permit shall e vokcd.
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'3! t - CONSTRUCTION LENDING AGENCY -I
i' 1 hereby uRrn,h t mere sa eonxtmet on lending ag ncy for the perform n
of ,M1 kf hcM1,h pc ," ud(S 3097'C' C) -
re e deName - .'.
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Uende sAdd
mdt I have madth. pplication andalme that the above information
vormet. I agreet comply with all city,ind courav ordimancia,and state ws relining
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to Wilding comstoiction. and hreby mnhorum*;xnmtjviix ofth city to enter upon
d, pent f . penton P rya ..
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(We) age io acmimmfy add hamlcs,he City fCpcuno .gam,,
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liaplves j dg a t d es,me, which may in any way accrue against said
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Cty e9 ftheg ntng fN p t
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�APpLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N'ON+ INT
Issued b : Date VVV v
y
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SOURCE RF .ULATION 7-
Re -roofs
nawrc of Applicamr Convac,or- -.t t
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occ MATERIALS DISCLOSURE at URE T�
WWII thbpplic, fw bJding cupamt orhandle hazwd+u+1,
.Type of Roof_. ._.__ _.... .__......__ ._. _. ., ...... .__....._
as def cdb th CHAPARDOUS'Mdmi
y open Mun c pal.Code Ch pt 9 12. and the H IN eM S f ty
,Cole 5 s \
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cton 2.SSJ211 ( f
[)Yes •, : IgNa'" '. ,. •
All• roofs_ shall be inspectedto any roofing material being Installed
Will rhe ppbcam or fm rtWilding' vans use eq p to de r«, n h
et h raid s numm ita deft d by ll Bay Area Air .Quality Manage t
m
'District?.
.prior,
If a roof Is installed' Without first obtaining an inspection 14gree to.temove
_. all new materials for inspection Appllcan[ understands and well comply with
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all non point source regulations:..-
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I ha ve'read the h eurdauo(natenals mqa rtmcnu under Chapter 695 of the
Cal fomia HcaIN & gufe,y Cale Senioas _5505; 25533 and 25531 I understand Nm1
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-onni buildingdocsnmionout
• an prarmy ouUmsibfa cenmify
IF -,requ reme is which mu. t De t p' o ssua ce f e certificate of
which must
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g ature of Applicant Date
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All roof coverings to be Class "B" or better
n<rornNo roe❑ :epl ... Dat
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.....OFFICE. ........ _..._. .. .. .. _.... ....