02010118 OF
CIBUILD NG DIVISION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
; 22653 WOODRIDGE CT A PERFECT CLIMATE 02010118
OWNER'S NAME: APPLICATION SUB DATE
KELLY DELEPINE 10570 S DEANZA BLVD 01/29/2002
gl PHONE: (408) 861-9545 SANITARY NO. CONTROL NO.
Z..ARCHITECI'/ENGINEER: BUILDING PERMIT INFO
w— BLDG ELECT PLUMB MECH
a Z 1__J LJ
Z m i LICENSED CONTRACTOR'S DECLARATION Job Description
0z—o I hereby affirm that 1 am licensed under provisions or Chapter 9(commencing REPLACE FURNACE .
QPit L"� with .-.am 7. of Dtvisionl of the Busincsse dPrufessions Cala anJmyliccnm ���6C�jp Awa®
y y� Lican ll a e e ✓Y- I N baa�rr
c 6 Licenx Lto.x
3 q J Cont�raytnr AUG 1 2 2002
F u O A CHITECr'S IIr;CV.ARA
— 1 understand my plans shall Ire used as public records
MOLicensed Professional , 1 I`1
n e OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt front the Contractor's License Law for the BV ?I yf,
t_Z a following mart(Section 7031.5.Business and Professions Cade:Any city or county YC'2 �5
which requires a permit to construct,afar,improve.demolish,or repir any structure'
irt
3Po -poor its ssuoc
ae.arias requires requires the applicant for such permito fil< sgned smmment. - -- - ---
thathesl'cenvedpuRaatty the pravlsionsofthe Commeto.Licen. Law(Chaacri) / rAAIrPpii se, *. t Valuation
nbg w
(comme4h Secl nm700)pf Divs..3 m ffib Bosmq d Puf;s,imns Cade) 4�1I� t 34;p11y7Ufj—.iVV•dj 4�,Y..1•j rti�;r i
or Nat he is attempt therefrom and the basis for the allkgtld ckemption.Any violation '
of Seddon 7031-.5 by any applicant for a permit subjects the applicant to a civil penalty
,of not mom than river hundred dollars($5w), 30lAPNfjPLUMBIN P" :<^ Occupancy Type
❑L as ownerof the propcny,or my employees with wages as their sole compensation. — ROUGH
-will do the work,and the suuaum is no,intended or offered for sale(Sec.70,14;'
Business and Professions Cede:The Contractor's License Law does not apply to an 364 - ROUGH E lFRqffIl3d(Mftctions 1. .'I '',.,.
or through
rof property Who builds or improves thereon,and who does such work himself __ 505 - FINAL -PLUMBING
ELECTRICAL
or er for
ti,l awn a ply provided that such improvements are not one toad Lir
"oRe le for the If,however- the ti ave s e I mpmvemcot nsold w thin one ycvr of " _ ._\`_,• __ _. ...... ..._ ......_
completion the owneobu'Iderwill have the WNcn of proving that he did not Wild or SO7 FINAL PLUMBING - `r
improve farparyoxofale.). 508 - FINAL MECHANICAL
011asowner ofthe c property.am picbmively licensed II •t
_ ronswa the does
ISec. to a Business and Professions Code:)The Corrosion's 1 •.; >f. . _ '.li.
—
License Wwdoes .mApply tomjowner of pro,miny or
"
and wctur's icens.focsuch.projens.with o contractors)licensed pursuant m.me
Contm<mr's License Law.
❑I am exempt under Ser.` .B'&PtC.for this reason
Ownr ••m'• - Dale
n
t, WORKER'S COMPENSATION DECLARATION
_ I hereby aRim1 under Penalty,of porj by ori of the following declamations
• ❑ 1 have acid will'maintain o carman sic of Consent m self-image for Worker's
Compensation, as-provided-for by Section 3701E or the Labor Code.-for the
perfmcrmrbi'of the work for which this permit is ksm,14
❑1 have`and will mnaimain worker's Compendstiomi Insurance,as tiquired by Sibilant
37W of the Labor CW[,for the performance of the work for which this permit is
is. d MyW kcrsCromea,mmo In.. ,mid
.�w.u.•.. ,cam
�'� LNoI+''• icy no. ._I {'lig 4.,,... i �.S i� .�r��:iiil•.� ti J S4 t
tCBRT FICATIq OF�XEMPTIDN FROM Nq1 ERS'-' .+•
COMPTNSATION INSURANCE'''- 'R's F t
'Iz
s xcuoti eJ not be completed rme permit is for one hundred do1Wrs "' t �'m I ''r t
($1001.1or loss.) „ •„ � t
' I bi that in the Par ftromance of
the wwork for which this Permit issue — _ - - - - tI.
&I non employ any proton m a ty my as to hnome subject to the Workers
Compensation Law,of California.Date
Applithapet
NOTICE TO APPLICANT If.after making this Ceniticasc of Cimarron.- •' - .__ .__. _ .___ - _ ..-_ _ . . ._ -._.._ . .. _— ..__. . ___.__ .. - __-._.._
you should -'S s ` •• -
become%objectto the Worker's Compensation provisions of the Lahnr Cole,you must
Q O � fonhwildnsmPly with such pruvisimms or this permit shall be deemed revoked. '
CONSTRUCTION LENDING AGENCY'
a:> 1 hereby a1Erm that thea is it conswmion lending agency for the performance
of the work for which this p 't N issued(See 1(197 C'v.C')
L (] —Lc der Name
. ._ �L' .t.. . . .... .. ....... ___-.__... ..._... . _. _ ._., _.._..._......_.. ._._.__
_.Z Le de Add s ri'h llgt,ll�I'•1o
U 1 certify that I have read this application and state that the above information is
{a."E•t coven:I agree to comply with all city and county ordinances and state laws miming
0_V to building construction,and hereby aumrrioe iepossemmives of this city to enter upon
} W the ahowrommioned property for inspection.purposes.
F..L
(We) g ro t d rhfy andk ph I stti Cty fC pcmmmo against
f/J
liabilities,judgment, t J arpeope, both artay in any Ysocrac agaian said
V'.Z Cly s p Ce Tilt gg t gnftl p mit
APPLN: 'UNDERSTiNDSAND WILLCOMilWo 0
D RCL Issued by: Date
Ignmor i mvcomm for T.. Re-roofs .
Y f HAZARD U )AICIr L$DISCLOSU F
pplic torfu re Iuptorst o hantllehaaamou ran I e of Roofn def d by th CuPcn opa9 12 nd th Healed and Safety
..Type.
" p v - '>> ._..._ .... .. . •`•' ro t
CN Section2553'_( 1 m 1.'i a V.- a'.t i .u44 qs. ..,:
•;, t r_ All roofs,shall,be inspected,pnor,to.any_ it
roofing,m material being installed.Wal th awlcans orf Lige butoccupant use cq P to device which If a roof is installed without first obtaining an inspection Tagree',to remove
c 1 baa cim can
ntam rants as deflated by the Bay Are Air Quality Manageme t
Det c _'I all new materials for inspection.-,Applicant understands and will comply with __
1 �Y all rioii-point source regulations m
.. I has<read the haardous,materials par,mmtnems under Chapter 6.91 the
Calif hria Health&Safety Cale.Scott...25505,25511 and 25534.1 understand that
ifthetroddingdoesnotcurcml y have a tenant,that h is myrespomibil'vy mnmify the
occupum hequiremenis which must be ran pririr to issu ee mf Cc "C"oP,
Ocempne ant Date
_ Signature of A li
°.4 „e All roof coverings to be Class"B" orbetterwren• a ern' . .
-' OFFICE