01040013 CITY OF CUPEM11NO
nuu,DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURISS: PERMIT NO.
STOKES AV A B A PLUMBING SUP LY R SVC01040013
OW NHR'S NAMH: APPI.ICA1'[ON SUR DATF.
AND BARBARA J 924 E FREMON'f AVE 04/04/2001.
PfIONfl: ,•�
SAN]FATLY N
Y NO. COI ROE,NO.
Z 1 l�a/ i 408)736-8978
O K 2 ANCiIir-C1dTNGINIFR: BUILDING PERMIT INFO
� B1. Ir XCr PLUMB MECH
I¢ IN:r 1=1 1 1 1-1
^ LI n;ldt Ii o CONTsed under S DITC ails ofC UN ]Ob �eSCCIpL10
a yz 1 ectcbyalllmnfilm1con ON*IRAundo Provision,r,f Cbapmr 9lcrnnmmicing
FyCy wile SeceanJlXXllnf IF,ieien J of the ltueineadand Prom inns Cod,.andtny license -
ax i,in lot race andeneet. GAS LINE.
x 6 Licnnx Clans Lic.N
O>.`-' Una -. rd a,mor
w 3 u.�, ARCHII rC`FS DUCI-ARAFION
I nmt.namd Inns P1clns enroll he us.•d a,Penh.«eosin C/
ua1 x C O Licam.md Prifir,k ed
°i e,n ee OWNITR-BUILUCR IIECLAI(A'I'ION io
o�i — 1 hereby aUmn mm I am a empt femn the Contractor's Licen,c law for rile
C=< tolowingremon,(Seelinn 7031.S.Ilueinunu and Prof...on,Code'.Any eilyor county
Z C which inquire,a Anail u,consrmer,eller,hollowe,demnikli.or repair uny snllmure
hePrm t L 4 m Ile pprtf perm,, fl g d,Ih nem
e. that lie is licensed pn the provisions orthContractor's II (Chapter° Sy. Ft. Floor Ar Valuation
(conormaii ng w)hSection 701101 ofD 1. a 1 ofthRusirm,andP I .. :Cala) $1000
or thin h.he i,cue Fpr themin n rood the !,for the t Ileged c,e n pt o n.Any v,lotion
of Section 7031.5 by any applicant lour a Permit wbject%the applicant to a civil penalty
r n/nm Ihor Fill I.;Imlmd doNnIs50(n. APN Number Occupancy Type
yN,.1�wmrofthe pmimay.orn,yempl,ee,with wage, their solecempen,ad„n. 3264701.5. 00
will In he walk.and the Nrucno,is not intended nr nlfered for sale(See.7014.
Bu,ine',and Proe,inn,Cod,On,Com.,un,Lmem,law docs not apply to an Required Inspections
orr rl oll"eIly Who bailee or inlpro...fhemon,and who doe,_each work himself
mmugh his own empml provided that such impmvemrnt,am not intended or 202 '— UNDERFLOOR PLUMBING
ollcred lin.vale,If,huwocr,the building or improvement i,.sold%min one year of
ample on.the ownerbuilder will have the bu den or proving that he did not built or 301 — ROUGH PLUMBING
improve fon purpose of sale.) 502 — FINAL PLUMBING ENERGY
01,as owner of the progeny,am exclusively contracting with rcenxJ eoatmcmrs it) X07 — FINAL PLUMBING
name,the Poicct ttice.7tW4.Broineus and Pmressione Code'.I the Cont"w or's ,-
Lice.law dee,not apply to an owner of Pnrp, who builds I.inn Prove,fIi'mon.'
ml tabu cuaoalo,for projects ib to cmn:q licen.md pursuant to the
Coniruclnr's Licca row.
❑Ina,ncmp cr sv _H&P C far hisemm
Owner �/
WOR RE:R'S COM PENSAI'ION DECLARATION
I hereby affirm under Anally of pe jun one of the following declarations:
❑ 1 have and will maintain a Ceniecate of Consent to sdGinsum for Worker',
Cnmpenemime, as Provided for by Section 3700 of fila Labor Calc, for the
,di farnunec of the work bowl thio Iermit is mil
❑1 have and will madmin Worker'.,Culn,ansminn Insurance,as required by Section
3700 of the Labor Code,lar Ne performance of the work for which this Permit is
hued My Wo;kern Co;npen,el on lo,urnnen an and Policy amerher arc
Carrier: I'uliey No.:
CHHEI'119CA1'I(1N Op EXRMPI'ION FROM WORKERS'
COMPHNSA1 ION INSURANC17
friis section new not M completed if the peonh Is for one hundmil dollar
IS 110)or less.)
I Certify Inas in the performance of the work for which this permit is ioaed,I
,hall not employ any Arson in any manner eo os In bee ort. ab,,,,In me Workers'
CmmAn,ahmn I-aws or Curfomia.nate
APpllcanl
NuricR rO APPLICANiI If,of for making this Cenifieme of pmerpion,You should
heannc ohl m the Wo,Ike,',Ca.. ,o,ti< Pmei,hon,or lie Labor Code,you mast
Q O forthwith comply whb such pmvisiom or this permit dealt be deemed invoked.
z
F' GONSTRUGnON ructioI len AOITNCY
Cao 7 I hereby intim,this mcke is a roved(See lending agency for me performance
m the work lin'which this pennn Is issued(lice.31097.Ci,Cd
Q Lender,Nam.
Z Ixndc',AdImw
V I cenlfy that I have read Iii,application and stake that the all inforrie ina i,
cancer I agree to comply with all city and county ordin Ouse,and Inde laws relating
Q V rebuilding conamction.and hereby authorize repeasenmthe,ofthin city termer area
tine ahovc.memioned Prgxvty far Inepeetinn Purposes. .
(We).,me ,,mvc.indemnify and kttP Lourdes, he City of CuPemnu aguim,
Fr V] lidhilldu,jud'amn..crus and ce Pcn,c,which a uny way seem,ngaimt aid
f> Z City in con` g�amin6 nl til; I. - `moo --1— —`�
AI'PLICA' NDr e I- COMPLY WA .�UN POINT ISSUCd by:
Date
SOU "kITGH I'I NS.
Signa cernPph�;Invcmntr, oma Re-roofs
I IABARIIOUS MA'r[RIAIS DISCLOSURE
Will he;IPphcam,,Form muddingcnq,am,,am orh;mdlchoeNommmcnrol Type of Roof
as d.lined by the Cnienino Municipal Cole.Chapter 9.12,and the Health and Safety -
Coca.Section 255311a17 /
IID Yr, !NN All roofs shall be inspected prior to any roofing material being installed.
Will m.;l,prcantErr hanrcedldiagnscowarh isdyuiponentordcvilcswhich If It roof is installed without first obtaining an inspection, 1 agree to remove
emit hvnNoos air contaminants as defined by the[troy Area Air Cranky Mmagenmm
Districts / all new materials for inspection. Applicant understands and will comply with
° G'
Ya` 'N all non-point Source regulations.
1 have read ere huaenfous nnncnaly re luiinm.al,ander Chapter 695 or deo
Califomla Health k Safety Cale.Sections 25505.25533 and 25334.1 undcnbnd that
it the hn l.1i rte Ai not O;rrendy 11 it unTilfO isl yre,pnnsdalit.to notify the
wcupum ol) yuircnke rc xlnich N:are.
Prior t s- free of a Cenilicam of
Oc..ptl rc ���� b Applicant Date
Signature of
r—,wt m aati)enren as'nt Ila,, All roof coverings to be Class •'B”or better
OFFICE