01110080 (2) CITY
BUILDI c DIVISIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10197 COLD HARBOR AV AQUATEK PLUMBING INC 01110080
OWNER'S NAME: APPLICATION SUB DATE
KASOF MADELEINE L 1716 STONE AVE #E 11/19/2001
f PHONE: SANITARY NO. CONTROL NO.
(408) 295-7767
M O C ARCHITECT[ENGINEER: BUILDING PERMIT INFO
re u BLDG ELECT PL MB MECH
y« I_—I LJ L L.]
-t v i LICENSED CONTRACTOR'S DECLARATION Job Description
Z=0 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P
„_C,qwhmseednn7(xlo)tdoromm�3mnneeaameaaJProf""'ImCodeand mylicense COPPER REPIPE .
lca-� inin^ull force ands `.3 F 6
re0 i V Lic Clas Lic p
]Z LL y Dal[ &I;at
-LLC ,ARCHITECT'S a pubo
- 1 understand az nd my plans shall used public¢tor
3 se C Licensed Prufessimal
OWNER-BUILDER DECLARATION
r'u 1 hcmby.from Na,I or exempt frnm the Conton0i s License Law for IM
!- a following recon.stiction 7031.5.Business aad Professions Code Any city prompt,
E C which requires a permit m consumer,alter,impose,demolish,or repair any swcm $5800
its 3w -prim ,. also requires the appl ,1 hoe to fie asgmed slammen, - _ _ .___.__ .---------
...
,hath licensed 0 locant 0lp,oi fib ContractorhLicense Law(Chapter 9 ,f_ Sp,,tct, FllQQppr• f \ . Valuation
(commencing with Sec, '1000)of cis J of the Bus w and Professions Code) <"; � . . •307V`J 0'L•1'.:V'U ? 1i.ir fAr1' .
or chat he ig exempl,he¢fom and,he haus for the alleged ascot Any violation
of Section 7031.5 by any applicant for a formic subjects,he f24P
.ehundreddollars(s5ta). 2 0applicant o a civil penalty y�
of not mom than five
�t"9RFLOOR PLUMBING Occupancy Type
❑L as owner of me property,or my employees with wages as their sole compensmion.
will do the work:and the'amclumf is not intended'.,costed for sale(Sm.7(ei4, _
Business and Professions Code:The Conowder's License Law dm not apply to an 502 - FINAL PfiVMtqA4(9TT*9RGY'i
owner of property Who Wilds or imporics thereon,and who does such work himself
on thaserect f his own employees. ended that such impro_emenm ere not imandorm ye d or .. ...__......._-_5 0 7_ .-. FINAL , PLUMBING •_
offered f w how ,h Wilding p 1 n Ia ,h' t f
mmoli pa <fs Id will have the bb Toro 'ng that hde notWild r --
imp f purpose of sale) r/�/�'//✓�
. ... ... .. __. .... .__.._._.._.._...... .._ x/ C_ ..._ _ _
I e fthe pr pertYin xclusivety contractingwth licensed contto to
con w t the prolan(Sm.]Ilia Business J property
who
Coda:)improves
Contractor mo s
License U doe , poly, her lh proorm no W 1e imp cs t to do-
Contractor's
o
and, hocontacts,f such proJen with cormorants)licensed p uant,o,hc_ .. . . _._ _. _ ......
C
OI=axe pt uroer5` - - ,B&PCfm cors¢axon nn
_ - Owner N Data
ORKER'S CO PENSATION DECLARATION
I hereby affirm under penalty of pedury one of the following declarations:
')(1 O 1 have and will moicado.Cenifiede of Consem in self-insure for Worker's
\ Compensation, as provided for by Section 37W of the Labor Code, for the
peitormaWe of die work for which this Perot is issued.
- O 1 have and will mainmin Worker's Compensation Ibsuranee,as required by,Section
37W of the LaWr Care,for,he p<rfo.itam of me-work for which,his permit is
. La..0 d My W�ei Cmapaysdi Insurance.tamerend Policy numbs,one.
aQre
CaoicrWhf.Axx<,Pul. ,N.,:,A/5O1
UO _
1 :CERTIFlCATION OF EXEMPTION FROM WORKERS ! \.$i s. I s i'.1 ',' �.. k is s ,•\• -.!
.. ._..._..._ COMPENSATION INSURANCE.' .•". ...: .. .. .... _
scorch meed nm M complemJ if the fermi,is for one hunJ2d dollar "• " t -��_---_�_—�--'��"". ,, .,,,t ,, ,.I�if 4 '_' __.,`__.._....__..........
ISIOp)m less]
` 1modify mal in the smninany ce ofanswer dsf whichthispermit the
seed:, - •„ •-• .._._-_
ho11 not employ any person 'n any answer as to become mb)ca,o the Workers'
n
ApPim sncion Lows of California.Data
_Applicant .. -. .. ...
NOTOCIE after making this CeniOcme of Exemption,you should
z hecumemhjenmlheWorkdesComp[mationPovision1oftheL.W,Cade,youmus,
s
O O forthwith comply with such provisions or chis permit shall b,demand revoked.
F s-c of cn<w batYonw can dor Sam is
CONSTRUCTIONLENDINGAGENCY
a., y tth tPe cu t , ndmg agency for the
performance -- --_ - _
W this Permit is rssuad(Sec 3010 Cis C.)
,
o,-O Lend” Nme.r .__,.. . .. _
;D-%z Lcnde AOdrcss
V'O1 nfy,Et I have ami application and ware man aWse imfchowion is
fso F. comma.I agnea m comply with all city'and.county ordinances paidsum laws relating
O.V to building construction.and hereby carbonic repmsenmlives of,hisci,y in arm,upon
the atwve-mentioned pmpeny for inspection purposes.
(We)-,,.'to save.indemnify and keep harmless Ne City of Cu"'ma o.j.mId
W liabilities,judgments,corm and expenses which may in any way ac rue against said
o V'Z City in conscquchce of the giaming of Nis permit.-" "c - '. !'
APPLIC fUN'DERSTAND 1gND WILL MPLY ITH ALL NON:POINrT 1 s
SouR "•E , 's. Issued by: Date
sign m fAppli ir/C t r Date
" Re-roofs
HAZARDOUS MATERIAL ISCLOSURE ' "
w ll the
PriPlicam Or whom Wilding memshom Or handle h6nrdoits n werial
Type of Roofas
de iDti dam53pen�OMunicipal P ll CM CT pt 9.R and O, H<hh dSa11 a ` K;i V 1-z
CNe Sato 255] 1 )+ ,`- :, .•
_ Al]roofsshallinspected prior to.any roofing material being installed. _
W 11 the ppl -, n furore Wdi edrtg byifct pa tune q ip nta d ,e which If a roof is ms[alled without first obtaining an inspection;T'agreeau'remove
emir hwN iammams M dcfneJ by,h Bay A A Q al ty Ma gement
D e1, _ all new materials for inspection._Applicant understands and will cote 1 with
1. Dyes a all non-point source regulations: p"y'
I
I have.read the h olm.t<nl re
aquirements under Chap,cr 6 g5id the s
Califomla Health&Safety Cade:Sections 25505.35533 and 25534.1 understand that
if the Wilding dos no,currently have a mmam.that it is my responsibilityto nonfy,hc' -'- -""- -- - - --
ocupan,of the requirements which must be ma 'o m issuance of a Certificate of ••
.. .t_ segs qy.,'. .. ;,. . • -,
_Signature of Applicant Date
owa< as hart .gem Date All roof coverings to be Class "B" or,betier
r. ....A....; ..•
FIC