02070111 TY OF
CI
BUILDING DIIVIISVO
IONPFRMYT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT
10205 VICKSBURG DR WATER SYSTEMS PLUMBING N 82070111
DSHENAME. 3844 HEPPNER LN APPLICAVO71'�P72002
toPHONE: (408) 266-8222 SANITARY NO. CONTROL NO.
0-,Z ARCHITEC MNGINEER: BUILDING PERMIT INTO
¢U F BLDG PLUMB MECH
v i, LICENSED CONTRACTOR'S DECLARATION
y Q 1 hereby afnnn Ihm I am beemcd under provisions of Chapter 9(commencing REP I PE J C ion st
rn t_� with Section]INIOI of Division Jof the Hos and Profession Cala.and yliectim 2OOf-
1s in fulk�r�and aRcc V ` (y •-y Cr T D[C
z a Linn— Lis.p D [ LJ
-G D a RCHITECT'S to
DECL TION 7
i O 1 understand my plans shall w used as pu he records �{/�' ILDItIG
r
ip Umuld Professional
e m, OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Convector's License Law for the $4000
?< Into,in,reason.(Section]031.5 Business and Professions Cade:Any city or county
Y s Q which requires a permit to connrvn,aper,improve,demolish,of repair any stmwure
w 1-$ _primnoits issuance,atm rryuim the applicant fw such permiuofleasilmednemmem-
d3- Ilei M1-elis)icen$d yussoenl to elreprbvisbns of the Canvemmrs License low
(Chamr9 , 3 64
Ica wid Swims 7Oy -V'-al-uvatio-n
orhmeis caemiuIhehcfrdso '
IX
and the basis for the alleged cxnnptlmti,Any violation "
-mf Scnfmn V315 by any applicant for o permit subjects the applicant to a civil pemlry-
,of do,inorcheh me hundred dollars(SSW)
2021PJ+I tIIh3fFd2FLOOR PL MBIN' - Occupancy Type
❑Lar Owner of the proper,err my employees with wages as their sole compensation, 301 — ROUGH PLUMBIN
'will"do'dia waoh.-i nd the structure is not im2fided-or-alrered for'sale(Sec.71)44. _ iNAlj r.
Business ond'Pmfasions Cade:The Contract.s License Law does not apply to an 51J2 $
owner of progeny Who wilds or improves thereon,and whm does such work himself 507 — F I NAL P
or througgh his own employees.provided that such improvements am not intended or
offered fof sale.If.Aowevec the building or improvement is sold within one Year of --- - - ---'- .----- �'-,----'-'---
':I wi 1 ", 'ML SO
improv for the owns-wilder will have the when of proving that he did not wild or .
improve for purymse of va1y).
_.__..._._ _ . _.._.. _
❑Las owner of the m n
p pe %ore Buc inlaaandi coprofentracting Cada:)
Comaors toconsumer Iw nepancs no(Sec.]044.Bmero pm enywhob Calor The improves
theron, :;.DL '-l_1 +lL:dLicense Law docs not apply to on owner of proper who builds or improves thereon,
'..:: _and_who is License
Law.eh.pmjuzs.wiN.a conllYwrts).licensed purtuant Io rhe --
'".s. Contractors License Law.
'I Olamexemlwider See." B&PCfonhis reason r_.. _. Ialtlll
0wne1 ' ,.f1SvDmev,;
Y WORKER'S COMPENSATION DECLARATION
I hereby aRrm under pouchy d perjury on of the following declarations:-
O 1 have and will'mainuira,a'Ckficam oI Cause.,Io self-inure far Workeh "
�Q�.. Compruation. os-pwvided for by Simion-3701) of the Labor Code, for the
perfurtttenca of thi for which this awit is issued;
- O1 has lmd wilf.' Ohio Wo is ComIiion ln
peitasurhnce,is required by,Section
3]00 of th Lswr Cod fw the pbrfq a c of th ark f which thispermit s
ssoed My W e Co pcnuI on su enee d Policy n mbar
m "
Itsz'1:DO:!10;1
r•. ,.CERTIFICATION OF EXEMPTION OM,WORKERS',1. ...
COMPENSAnON'INSURANCE
.......... ........ .
lsl:,. flhtsstttionnced not Wmomplemd if the pcont is for one hundred dollars '• 1 ..'1 +'.' )t L,.I;.l?s,
(5100)orlosi ., 1'
l e n fy Ili I re Iliperf mnca of the work( N M1 Ili gamut rs issued,l s. ,s i n f („,I' I`M
stall not employ any fCali ar any manner so as m berome o"j'a to N<Workers
Compeasition Laws of Celifomie.'Date'
biccmcNOTICTOAPPLICANT-
the ormi'sIf,after noting this visinamm Exemption.you.you old PITI ` •' -"' '
Z ffarmwchicompt the Workers Campermat i provisions ofthe Labor Crede,Youm or,
Q 0 fonhw Ut comply� N such provnlons or Ili s pc iI shell h deemed rtvakcd.
�.N
t-i • " st 't CONSTRUCTION LENDING AGENCY
1hereby eRmr that their, s e consti icuon lend rapp agency fw the perfomrvrca ''1
�.. of lh ark fo 'which this perrot s d
sus 3M]'C C) ', ... ..... .._.. _._ .. ... ... ._. __ ......_ tart. _ ..__
Q DrollName '�••w
Z Lenders Address
U
U Q
1 can fy.a comply 1 hely with al s appity andt o d st t ances a awvte laws alio rs
gr. J.U noWild n agree initi :a with all coy and mammy ordinances and state lows relating
Qf U. no Wilding mrdimn:and tiertbyspecti n psenmtivcs of This city to enter upon
y 0. the eboc Iorwd grope- forinspection purposes. - ._ ;
4L.t G (W) gr'e io w e demnflY en cep hand s the CUY of Cupen no ageimt
-fn liebil I 3 dg n co an d a h h y rs any bo y 'clue erg ret said
U Z City 06 of gray '� is .it.
/I
^'1 APPLIC - 15YSSA� � MPLY W nE 'AA h P M Issued by: r Date v v
t dl Ne. clHiAAZZARDOUSM n. D11V--- Re-roofs
' ALS DISCLOSURE " l '' `
W VD pmt Iofeo handle hovrdwa venal a o
�I f Roof - ...
a Defined by the Cupenrao Municipal c Chapter 9 12 d the Health and Safety Type P
Code OcYa 25532fe� a)�{j„o s r r I'°• yr r 1 s 4 .,s
d l AI1.roofs shall be inspected prior,to any roofing material.being installed..___.....
Will Ute ii,plimunto (rev When w p t cquipmynt,o d,tea which If a roof is installed without first obtaining an inspection", I agreeto remove
emit heaudous air conmmmems as define 63 IM1e Hay Aree A r Quoliry Menagemem ,
Dismacomply—With
._, stands a_nd will
a new materials or inspection. Applicant understands
f , :- -.T , - all non-point source•regulations; -
'4:� '' 51 have rcodMe haurdo
macron,requirements under Chapter 695*of the l
cllifomla Health'&Sal C :Sections 255 35533 and 25534.I undersand Net
ftha WlI in,do to yh veare that it rayons b ryt- -ryttic - - - -- - - - -
Oavtc I N' fan mch ren poo{tot 'e 0 aY C mf ate of -
_ :ad' G _ Signature of Applicant
_ Date
1c1� _ ._. _ . .
ag n, 1.;1 t D,t, All roof coverings to be Class "B"or better
OFFICE-.. . . . . _. _. ... . __.. ..._ . . . tart. _ .. .. .
TY OF
CI
BUILDING DIIVIISVO
IONPFRMYT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT
10205 VICKSBURG DR WATER SYSTEMS PLUMBING N 82070111
DSHENAME. 3844 HEPPNER LN APPLICAVO71'�P72002
toPHONE: (408) 266-8222 SANITARY NO. CONTROL NO.
0-,Z ARCHITEC MNGINEER: BUILDING PERMIT INTO
¢U F BLDG PLUMB MECH
v i, LICENSED CONTRACTOR'S DECLARATION
y Q 1 hereby afnnn Ihm I am beemcd under provisions of Chapter 9(commencing REP I PE J C ion st
rn t_� with Section]INIOI of Division Jof the Hos and Profession Cala.and yliectim 2OOf-
1s in fulk�r�and aRcc V ` (y •-y Cr T D[C
z a Linn— Lis.p D [ LJ
-G D a RCHITECT'S to
DECL TION 7
i O 1 understand my plans shall w used as pu he records �{/�' ILDItIG
r
ip Umuld Professional
e m, OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Convector's License Law for the $4000
?< Into,in,reason.(Section]031.5 Business and Professions Cade:Any city or county
Y s Q which requires a permit to connrvn,aper,improve,demolish,of repair any stmwure
w 1-$ _primnoits issuance,atm rryuim the applicant fw such permiuofleasilmednemmem-
d3- Ilei M1-elis)icen$d yussoenl to elreprbvisbns of the Canvemmrs License low
(Chamr9 , 3 64
Ica wid Swims 7Oy -V'-al-uvatio-n
orhmeis caemiuIhehcfrdso '
IX
and the basis for the alleged cxnnptlmti,Any violation "
-mf Scnfmn V315 by any applicant for o permit subjects the applicant to a civil pemlry-
,of do,inorcheh me hundred dollars(SSW)
2021PJ+I tIIh3fFd2FLOOR PL MBIN' - Occupancy Type
❑Lar Owner of the proper,err my employees with wages as their sole compensation, 301 — ROUGH PLUMBIN
'will"do'dia waoh.-i nd the structure is not im2fided-or-alrered for'sale(Sec.71)44. _ iNAlj r.
Business ond'Pmfasions Cade:The Contract.s License Law does not apply to an 51J2 $
owner of progeny Who wilds or improves thereon,and whm does such work himself 507 — F I NAL P
or througgh his own employees.provided that such improvements am not intended or
offered fof sale.If.Aowevec the building or improvement is sold within one Year of --- - - ---'- .----- �'-,----'-'---
':I wi 1 ", 'ML SO
improv for the owns-wilder will have the when of proving that he did not wild or .
improve for purymse of va1y).
_.__..._._ _ . _.._.. _
❑Las owner of the m n
p pe %ore Buc inlaaandi coprofentracting Cada:)
Comaors toconsumer Iw nepancs no(Sec.]044.Bmero pm enywhob Calor The improves
theron, :;.DL '-l_1 +lL:dLicense Law docs not apply to on owner of proper who builds or improves thereon,
'..:: _and_who is License
Law.eh.pmjuzs.wiN.a conllYwrts).licensed purtuant Io rhe --
'".s. Contractors License Law.
'I Olamexemlwider See." B&PCfonhis reason r_.. _. Ialtlll
0wne1 ' ,.f1SvDmev,;
Y WORKER'S COMPENSATION DECLARATION
I hereby aRrm under pouchy d perjury on of the following declarations:-
O 1 have and will'mainuira,a'Ckficam oI Cause.,Io self-inure far Workeh "
�Q�.. Compruation. os-pwvided for by Simion-3701) of the Labor Code, for the
perfurtttenca of thi for which this awit is issued;
- O1 has lmd wilf.' Ohio Wo is ComIiion ln
peitasurhnce,is required by,Section
3]00 of th Lswr Cod fw the pbrfq a c of th ark f which thispermit s
ssoed My W e Co pcnuI on su enee d Policy n mbar
m "
Itsz'1:DO:!10;1
r•. ,.CERTIFICATION OF EXEMPTION OM,WORKERS',1. ...
COMPENSAnON'INSURANCE
.......... ........ .
lsl:,. flhtsstttionnced not Wmomplemd if the pcont is for one hundred dollars '• 1 ..'1 +'.' )t L,.I;.l?s,
(5100)orlosi ., 1'
l e n fy Ili I re Iliperf mnca of the work( N M1 Ili gamut rs issued,l s. ,s i n f („,I' I`M
stall not employ any fCali ar any manner so as m berome o"j'a to N<Workers
Compeasition Laws of Celifomie.'Date'
biccmcNOTICTOAPPLICANT-
the ormi'sIf,after noting this visinamm Exemption.you.you old PITI ` •' -"' '
Z ffarmwchicompt the Workers Campermat i provisions ofthe Labor Crede,Youm or,
Q 0 fonhw Ut comply� N such provnlons or Ili s pc iI shell h deemed rtvakcd.
�.N
t-i • " st 't CONSTRUCTION LENDING AGENCY
1hereby eRmr that their, s e consti icuon lend rapp agency fw the perfomrvrca ''1
�.. of lh ark fo 'which this perrot s d
sus 3M]'C C) ', ... ..... .._.. _._ .. ... ... ._. __ ......_ tart. _ ..__
Q DrollName '�••w
Z Lenders Address
U
U Q
1 can fy.a comply 1 hely with al s appity andt o d st t ances a awvte laws alio rs
gr. J.U noWild n agree initi :a with all coy and mammy ordinances and state lows relating
Qf U. no Wilding mrdimn:and tiertbyspecti n psenmtivcs of This city to enter upon
y 0. the eboc Iorwd grope- forinspection purposes. - ._ ;
4L.t G (W) gr'e io w e demnflY en cep hand s the CUY of Cupen no ageimt
-fn liebil I 3 dg n co an d a h h y rs any bo y 'clue erg ret said
U Z City 06 of gray '� is .it.
/I
^'1 APPLIC - 15YSSA� � MPLY W nE 'AA h P M Issued by: r Date v v
t dl Ne. clHiAAZZARDOUSM n. D11V--- Re-roofs
' ALS DISCLOSURE " l '' `
W VD pmt Iofeo handle hovrdwa venal a o
�I f Roof - ...
a Defined by the Cupenrao Municipal c Chapter 9 12 d the Health and Safety Type P
Code OcYa 25532fe� a)�{j„o s r r I'°• yr r 1 s 4 .,s
d l AI1.roofs shall be inspected prior,to any roofing material.being installed..___.....
Will Ute ii,plimunto (rev When w p t cquipmynt,o d,tea which If a roof is installed without first obtaining an inspection", I agreeto remove
emit heaudous air conmmmems as define 63 IM1e Hay Aree A r Quoliry Menagemem ,
Dismacomply—With
._, stands a_nd will
a new materials or inspection. Applicant understands
f , :- -.T , - all non-point source•regulations; -
'4:� '' 51 have rcodMe haurdo
macron,requirements under Chapter 695*of the l
cllifomla Health'&Sal C :Sections 255 35533 and 25534.I undersand Net
ftha WlI in,do to yh veare that it rayons b ryt- -ryttic - - - -- - - - -
Oavtc I N' fan mch ren poo{tot 'e 0 aY C mf ate of -
_ :ad' G _ Signature of Applicant
_ Date
1c1� _ ._. _ . .
ag n, 1.;1 t D,t, All roof coverings to be Class "B"or better
OFFICE-.. . . . . _. _. ... . __.. ..._ . . . tart. _ .. .. .