02040075 (2) CITY OF CUP
ERTINO " _BUILDING DIVISION PERMIT CONTRACTOIt'PINFORMATIQ}N;:
BUILDING ADDRESS: PERMIT NO.
02040075
OWN'ER'S NAME: APPLICATION SUB DATE
RICKMAN WILFORD M AND HELEN It 04/16/2002
PHONE: - SANITARY NO, CONTROL NO.
o ARCHITECT/lINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
< u C_I L. u
�i LICENSED CONTRACTOR'S DECLARATION lob Description
ae. I hereby affirm that I am licensed under provisions of Chapter 9(commencing
KI: withSection7000)ofDivision3ofth BusinessendProfenionsCWamdmylkenu COPPER REPIPE
is in full force end'eBect.
s6- Licenu Class Lice
0 Dale Convenor
LL p ARCHITECT'5 DECLARATION
I understand my In.,shall be uved as public records
D o Licensed Prof,.i..d '
R� OWNER-BUILDER DECLARATION
-y 1 hereby off.that 1 am exempt from the Conuamr's License Law for the
C Z following mason.(Section 70713,Business and Professions Code:Any city or county
whichpennit requires a prat to ccnscsvct alter,improte,demolish,or repair any structure $6500
C3�..prionoslss anceials, regreelpo
Chet he Ittnsed duisuanuo Urc PNn ions of the ConuacloWf License law IChapur 9 ----
frnmmvncvBdNSecuonl000)afD'visiot cocauanau quad Profaaia Cadet t„(i a , ,'-\ V tlGn.'.
or that he a uimpi rhertfrom ad the buis for the tlleged esanptcn.My violation
dolhh
-ors E 7031 by any oppllam for a permit subjecu the oppllnnt m e civil penolry'-
or1.us e!ActaravefiaWrcArmyacrS.l . 201&N RFLOOR P UMBING° Occupancy Type
❑1,as sonar of the progeny.m my employers with u oges u their sole compenution,
w'ilI Lo ttie'work and the inucnme is not intended`or-rerid'forle(so&--jW.-
'Business'end Professions Cade:The Contractor's License Lew does not apply to an t n DAT'
ower of progeny who Wild.or improve thereon,and wW dttuucb woh himul( 5 0 2 - F I NAL P$€iMtSp�N'k3&GY
grthroat{h his own emplpyees.,pro,kedthat such imptpverrenta art req intended a, S0.7_..=_..FINAL_ PLUMBING
oB<Kd fo -le,If,ho ver.the building or imprnwmem is sold within one year of --"- -�_ - _..._. _I.._ ------
Yompleoon ave N
the owner twild,,will he W Nen of proving the,he did not build or
V`
for purpou of sole.).
1;as owner of du Progeny.am esdusisxly contracting with licensed contractors to __ ;r F ;Ls�; ,:F --"-""-"
' ----
cc
swct the Prosect(sec.7000,Business end Professore!Cade:)The Contractor'. 91.:Y: iRIPd i71
Li rase Low do-.not apply to an wear of propany who W ild.or improwu thereon, '
.and W. omoccta.fa rah pmjeess wvh eontnato0,)htt&W,punant.0 shs ._.........
gpl
Con n Uc.me 4aw t
❑ e u '" P,C/f,o-
!.
G`°° AD TIO MAY 2 Q 2002
e 'WORKER S COMPEN
'-1 here �rrn vrNa nett of V otic of the follwing dedentiom:"-
� .:P .Yu„pc07
BUILDING
❑ 1 hove and'wilrmvided-e'Ceriifi action 37M of
uL ibor for Worker's
Comp rams.oc u.pmi,for which
p.,ndt 4 issued.
Nv Labor Code;-for the
perfortnence of iAe work far which that pcmot u issued.c 0,
❑1 have,end will meinw Wotici Compenutlon Insuience,u required by Seetibn
3700 of the'L.W,Cade.for thepirforinaae of Ne work far which Nsi„permit is
t read M Wohefs Com inion Insurance comer and Policy number are
Y K
eirlr .Polley Nd.
-7,...a9•.CgCIEA?TI,fC.,A” IONOF . FRAM WO..R�K_ES
;COMPENSATIONIWSURANCEir -,}._fir-rc-..c..^�,._. r_, Y•� .�'� ' a !%`li.•lr�f. :. .s.)v s.a r.
_.,....__......,.__..____.. �
•%:..elk dR ,.,� . . ., ;..t .,„,
ffhb secuon need not W conipletad if the permit is for ane hundred dollen '''-'` ' ”' " t'�.
100) r kss � ,u
shy"�I ttNf tl"inf GallOmla.Dau 6f tW woh faf, hteh Nh perenn is nsued T ' - V. .,.. ,-, _ """-"""' "'
Y 0<
all not crop!y anY p.raaP In a Y manner w into Wcome sub)em to the Workcri 'Vii! I'i + ,.,X11.C:.Ji'�''` �' -
'N CE TO APPLICANPI Nt rata n this CEniBan PfEu pt on y ushpuld .....
. - - _"-
.;y r
Q fon w.pb)ldwlheW rker.Compenud nprov ns of the Lobo Cad You musi �\'r
7i Wi
h th mpry w th'su<h p mons o that perm t shell W deemrd rtvok d
Z _._
pG
y '+' ' s,"CONSTRUCTION LENDINOAGENCY '� `1O v _ - ---------
iC
ccr t 1 h rtbY efBsfi that thtrt n a ronswbuon Imdih inc ,( .L ;S ..
'U
P Y Yfa dq'perfoimen<e .:-f
W.QofVK orR for hdh Nls perminnswed!quer J097 t C)
V:0 .,dor't Address.. ' ,i x
,I , r..,N .Y '.r'h r"
(S1 emify th t I W reed that vpplicat n end state that the eWvo information is
correct I agree to caroml,with all eny..uM county oNmanees and sat Laws relating
0 to budding construction,and hehbysuthonu repnssntau"tMWscity to enter upon
the above menooped property,for inspeaian puryous.
Ea LL'j (We)agrce i6u e,and npYify and keep harmless the Qty of Cuperunb`iyunst
sera Z: Iiabil tyy;judgments,cot rad fp nus xht h may ,.any way sccry ase rest raid
V Clty)yfan genre of mn0 This pe It r.
PP}+'/CC B1;y ti Co�fPLYliilTH AtLN Issued by r Date
u l:: y lHA2ARDOUS MCadc chat ore end the Hearn.nes Re-roofs
N G of
IP an nthmm
f MATERIALS DISCLOSURE ; ' F
r Will fie sppbcan!a future b IdWg occupant store"handle hauNoa mmenal Type of..Roof
u defined b the Cu rano Mumc P Safety
Cdde ❑Ycs�Section 25532(a17L tc L'1t)sfa .ztkgf
All.roofs shallbe inspected pnor.to.any roofing-matenal being installed..._.—.__
L WJI Ne ePphcent or funtre W ildnng occupant use equip rat or d t o h ch n '
Oman
u < 1 mmeot,iyd finedb"c90YAseaA Q slhyM Ii m.nt If a roof is iris{alled'witfiout fust obtaining an mspechon I to remove
—
D1str alb new materials.for inspection.,.Applicant understands and well comply with
❑Ya 1 a,. Nd I V r :.
tL' (. r r ,'+_ all non-point source regulations t ,
1 have rad'ihe hauNousmakriels KgmremerasturiEu LTepla 695 of Ne
Califomu HuIN A Safety Cad,c,•dons7550!75333 and 25!36 I understand that
tf the Wd in tloca n0Ic dd h -e --_... . _ __. ___ .._..,.._. .. ___.. _.,._.-..,._. ,___ _ _
u Y unwt eP It responsibility m net. . ,r i
G V t ,• trance of a Ceniacata'o/
p
quite xhrt muu W met nor tolu
Z. Signature,of.Applicant..... .... __.-Date .
_ ..
a agent + , - q,, ,'c* ❑ All roof coverings to be Class .B or better
__..OFFICE__...._ " . _,.., . ... _ __. _.. ._., .. . _.... ._.. __._.__