01110040 OF
ERTINO
CI set DING DIVIISSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
985 S TANTAU AV ALL VALLEY PLUMBING 01110040
OWNER'S NAMEAPPLICATION SUB DATE
DALE MCATEE 170 BRANNON DR 11/06/2001
(41 HONE: (510) 376-4816 SANITARY NO. CONTROL NO.
M ne O ARCHITFC ENGINEER: BUILDING PERMIT INFO
u C BLEG ELECT PLUMB MECH
a
LICENSED CONTRACTOR'S DECLARATION
.5 Ei? finnChapter Job Description
I ).(DhmlamlJ,hadundcrprovisiofssinsCoda9(rommencise SEWER LINE REPLACEMENT.
H C with Semon y0001.(Division J a the Business and Professions Coda.and my license
e at S< is in full force; J eftecy�
i at0%V Limnu C t� Lic.a
Date C........ hf�
i 3 u ARCHITEf 'S DECLARATION f
'e O 4 I understand my plans shall be toed as puhlic mcmds
T
i x p O
Licensed Profcsxiowl
OWNER-BUILDERexempt from
w I hereby afhmt on 1 vin ausi from the Contractor License taw for the
r z Q following reason(Semon 7031.5.Business and Professions Cede:Any city nr county $3000
-
F F p which requires a permit r,conniver,alter,improve,demolish,or repair any structure
�3c� .-prinrm hs issuattce:elso requirevnhe applicem fm xuch permino Misaligned staemem.
that hd is,licomed puEuim ro the provisions of the Conuanors Licenu law ons C .3 .3a�L'e�a Valuation
(commencing its SeatignlIDW)or Division 3 of the Bantu.gqartd Prpfcsions code) 4�-?,`• i'- /�1:11711y3_ t. ..:,ri 2�tt 2_•.
or that he ii escmpt theiefoin and the basis for the alleged elemption.Any violation
of Section'I031'.5 by any applicant for a permit subjects the applicant to a civil penalty
;nfo.,mare ban five hundred dollars n50(i - 106AP-NNEWER & WATER `• '+' -Occupancy Type
°1.as owner of the property,or my employees with wages as their sole compensation, 202 UNDERFLOOR PL BING
'warn a work:and the ode:oreThe Contractor's not intended License offered'for xnot apps: to an 3 01 - ROUGH PIJUgB&N ilspectiohs
%illdo'Business and work:
and
Cad The L u er d t pec: man
owner of property Who builds prove dicrion.andwho does such work himself 507 - FINAL PLUMBING
or dirough his own empl(y .provided th n such improvements are not intended Or
B icC.( f If h thbe IJ g . .p t soldwithin . y -7 .._ .. .._....._. ..___...._ . ..._. _ .. ;i _..-.-
�iicompletion.the owner-Wilcunr will have the burden of proving thin he dei not W'Id or
improve far p." f I )
❑1of the Properly. exclusively contracting with licensed tot. t _.._ _..__.__._.._...__. _. .._ .. - ( f I ,.. _. .
on tom thecct(Sea.2044 B d Professions Codc:)Th C t t ,
Contractors License Law, r who builds m improves thereon,
,_ _L mnor(s),IicctuW Possuant.ta.the. ____._..__...__.___.__.._..__._..._.__...__..._.__._._._ __..•t_ _. _ ____.�_..____._ .__..
se taw dum non apply man owner of pmpcn r `t
erW�who.coLicense Law.,
projttu.with a cont ��7—
-- `
°I am eaa.pt under Sec. 'r ',BI&P C for this reason • 'roti i3�n'ipb.7:�
owner i.Date....'.�r(. . „ pl
WORKER'SCOMPEtt ATIONDECLARATION
1 hereby affirm under Penalty of,,a,one of the following decimation:"
1 have and will maintain a eenibcme of Consent to alf-insum for Worker's
-by
Compensation:as,pnivided forSection 377 of the Labor Code,Yon the
performance of the work for which this pemtin is issued.
°1 have and will maintain.Worker's Compo isaiion Insurance.as iequimd by Section
F
31W of the Labor Code,for rho p6iformaircu,of the'work'for which this permit is
issued My W Ads CovtprnsslPon Innumaxle canis and Pobcy ibe.arc
Cert t. -9.ri tK44 .PolcyN ,... . I. . L:�� �. �.i t l.. a.�mf,1 j��/..A!
CLRTIFICATION OF FXEMI'TION tROM,WORKER$a-
"' COMPENSATION INSURANCE_';:
:.t., t . .,
(This section ncN-not tie complete)if the Permit is fere one hundred dollars
($100)or lesx.l
1comfy that in the pert nie n th< k'(or which th ;pert.t u issued'1
Z11 ti t cmP1oK ny pc n Y m n sl'a be b)' t o "nM1 Work ' -
Nompc Le of D t '
O —f 'CE A If eB k gth C o f t fEx pn y ysM1eold
became s bl n he Workers C ,p m Provisions-of th lab Code you n
Q forthwith e y with inch provisions or Nis Permit shall be dammul rt oked.
r-Uj 4ila ' CONS3tUCPION LENDING AGENCY
-; (hereby e'tm that thererest O lending agency f' th'Pcrfoim is
6fthe k! which thispsio t 'ioued IS 309/.Civ C) , '
-Fender N - -' '
04 Under`Addo, ,t.1 r-rt' P �'t'h•I
l aeercfy diatpl have W ad this is y lication state
h.. . o
U.O a ricer,1 e no c 1 with all cit nn coo
.. y pp and xta¢that the about information is '
nty;prdinanccs and sue.laws rdatin8 - - - - ----------- - — ._ .-
Q�V rebuilding construction,and hereby amhonae'iepoaantetiJ6 ofthis city to enter upon
the above-mentioned propeny for inspection purposes. - ._ .. ... .. .. ..... ...
_ ..i.0. (We)egreittosave,indeinnifyadd keep hamleistW6ni of C.A,1inoein
gast —
. . .
m I eb i s j tlg nems sc and apensc -lith yin any y against said
U-Z, Cit co seq ce the g n g of th a n "' _
S0, Ico 'n �R$TAvlis ND 4ILL COMPL-f yiTH at.i,ov=PolnT^` -- Issued by: r - Date
_
HAZARDOUS
AZ
Si a PpplicHALARDOURReroofsS'MATERIALS DISCLOSURE � " /
.. pylic t ft Wldrig pattreor handle haivdo ditmal-
Type.of Roof
az
Basal by the Caperton Municipal Code,Chapter 9.12. d the Health and Safety /
ends
Section 2553201)
❑res No --_„AIL roofs shall be inspected.prior-to.any roofing matenal.being_installed.__-._--_
•,
Will the applicant of future Wilding occupant use equipment or devices n eh If a roof is installed'without first obtaining an inspection-I agree'to?&move
mail h rd aircontaminantsas fine by the Bay Area AlrQuality M ag me t
r, 7iarc'? _ all new materialsy w
for inspection. Applicant understands and will complith,
EI yes "all*non-point source regulations.. . , _ I t .,1
I h ve read'the Wait ous'araga all.requirtmenls'unda,Chapter'6.95 of the `
California Health&Surety .Section 25505:25533 and 25534:,]understvnd that _
if Wilding does not cu have aenam]thm it is my re'sponsibilityrenobfy the
cu 1 of the aqui u h h, tint be met pn m is; ce cif a CeniRa t of
octet Signature_ofApplicant _ ... .. ._... ._. . ._. _ Date ..
r. �,. -„
Ow er slush rived agent; - .� Oita, -
] �,� All roof coverings to be Class,"B" orlbe[ter .
�; •.,... _ _ . . . . . OFFICE .