02020030 (2) CITY
BUI DINGUDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10508 FLORA VISTA AVE DOYLE CUMMINGS PLUMBING s� 02020030
L ROBERT RAY 14311 BUCKNER DR A02G/07/ 2002
.� PHONE: 4089234221 SANITARY NO. CONTROL NO.
K0 O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
Sec G BLDG ELECT PLUMB MECH
h z w L'J
�"' LICENSED CONTRACTOR'S DECLARATION
_ =z I hereby affim,that I am licensed under on of Chapter 9(commending Job Description
o p1OVPr P e SEWER CLEAN OUT.
p.—n'w with Senior]00d efeDivisiont3 of Ne Buxipcy and Profusions Code.and my license
z Y j is in full forSr�and effect.
J(
p i Ciccone CI, Lic.N -
Dam� Comma
O f<n ARC REe use as pre RATIO
J I understand my plans shall be used as public records
Y
orcarO O Licensed Professional
OWNERBUILDERDECLARATION
I hereby affirm that I am exempt from the Cuntactor's License Law for the
t_-z a following mann.(Section 7031.5,Businus and Professions Code:Any city or county, $1000
ed s o which requires a pcm,it,°constrvm,alter,improve,demolish,or repair any swcwm
m t-o prior to its issuance.also roues thea licant fursuch _
e.3 q PP permit License red satemtm.
ththe etcenud pursuanttothep iolimns thedeaticanne toldPLewmas Ceded
3nCnnG..Gi(�r-Amo � - Valuation
1 meet 8 with fir Semmn]ia'an The basis
on 3 ofthc ausmus har Professors Code) �` (�e�•�" ;♦ w c t y k?!y �w�ili:1
of that ,n exempt theream and the bus for the alleged ezcmp io9,Any vmluion a -
�ofSec,ion9W LS by any applicant for a pem,it subjects the applicantto In.civil penalty-:of not more than rise hundred collas IS500). 202Al?NUfflBt$RFLOOR PLUMB'I'NG— Occupancy Type
01,alowsoureflibe property,or my employees with wages as their sole compensation, 301 ROUGH_ PLUMB N '
e
-will do the oro and o, h Th is not ac's Lieir offered foessale
no (Sec ]o a,-
Buri
d e f mos Code The Catamount's,add
w law does not apply m an 502 - - FINAL PIR IBrYffi4As SR£3Y,t"-r�.'.°'
owner of propeny Who Wild,or impedes thereon and who dews such work himself
507 - FINAL PliUMBING
or through his own employees.provided that such improvements arc not intended or
gI(<red for talc l[hdwevcr;the Wilding oiimpibvement is mid within one year of
completion,the awnenbuilder will have the burden ofProving that he did not build or
for
improve puryouofsale.). '
-. - .. .-.". ". -_ _-_--- ___ ._..__ _ --_ -._.
...__. .s. -.. .__..
OItr c f .propenyam eusinessY�d Professions Code:)
I' he t dorst's Lt. ,
Li .1 I theproject no(Sec Ito a Business and Pro whop Gde')Th C to mr s t
License Law does not apply m an owner th propeny who Welds or improves t.m.the i -• ,
..and who comma[ s ch.projects.moth contractors),l ttnsed.pursuam t the
Ct t t 1 nscL
[I 1 pt oder S . ""B;&P C for thrs
Date ... - .._ _
1 WORKER S COMPENSATION DECLARATION /
Ih by IRrm d p ahy of pe 3ury of chef II 'ngd ratio r
❑ 1 have and will'mainain a Ccnifleme of Conse,n to self-insure for Worker's `/ J
Compensation:as,provided for by Sermon 37M of-the Labor Code, for-the C
performance of the work for which this permit is issued..,
❑1 WJc Sod will maintain worker's comlxnsauon lnsuranee,as mluirtd tiY Seniors
3700ofihe'Labar Cede,for the performance of the'work'for which tris'permii is.
issued,MyWorker',C penial Isumnce tamer and Policy number so:
¢At 1ST `— — 7),
" CFRTIPICATIDN OF E%EM�H1rk//F�NWORKERSGG i .h,;,\ r�..�y-�F ��•c;.,~j i': 's!1 A"".-±.
1 , 9h
".. J COMPENSATION INSURANCE= =s j!t
(Tfis et"n 'ud nm W compladf the I'mil is for one hundred d°I len
(31 W1 ar lea) '
.:. .:.... .:. .. ,..: .. s . ..qtr ' .
red,fy}hm'i the part c' f the i hec m rh ti 's. e 1 - -
shall ate PIY nype n' Y an object to the'W kers' (", .� ti . '.L . . fUn, r
Compensmmn 1-taws of Cahfom a.Date '
-:Appl,iishat pmv s permit hall W d c d resale c
D 1 TO to
the Worker
If ft k ion C nr ,e of Ex rapt yo ho Itl r
Z bucom, 63ecuoth< - C rope t np ni of the DaW Cnd reit � � t
Q fonhwnh comply with such ons or this ore m
-W t t ':CONSTRUCTION LENDING AGENCY ^t"' :, 11,
t� ,
tr
yh by (flim th rebore mesa t I tl e S n Y f d qp f m cc
GLS
of th okfo Fch thiss point tssutl(S 1097 Ce C)
Z Leede -Adele t. .. -. - i:(t , IJP I`• ri: __. - .-.. .. __._..
I c n fy that 1 hrot mail this application and salt that the almovs,rarmonatima is
- fir.+F -'me' I,agrte to mmply,with all city and....trey ordinances and nate laws mlming V to Wilding construction,and hemby authriimpeenmtiJes of this citym enter upon
Ir] the abovemicritured pouptmy for-nepveliom prr,mse,
IW) Sme m ooc. nd - dydndk pWrml fihe Cty fC pen no ngmnn
W liabilities,judgment,costs and expenses which maY,in any way accrue against said
Viz Cny nco game of the gaminR
fth -
APPLICANT #STANDS AND WILL COMPLY WITHLL AOy:PI]I`IT' Is$Uedbate
0 t/
UR CATIONS. _q-tip" y ale
A!,nam, 1Appic.,nVCamrxcter
Wil dice
SURE SCLC E HAZARDOUS,MATERIA
e Re-roofs
Ii*rxm 6, il p t.mrc or hdl haam modal
as def d theCupoo Municipal Cou ._Type ofR
OQf." .._., ...-_, . .-.-
Cad Scott.. apt9 12 a d th He lth and S ",
+w
3 j: S- .7 ��_"�•_'
❑Yes - N ice^' <I1s ,f sa - - iltit if 4 ✓ { :aY :•
..,. , All
to
shall be mspected,pnorto any roofing-material being installed _
• W ll the air
f t e but[el g occupant nt qu pr Qm a which' If a roof Is Tiistalled without first obtaining an ms cellon' I'5gree`tti iemove
treat lthe tin tadfndbythneyAreA Q 1tye1 g et B P
Duarte,?i - all new materials for inspection A_ pplicant und_e_rstands and will comply with
- -
'all non point source regulations.-
have :rW -
k" 1 ' ad the hazard un an ted I. req rement:and r Ch pter G 95'of the.,California Health&S 1ny CWe.Section.25505,25533 and 25536 1 understand,hat
-if,htbudtlmee real
not arrcntl_vha,ard,I a at.tett itumytesponsiof earro
occupant.Tithe rcquircmgnt which must be me,pdono issuance of a CeniFcam of '
Occup;mq;.t.. .
Signature of Applicant
Date
tnoraee ag t Date 1, . All roof coverings to be Class `B" or better' It L..b _- ... .. . -OFFICE... ____