02050022T
•
'' OFFICE
CI OF
BUILDING DPESN�
IONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
7608 WATERFORD DR
COUEY CLIFFORD W
PERMIT NO.
02050022
OWNER'S NAM[:
COUEY CLIFFORD W
AOS /TION O 6S/ 2 DATE
0 0 2
PHONE:
SANITARY NO. CONTROL NO.
O
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
U F
p�
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section ]000)ofDivision 3ofthe Business and Professions Code, and mylicense
Job Description
REMOVE FIREPLACE/ADD CIRCUIT &
g j
iV
F
0 <
is in full form and effect.
License Class Lic.#
Data Contractor
ARCHITECT'S DECLARATION
- REMOVE
,o, �
1 understand my plans shall be used as public records
i
ppf
EMSP
Licensed Professional
OWNER-BUILDER DECLARATION
I herchy affirm that) 1. exemptfromthe Convector's License Law for the
follwingreason(Seaton]031tr Business andProfessions Co de: Any city or county
ve
which raquaws a permit tnmvm, ulcer, improve demolish. or repair any structure
m
patio as also requires rheappomant for t Lfile . statement
itsicensed
—
eislto
Contractorsicense Law
that he nce nith Se annpthe 00)of Division
n the Ce Businrs manPrLawons Crude)
with Sen o J Div s an 3 of the Businessman
Sq. y S Ft Floor Area
r r "y �' '1 q• dv t i f t w
Valuation
w,(commencing
Tread
or than he is exempt Nerefrom and the basis for the all4gcd exemption. pay nolauon
i.m. Anonsilman
M .,t I ", , -
of Section ]031.5 by any applicant for u permit subjects the epplicanuo e civil penalty
'or not mora man five naharea dollars lssW).
APN Number
OccupancyType
°I, oa owner of be property, or my employees with wages as their sole compensation,
i O1 FOUNDATION
will do the work, and the structure is not intended or offered for sale (Sec.]044,
Basin,. end Professions Code: The Contracmr's License Law does not apply to an
_
10 2 — PIERS Required Inspections
owner of properly Who builds or improves thereon, and who docs such work himself
10 3 - UFE R
or through his own employees. provided that such improvements are not intended or
sale.whoweverethel int
j; provement is sold within one-year of
-"
1O4 — REBAR - ..
completion, have
completion, the owner -builder will have Ne burden of proving that he did not build or
improve for purpomaf sale.).
105 - ANCHOR BOLTS "
co I, as owner of the property, am exclusively wird licensede tom to
106 = SEWER-.& WATER ... _ ..--.
coname the d Profiting
Colu
oesho(Sec. t apply maBusinessanderlyall.bCode:)Thevestmemma
License Law does properly who builds thereon,
202 - UNDERFLOOR PLUMBING
-.
far such p, j.towner,h seimproves
and who contracts for such projuts.wiih.a.conba °mss)bB&Ppursuanttothe
2 03 UNDERFLOOR MECHANICAL.__.
G nmanore a ease
ante It d
�
,B&PCfonhis reason
( Dat JJ'S-D 6-O�—
her- WORK COMPENSATIOT(,yECLARATION
_
204 UNDERFLOOR FRAME.:..,
205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
Ihereby afdrmunderphaltyofparjoryoneneofthe following declarations:
302 — TUB & OR SHOWER
Cl I have and'will maintain s Cenifrch, of Consent to self -insure for Worker's
303 - ROUGH MECHANICAL
Compensation, as provided for by section 37W of the Labor Code, for the
performance of the work for which this Permit is issued..,
304 - ROUGH ELECTRICAL
° I have and will maintain Worker's Compensation Insurance, as required by Section
305 - FRAME
3700 of the Labor Code, for Ne Performance of the work for which this permit is
issued. My Worker's Compensation Insurance carrier and Policy number are:
306 — HOLDOWNS
4
307 INSULATION
CERTIFICATION OF EXEMPTION FROM WORKERS'
t i s5 ''3 OSi y.' 1'SHFETROG'K; s s
ENSATION INSURANCE
(This section held nm be completed if the permit is for one hundred dollars-
(SBIBionesa.)
310 - INTERIOR LATH
I certify ihatln the perfortriallas f the work for worth this pcmiit is issued,)
311-- SCRATCH COAT
"
shell earl e npny Pers^y mypper soes.te b&coryG a b�
ante workers
c,ka��pnati wa till' frniaD U[1
3 13 — ROOF NAIL
OG
501..- FINAL .ELECTRICAL ENERGY.... _
�.
. alt9r{Ce L A .tat amgmts Cemrame of Exemption. you shoWd
be2ome subject m the Worker's pensation provisions of the Labor Code, you must
502 - FINAL PLUMBING ENERGY
mnhwitnenmplywitnavenprovisionaormiapemit hanbetl toed yoked.
503 FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
_-
504 - FINAL BUILDING ENERG�
I hereby affirm that there is a construction lending agency for the performance
ofthe work for which this penalisissued (Sec 3097, Co. C.) '
505 — FINAL ELECTRICAL
Q
Lend'er's Name - - I ,. 1 1 . -
-•
Lender'sAimless -
506 = GAS TEST _. ..
. I certify that I have read this application and state that the above information is
507 - FINAL PLUMBING
-Ey
correct. I agree to comply with all city and county ordinances and state laws relating
508 - FINAL MECHANICAL
V
w.
construction,
the above- construction,andy for mauthorixerapsma,s. lives of this city to enter upon
heabaWe)agrioned
509 - FINAL GRADE
V1
eetosaopindemifyandknpmattre.
We)agreesave Indemnify end keep harmless the City of Criterion'egalnn
liabilities, judgments, costs and expr m, which may in any way accrue ewmw seed
City is causequ ce of the grand this
510 _ FINAL PL I NG
permit
DWILL COMPLY %HmALI.NON-C
AOPLICE ATI
514 N WORKS
"GL NSN p,
Issued Date
fticaturiftL6glicant/Comracmr - Date
-
Re -roofs
-
HAZARDOUS MART S DISCLOSURE
'
- Will the applicant or future building pent store or handle hazallous'material
,Type Of ROOF. .. .... .. --, .-. ,...
ad yche Cupenmo Ml
pa9 12, and the Health and Safety
CCode_
Code, Sector 255321e)
YC5
�' I- r
All roofs shall be inspected prior to.any roofingmaterial being installed...
t i tui rc building
Romespat vac cut o devices when
ip a
Will the aI,
with¢ardous
If a roof is installed without first obtaining an inspection, I agree to remove
crai
aircontam, �es)definetl by he Bey Arm
y m Air tory Management
1, etII3y.all
new materials for inspection. Applicant understands and will comply withall
non -point source'regulations.1
I
have read the haardous materials rcyuimar nts under Chapter 6.95 of the
alifdmia Health & Safety Code, Sretlons 25505,-25533 end 25534.,1 understand that
cone y have a
adcupdnt of th r reme which mustbe met prior to issuance of a Ce ifcate ofccnpanc
O
Signature of Applicant Datewn
All roof coverings to be Class "B" or better
ror authorized agent Date
'' OFFICE