01060015 (2) CI BUILDING pI ON ERT
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19990 PEAR TREE LA 14r'A.--T-r'Pq TNC
OWNER'S NAME: APPLICATION SUB DATE
• SAN ARY N CONTROL NO.
non -090i
n W ZZARCHTTECGENGINEER: BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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Z o N i LICENSED CONTRACTOR'S DECLARATION Job Description
oz—o I hereby alarm rhos I am licensed under provisions of Chapin 9(commencing
t„mtw wire section 7000)or Division 3 of the Business and Professions Coda and my license
< f'I is,In full forteand cHcn.
p"odv License Lie.g REPLACE 50 GALLON GAS WATER HEATER.
x Dam Contractor
w 3 ARCHITECT'S DECLARATION
t= g 1 undersand my plans shall be used as public rc milit
war<o Licensed Professional
repo
OWNER-BUILDER DECLARATION
n m'g—'a 1 hereby affirm that f am exempt from Ne C°m actor s License Law for the
t-Z afollowing reason.(Section 70315,Business and Professimu Cosmic Any eiry or county
m�o which requires a permit to construct,alar,improve,demolish,or repair any structure
w-3m prior w
orto its issncc,also q thea ( permit cant for such permio file stogacd sammm
c - - -- - - --- ----- - - ------- -
e. — that heli licensed pun t to Ne pibltiuoro of de Contractor s License law(Chapter 9
mcmmer¢n thSci nn 7000 of Division3°flh.Butu essardRofmmnsCWc) + 'i a ,: Sq:F[ Floor-Area , x "-I',i 3 unison
or that he is a empt usertfrom and the basis for the alleged exemption.Any violation 1 I .., ...,.i .J . .k-'•: 11. .. y 7 S Y
of Section 7031.5 by any...u zm for a Adan stibjec.the applicant 1.a civil penalty qp[��.l beI
of not more than five hundred dollars 65001. 316 AID Nu Ott I Occupancy Type
❑1,asownerofthend the s,sermYcmplot inwithwartsfered for
310(1 uU
will do me work,and the atrvcwrt is not dot's L-or offered doe znor apply as an
Business aM Professions Cattle:The Contractor's.and w law docs not apply m se S �t
owner of pmpeny Who builJs or improve mcrcon,and who docs such work himself 502 - FINAL PLUM'B7.NG �rtS'�Y
or through his own employees,provided the such improvemena arc not intended or
'offeRafor.ale.If.however, heWildm -improvement .. f . . 506 —=-'GAS TEST ---..._. ._,. ........ .... . ...__.---: ----
gorurdenofpoi n Ycld° r m
improve
theose of salla?will have the burden of poising that he did not build or 507 - FINAL PLUMBING
improve purpose of
......_.. _ .. . tate.. __..._... ---
. _-------
construct
___._
°Lasowner ofNeproperty,am exclusively co Professi withoa)Th Onroorsm
Licanxdaw the project(Sec, no
ownBusers..itProfession,who
Ca,or The Crmrt reon.
License Law does not .1., t owner of property who bumlds or Improve mcreon, 1
-and who comrxa fo s h.p J ¢with a commclMsl hansW Pursuam m the _. _ _ _ �yjY_'_._v..
01 a. mr License La „a ,
°IamcumPwMcrS - d 'B&PCfor tNs Teasers7/
WORKER'S
Owner -Date - ` `
WORKER'S COMPENSATION DECLARATION ,
1 hereby affirm under penahy of perjury one of the following deelamtimmin V /
° 1 have and will maintain a'Cir ifi2am of CLnscm m self-Inure for Wwku's
Compen anon, as provided for by Section 37W of the Labor Code, for the
_ .. performance of rhe work for which this permit is issued. , ,
_ °1 have and will maintain Worker's Compensation Tax...ce,as required by Section
- 37W dire Labor Code,for the performance of rhe work fm'which,hi,permit is
issrm.My Workers Compcnsaion Insurance carrier and polity na , art,
: ,
_. .... ..
-
Comer t m f.i`..:pot'
t. ' . r
[ERTIFlCACOMPENE TION I .S .ROM WORRERs" I n t 11
COMPENSATION INSURANCE
'(This scirion need not be completed if the permit is for one hundred dollars
(S:00)or las.) r
.,., __..,d. -
1 cemploy an in the performance nn the work for become
this Remit a Worker,l
(shall not employ any person in any manner,so as m become subjcn m the Workers'
Compensation laws of California.Dam ;�r
NOT(her. .. .. -. tett -.tete tate ..
. . ... . . _ .. ._ .tett.. _. tett tette.tete_ tete... _L -_ _. _ _ _ _
'NOTICE TO APPLICANT.Work Workers
after Compensation
thisCertificateof the
Labor ode.you
•• <
becamesubjectcom the Workers Compensation tremor shall
haof the Labor Cade,you moa
z O forthwith comply with such provisions .this pctmit shall h.deemed revoked.
Zr.c .. . ... .... .tett .tett. tett .tete tett.tete — .... tate. ._ tate .tate .tate .tate.. ... ....-_ i .tett....tate -
`''CONSTRUCTION LENDING AGENCY - t
1 hereby alOrtn ma mere is,a constrvnion Irntlinq agency fonhe peRormance' I .. .- r
�.:n.
of the work'for whicM1thii permit is issued(See.3097.Civ.C1 .r.. ..tett. tete-.tett._ , _. ......tett-tete
L10 Larder's Namc'.,. .:_ . . _....,._._ _ ... .... .. .. -
.Z Lenders Address - -
ir w
n
Isand that lh m.:.dth .application
,. .and inform, .i
U � y me read this city
and
and satin that above information relati is,
f>r Far torten.I agree to comply with hereby l eiry and caamrcscroadncea and state laws enter
upon
- >, U the above
mentioned
pr,andharinspection rep scn , .,of this citymcn¢r upon
.r,r.0. the abuvcmemiee 1.property far inspection purposes.
to (We)agree ts save;indemnify and k«p hamay in!he
any a of erac agai against
vs, liabilities,judgments.cosy and apenus which may in any way nerve against said
C.7Z Cuyinconscq NDERfthe ytnS AND
COv., ., . ._ ....
APPLICANT UNDERSTANDS,I.YD WILL COJIPLY NITH ALL NON-POINI"' Issued by: Date
SOURCE REGULATIONS. ' ',�� - �• Y'
Signammof Applwam/Canrmcna. ✓ p r, -,d, (Dam:. {r. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will me a,it e Wilding w,siorm m handle isizardmi,astracrall Type of Roof ---.-
u defined" by me Cu,"im,Mumcspal Code Chapter 9.12 d d Health d Safety yP JJ --- - _ 1
Code Section 353_`ta1^.. .., rt .;\ti` ..J . . A s'
'°Ya. . .r . t ❑No, a-... 411 -�i. s,.
__All.roofs shall be inspected.prior to any.roofing material bemg_installed. . ....tate
Will the applicant or future building occupant use cynipmem m devices which t
crnkhiaardous airromo mamzasdefired bymc Bus Arca Air Quality Mnnagemem If a roof is installed ivit}ibut first obtaining an idspectidn I'Sgree'to remove
Diarricr " .. ._.all,new,materials for.inspection...Applicant,dnderstands and will.comp!y_ryith'.
°Ye °No - all non-point source regulations: .
I hme read he haz.W..s materials requirements under Chapter•6.95 of dim
California Health Sir Sari Coda.Sections 25505;25533 and 25531'I understand that - _ . .. ... .. ... ... _ _ -
iRhebuWngtlomnmmentslybaaeamnant,mmltrs ny sp sof a Cenmify of
t ,.
Occupancy.
occupant of the rcyutmmcnts which muithe inn poor m mssuana or a CeniEatc of "
Occupancy.
•- '" :�•.tete_ " ' "° " '. _ Signature of Applicant.. ..... .... .. ..:_ __....._ .Dale
'-- Ownermaumariea g nr- pate,: All roof coverings to be Class."B"orrbetter
.
,
. . ..tate .
- - � .. OFFICE