02060054 (2) Ci sin of c opv sioNNO CONTRACTOR INFORMATION:
PERMIT
010680 RLA RODA DR DIJOSEPH' S PLUMBING PCRMITNo. 02060054
AMEMCFARLING 205 WYANDOTTE DR 'R"tIcT" U2
PHONE: (408) 365-2058 SANITARY NO. CONTROL NO.
❑rt0 0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
a a I I_l L-1
5 y 3 LICENSED CONTRACTOR'S DECLARATION .1�l nn rt�t
i,In Ihereby ufirmthat Ianlicensed underprovision,cdChopmr9(cnmmencing REPIPE HOUSE/WA'1'ERe �gCE
_tt9r with Section 7000).(Division 3ofthe Business enJ Professions Cal rid mylicense
yfaj is in full force andaffecc_3� NEW WATER HEATER
1O0<
u License Clae 1D Lie.a
Dam d.nn Contra mr
LL u.� RA CT'S DECLAR I
g l understand my plans shall be used as public records
MO Licensed Professional
OWNER-BUILDER DECLARATION
to 1 hemby affirm that 1 ora exempt from the Contractor's License law far the
t 3< following reason,(Section 7031.5.Business and Professions Code:Any city or county
E Z G
which requires a Permit to construct.alter,impm a demolish. p ny structure
Poor to'its issuance,also requiresthe applicant for such Permit to file a s'g ed steamer, _ _ _ 15,0 0-0".,
"at
h t n an ed ppis a,to the p m,m of the Corona,...na,or L Low(Chapter9 . ? q. . Floor Areas r y � ,'1 ' ,'. Valuation
(communing,
c rte, mgwtlSec, 7,000] fDiviio 3 of Businessandkrofss,onsCode) S ht
or th'he Is enempt therefrom aril the bas s fn the nudged kemgiori.Any violation "• r. S `3 6 9 3 3Ot12 '
-of-Semm�4031.5 by any applicant for a Permit subjects the applicant to v civil penalty Occupancy Type
lo(n'mom than fico hundred dollars(S500). APN Number .rl:x:::
°1,as ownerofthe property,or my employees with woses as their sole compensation, 106 - SEWER & WATER
will do the work,and the structure is not intended'or offend for sale(See.O(Wd,' - _
'Business and Professions Code:The Contractor's License Law does not apply to an 1 1'I',I
owner of properly Who builds or improves thereon,and who does such work himself 3 O 1 - ROUGH PLU B ING
or through his own employees,provided that such improvements arc not intended 0r
offered forsalelf hdwevei the building mii vetnent usold withinone year or -- ---3'02'-'— 'TUB-"tS�`OR--SHOWER'„- - - ---- -
-comw
pin on,the oner bolder will have the burden of proving that he did not build or �
improve f'parposeofs.le). 502 - FINAL PLUMBING ENERGY
- __..- .. _ 506 ---'GAS TEST-' ._...._.
❑1;as owner of the property nm exclusively comma,rte w th 1 n J c u tors to ,; -
coastmct the p,.je'(Sea nwa,Br,uhmas and Probe..ons cm )Th e tractors 507 — FINAL PLUMBING t t I:t.'1
License Low docs not apply to an owner of propsny who builds or improves thereon, "
Ii _". _end who.commcts.forsuch.prolccu with.a commcomfi)licensed Putman t.m the _.. .._.__. _...._.-...._ .____.._______._._... _..__._._._._l_ .__.____._.__..__...-__.__ ------
c.
__
Coroomst's License Law... ._...-_. ._ _ -
°I.m exempt order Sce:'-'' " f f '.B&P C for his reason
wndr"' Date'
WORKER'S COMPENSATION II ECTARATION -
"'' 1 hereby eRrn under penalty of perjury one of the following declarations: 04
C l have end as provided
pa Certificate Sem of Conant's Labsturt for Worker's �I INA �� ■
. Compensation, he provided for by Section 3700 of-the Labor Code; fee ,he �m tis
- performance of the work for which this permit is issued.
XI have o tl will'ma,ma W ker's Co pen anon Insuronc required by Section JUN 2 5 2002
3700 of tireLaborCM f the perfoirm ne of the work f which this permit is
issued.My Worker
s Compen ilon Ins.. goer and Polut be e' Y-- --
GL 1. /(y (I . ......
' Cf,(1�CERTIPIEXEMYPTION F'ROM.WQRI(ERg�roo�3 5� ;., :�iT '.P i} iv Ms tt'dt ,z�-t ', 1, z t t �u�L���� v3t -
_cr COMPENSATION INSURANCE _
C'IP,. ;5.: .. 11_!:d' f,lU Li t Iv,
(Thssen nn need not he completed RiM1e porntis for one hundred dollars
(s loo)or less
m,
rih r I c employ
That in the n fo my ce tnthe 'ark for hieh object
peon,l orke.I
h ll not employ oily person m any ate' r m vat to hedome sublet m the Workers' Y'-
Compo stn Las (C 1 f m 'Dare
._Apel earl ..... ._....._-._. _. _.._ .. _ ..__.._ . .. .. _...._
NOTICE TOANT If Bma
erkmth
gsvnfem fExy_y should sd':. .
bac Il a�to the W k r Compensation p ons
the1 Labor
Q fonhh comply with such p sons or this pe t shall
a
be deev ,you must
w, deemed evoked.
1`1-CONSTRUCTION LENDING AGENCY .....
, 1 h rcor H7m that the conswnion lending eg y f r Ne pkriormanm ,,,, _, n .r,-
3: Q Un work! which thl pc t' issued(Sec.3097,Civ.C)
-Under e N. ..'- '- +-...-_. s.. _ ._ .. __. _... ._. ___
L: __ ._. .. .. _ ._.. ... _ ._... ...._ -._. .. ._..
P>z Lenders Addrea; '(' ,..1.• .
V, I cearlify,thtut I have mad all ny'anat on d store that thedabove information
'built 1 agree to comply u b e ry o d county ordinances aptl stem lawsrelating / S
[)
to'buove-m st ed dh rtbyd that ze pos t tJd of thscty met Pon
fj] the ebo a cd save,pony fo peer oat p qw _
G- W)agreetodemope and keepharmless thegty term.,.f egons,
U V] Cliabilities,judgments,costs and n,of
pe{h y n any way c .,.fast said
V City inmeanT nce o(theg fag of thspeCOM
APPLICANT ST 1) Vu COMPLY WIT HALL'NONIPOINT` r '
90Urs' RFD JATTIIOONNs _ /- Issued by: Date
Sip arm of Appl¢wUConuanor' u- ' ;^Date
'r RDOUS MATERIALS DISSURE '.%`:Ir Re-roofs
HAZA
�;,', WII the applicant hwre bu(ding orcupam stow or handl liaiardou.
..coal Type of Roof z .., ....-.
es deft dby th CpmnoM cp lC de Chant 912 edzhe li hh ---------
d Safety
❑ret r' °N F :! f ., All roofs shall be inspected prior i(5.any"ofing-material beinginstalled.
„a _ W'lltheapplicamorfmurtbuddmg upantuucgop t �5e.��«which If a roof is installed'without first obtaining an-inspection;'I agree tci iremove
eon herardous air comamments ai defined by the Bay Arca Air Quilty MenIgement g g
all new materials for inspection..,Applicant understands and will comply with
: - .-
�', all non-point source"'regulations
ws� '' 111ave rcad'the h z d ,materials q ementy and Ch pi r(i 95 the
Cel! e H uhh&Sof ty Cad Se$o s 25505 33333 d 23530 1 undemand that
rfNe bo ltl ng does o, dyh veafen tthtt myrcpo blryt noti(yahe / --
ode plot(f,the uircmc , Nch to be t p'or m iesu c f.CeniBeam of L'�VI!`_/ .' /l.�il2Q.�Qef Cil''// G`
e nce - ..
�lLG+t a ��^ Signature of Applicant Date
-A
w n raeaagent I �� Date. All roof coverings to be Class "B" or better '
I '
_OFFICE
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