02060105i a
CIBUt OF DPERTON CONTRACTOR INFO TION:
PERMIT
BUILDING ADDRESS: PERMIT NO,
6080 WILLOWGROVE LN DICKINSON JAMES 0 JR AND CHRIS 02060105
OWNER'S NAME: APPLICATION SUB DATE
DICKINSON JAMES 0 JR AND CHRI 06/18/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
C7 —
LICENSED CONTRACTOR'S DECLARATION Job Des p,s
Ihereby 0)If is lam licensed under provisions of Chapter Cona9 (commencing
`a'f.' �oo�
wahsacaoreandefect. n3mrtheBaameaaaedpmrmamnacede.aedmyhatse REPLACE WATER HE
" to full force and effect.
License Class Lice O -
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION �7
1 hereby arcnn that I am exempt from the Comsacmr's License Law for the
following realms. (Section 7031.5. Business and Professions Code: Any city or county $500
which require.` a permit m consaucq alter, impmve. demolish, or repair any strudum.
-priorto its issuance, also requires the applicant forsuch Person to file augncel statement
"d h2 itlittnsdpunuan(mMp pr�av3zioiis of the Convactoh Liana lsw (Chaptcr9 $fy fsr,�pP16 [ .Ye Valuation
led,;, ndnB whh Sccio^i"I(1000j of Division 3 of the juinesp and Proferssions Cale) �,tpr�'� `,�f�]}.y$ �,y, �"+`/1VrJ]Z1§'-I1�•l. J?. ai, : .
or that Ke Is exempt therefrom and the basis for the allegW en,mAtici. Any violation
-of Section 7031:5 by any applicant for a Permit subjects the applicant to a civil penalty
�mrrm more man five hundred ean:,ra (s51w). 502 ApNJ�� r PLUMBING ENERGY Occupancy Type
%❑ 1, as owner of the pmpeny, or my employees with wages as their sole compensation.
-will tl thework-and the spucture is not intended a, nff and far sale (See:71144;' ""_ -' "- - -- -- - t ---- -- -----_'-- "- ---- ---
'Bildrias aad'Pro@ss o rs Code The Commcmr s License Law does not apply to an 507 - FINAL PLOf§4$tl&rDCinspections ° •'''-
owner of Property Whm builds or improves dialect, ani who does such work himself
ter through his own employees. provided dial such improvements are not intended or _
o0' ed for ...le'ICh. er. thebuilding., m - - t lJ w m ii orsii f _._ _ .. _._._ ...... ....._. __. ... _ _.-_ _..._ _. _.-.. _ -..._ ._ ........_ ._. ..
'capiPletion, the owner builder will have the burden of proving that he did not W Id or I'
improve for puryose of sale.). j
❑ L a` cl her pro tea n tom Professorial
i Cod,,) Tat, Coremmrs m - -- - -' - - -
prop, y. am exclusively g
tVnaWm the project (Sec. to a ownHoler es and Profusions Code:) The Conmccon, 1 'L.i d. V.'
License Law does not apply , an owner of property who builds le improves thmeo^,
_and.who commentforLaw. ch.projccts widi-a commctorts).liccnud pursuant m. the_ _.. _....__. _ _.__.__. _...___...—___..__.._.__.._...__.1.__..__ _____.._.._.___. __._.._.... ..... . ... .
C vectors License Law.
�tla crept un'Jer Sec'. blt"''1 ' '`"/' ",BAf.PCfor this reason ,. i., t}::•.. '❑
.�1.. �1D ��8/o
R:c• .
WORKER'S COMPEN. TION DECLARATION
I hereby mBren under penalty, of perjury one f the following declamtiotn:-
O 1 have ind'will achi Gin a Ccnificmc 'of'Consent to self -insure for Worker's
Compcmaion, u provided for by Section 3700 of the labor Code. for the
perf...Le'mf the work for whicAl Ih this permit is issued.. 1,
❑ 1 have and will maintain Worker's Compensation Insurance, os required by Section
3700 of the Labor Cdde, poi the performance of the walk for which this permit is
issued. My Warke7s Cmmpeiiutina lniurunce earlier and Policyumber are: '
^
Cam s i!'i: f f) d'9 `U Policy Na
'-CLRrIF1CATION.OFEXCMITIONFROMWORKERS'- r.•t. -f't I.; .;�.. :- 1 7^F1.•J\�l�:
COMPENSATION INSURANCE')' 'hl 1•
(This iceiian'need not be cmmpleled if the psorn, is polar, hundred dull... A r' ' "' "`' ''1 f t." i n•t '
(S 100) or
certify that theperfo a the orkfor which th permitis issued,
{hall ml emP1 Y Y a Y lire ncr so m t to the w rkcros P•
C mpensm w f I1 Dat -
III
V 1C7 "
paopp��.ao s a
..'Apple n 4'J� In
NOTIC APPLICANTIf fter makumg this Cenittene fscroll.;, you should • � 5 / -
become subjectto the Workers Compensation provisions of the Labor Cale, you must
fothaithi comply with such provisions ar this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hieiehy affirm that there is'a comwnion lending agency for the Per ram nce
of the walk for which thiel permit is issued Eicc,'3097, Civ. C.) - -, __--.-_--__,_ -, _,_-_-,_-„_. _
- Lender's Name . _... _. _. '. _.._c:c ...: ......... __._sc.... _.�.. ___ __.. _.... .._...__ .___. _.—._______-
Lend Add �. it„s t i;'• ) V
It
I certify nth I M1 ad thisapplication mW t t th t th Em f rmai ren is
cotrtctd g t comply with II city d county J n and state laws mlmmg
m slave- o.t a dherebyamh ureprc.' itiv fib ctyt enter upon
th M mens ted property !inspectionP W
(We) ag to s dem fy and keep hm may
3 the Cry f e penmo said
liabilities,i1 q ns t and pens hon yin any y gains said C
City nc 9 c ofdi gram ng spm petrel f�1Va1 r'n /
APPLICANTUNOERSTANDS \\DWILLCOMPLY WTfHAL NO PoINsf
5 IOU
AT , Issued by: T Date
'sigwturS of Appla, t/C^ntraaar ,Dam ,' Re -roofs /
HAZARDOUS MATERIALS DISCLOSURE
Wll the applicnto fmurebaild'ng occupant store Orh dl h trdousmaterial
as d f ncd bydhe C r Municipal Cod Chapter 932. d the Health and Safety s
curl Stan 2553203 ..s. a''"'o;y'iY if"rin)sas dal;Zl�r�GFi i'i15�.
)�a'§= 1 � t roofs sfiall be-inspected.prioi to any roofing material bemg,mstalled- _
Will theapplicant future bili ng occupant use equipment ordevices which If a roof is installed without first obtaining an inspection,:I'agree'to remove
c t h d .a a rc t tis ai defined by the Bay Area A Quality Management
Do t ct all new materials for inspection. -Applicant understands and will comply with .
oY �Sqm all
t on -point source regulations.
.,
I h toad the tiaivdous matenals equirements ode Chxpie"695 of Ne
CaliforniaHealth&Safety Code,Sections 25505, 25533 and 25534. 1 understand that
'ifthe building docs not currently have:nenant. tete it is my responsibility to notify the - '" - "-' ---- -- - --.
a
cupotn of the requirements which must he met prior to Issuance of a Certificate of
Signature of Applicant Date _
Owner
All roof coverings to be Class "B” or better `
or aamonaed agent -'-. :,. to
I , •
i a
CIBUt OF DPERTON CONTRACTOR INFO TION:
PERMIT
BUILDING ADDRESS: PERMIT NO,
6080 WILLOWGROVE LN DICKINSON JAMES 0 JR AND CHRIS 02060105
OWNER'S NAME: APPLICATION SUB DATE
DICKINSON JAMES 0 JR AND CHRI 06/18/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
C7 —
LICENSED CONTRACTOR'S DECLARATION Job Des p,s
Ihereby 0)If is lam licensed under provisions of Chapter Cona9 (commencing
`a'f.' �oo�
wahsacaoreandefect. n3mrtheBaameaaaedpmrmamnacede.aedmyhatse REPLACE WATER HE
" to full force and effect.
License Class Lice O -
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION �7
1 hereby arcnn that I am exempt from the Comsacmr's License Law for the
following realms. (Section 7031.5. Business and Professions Code: Any city or county $500
which require.` a permit m consaucq alter, impmve. demolish, or repair any strudum.
-priorto its issuance, also requires the applicant forsuch Person to file augncel statement
"d h2 itlittnsdpunuan(mMp pr�av3zioiis of the Convactoh Liana lsw (Chaptcr9 $fy fsr,�pP16 [ .Ye Valuation
led,;, ndnB whh Sccio^i"I(1000j of Division 3 of the juinesp and Proferssions Cale) �,tpr�'� `,�f�]}.y$ �,y, �"+`/1VrJ]Z1§'-I1�•l. J?. ai, : .
or that Ke Is exempt therefrom and the basis for the allegW en,mAtici. Any violation
-of Section 7031:5 by any applicant for a Permit subjects the applicant to a civil penalty
�mrrm more man five hundred ean:,ra (s51w). 502 ApNJ�� r PLUMBING ENERGY Occupancy Type
%❑ 1, as owner of the pmpeny, or my employees with wages as their sole compensation.
-will tl thework-and the spucture is not intended a, nff and far sale (See:71144;' ""_ -' "- - -- -- - t ---- -- -----_'-- "- ---- ---
'Bildrias aad'Pro@ss o rs Code The Commcmr s License Law does not apply to an 507 - FINAL PLOf§4$tl&rDCinspections ° •'''-
owner of Property Whm builds or improves dialect, ani who does such work himself
ter through his own employees. provided dial such improvements are not intended or _
o0' ed for ...le'ICh. er. thebuilding., m - - t lJ w m ii orsii f _._ _ .. _._._ ...... ....._. __. ... _ _.-_ _..._ _. _.-.. _ -..._ ._ ........_ ._. ..
'capiPletion, the owner builder will have the burden of proving that he did not W Id or I'
improve for puryose of sale.). j
❑ L a` cl her pro tea n tom Professorial
i Cod,,) Tat, Coremmrs m - -- - -' - - -
prop, y. am exclusively g
tVnaWm the project (Sec. to a ownHoler es and Profusions Code:) The Conmccon, 1 'L.i d. V.'
License Law does not apply , an owner of property who builds le improves thmeo^,
_and.who commentforLaw. ch.projccts widi-a commctorts).liccnud pursuant m. the_ _.. _....__. _ _.__.__. _...___...—___..__.._.__.._...__.1.__..__ _____.._.._.___. __._.._.... ..... . ... .
C vectors License Law.
�tla crept un'Jer Sec'. blt"''1 ' '`"/' ",BAf.PCfor this reason ,. i., t}::•.. '❑
.�1.. �1D ��8/o
R:c• .
WORKER'S COMPEN. TION DECLARATION
I hereby mBren under penalty, of perjury one f the following declamtiotn:-
O 1 have ind'will achi Gin a Ccnificmc 'of'Consent to self -insure for Worker's
Compcmaion, u provided for by Section 3700 of the labor Code. for the
perf...Le'mf the work for whicAl Ih this permit is issued.. 1,
❑ 1 have and will maintain Worker's Compensation Insurance, os required by Section
3700 of the Labor Cdde, poi the performance of the walk for which this permit is
issued. My Warke7s Cmmpeiiutina lniurunce earlier and Policyumber are: '
^
Cam s i!'i: f f) d'9 `U Policy Na
'-CLRrIF1CATION.OFEXCMITIONFROMWORKERS'- r.•t. -f't I.; .;�.. :- 1 7^F1.•J\�l�:
COMPENSATION INSURANCE')' 'hl 1•
(This iceiian'need not be cmmpleled if the psorn, is polar, hundred dull... A r' ' "' "`' ''1 f t." i n•t '
(S 100) or
certify that theperfo a the orkfor which th permitis issued,
{hall ml emP1 Y Y a Y lire ncr so m t to the w rkcros P•
C mpensm w f I1 Dat -
III
V 1C7 "
paopp��.ao s a
..'Apple n 4'J� In
NOTIC APPLICANTIf fter makumg this Cenittene fscroll.;, you should • � 5 / -
become subjectto the Workers Compensation provisions of the Labor Cale, you must
fothaithi comply with such provisions ar this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hieiehy affirm that there is'a comwnion lending agency for the Per ram nce
of the walk for which thiel permit is issued Eicc,'3097, Civ. C.) - -, __--.-_--__,_ -, _,_-_-,_-„_. _
- Lender's Name . _... _. _. '. _.._c:c ...: ......... __._sc.... _.�.. ___ __.. _.... .._...__ .___. _.—._______-
Lend Add �. it„s t i;'• ) V
It
I certify nth I M1 ad thisapplication mW t t th t th Em f rmai ren is
cotrtctd g t comply with II city d county J n and state laws mlmmg
m slave- o.t a dherebyamh ureprc.' itiv fib ctyt enter upon
th M mens ted property !inspectionP W
(We) ag to s dem fy and keep hm may
3 the Cry f e penmo said
liabilities,i1 q ns t and pens hon yin any y gains said C
City nc 9 c ofdi gram ng spm petrel f�1Va1 r'n /
APPLICANTUNOERSTANDS \\DWILLCOMPLY WTfHAL NO PoINsf
5 IOU
AT , Issued by: T Date
'sigwturS of Appla, t/C^ntraaar ,Dam ,' Re -roofs /
HAZARDOUS MATERIALS DISCLOSURE
Wll the applicnto fmurebaild'ng occupant store Orh dl h trdousmaterial
as d f ncd bydhe C r Municipal Cod Chapter 932. d the Health and Safety s
curl Stan 2553203 ..s. a''"'o;y'iY if"rin)sas dal;Zl�r�GFi i'i15�.
)�a'§= 1 � t roofs sfiall be-inspected.prioi to any roofing material bemg,mstalled- _
Will theapplicant future bili ng occupant use equipment ordevices which If a roof is installed without first obtaining an inspection,:I'agree'to remove
c t h d .a a rc t tis ai defined by the Bay Area A Quality Management
Do t ct all new materials for inspection. -Applicant understands and will comply with .
oY �Sqm all
t on -point source regulations.
.,
I h toad the tiaivdous matenals equirements ode Chxpie"695 of Ne
CaliforniaHealth&Safety Code,Sections 25505, 25533 and 25534. 1 understand that
'ifthe building docs not currently have:nenant. tete it is my responsibility to notify the - '" - "-' ---- -- - --.
a
cupotn of the requirements which must he met prior to Issuance of a Certificate of
Signature of Applicant Date _
Owner