02020083 (2) CITY
'6
BUILDING DNERTOYNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
220(;C RAP, TtN Pgn-PLUMBING SERVICE Q2020083
OWNER'S NAME: APPLICATION SUB DATE
BORING DONALD R AND ALICE D 2048 ESTATE VIEW WAY 02/22/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 828-1060
.4 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w w o BLDG ELECT PLUMB MECH
Fico "" LUI L-1 1_1
i LICENSED CONTRACTOR'S DECLARATION
�z-o Ihereby affirsr that lnmbcensedvade,provision,ofChapter 9(commencing
Job Description
„t a, IsimSection 7000)ofDivision 3afineBusineysmad PrnfessfonsCade.and myverne REPIPE Sc WATER SERVICE .
I,Y f;s full roM<na<rce �C.
mo i u -0Lixcecnu CI Lic.p
3 u N .7St r7,,�� Gamma r'
...7TTTss nRCHITECT'S U[C R ION
-a O S 1 understand my plans shall be used as to tic records
to Y�«
i m❑O Limnxd Professional
HiOWNEROWI am exempt
DECLARATION
vi I hey athat am exempt from the Cnnlmem i e:Any c law for the
ollow.Inch re reason Permit
1 ID31 s,Business and ova,Professionsdeli Code:Any city or county
Y i o which requires a permit to ronslme,aper,improve,demolish,ore pair any ewcmm $5500
p�3�._that hor s 9 o fic pr applicant o lm such f the Contractor
m file se Law(Chapter enh -- - - ------ - — - - - -
(com sr dp 'u2nn7000) ion3OtheBusmrsLianuLawnsCos9 CON
s5 .-Fk�FloorArea ,Tl ., Valuation
or that
ned mSci ]000) fhe -sisor he.Iijid and PmfAny vilmimr fps)'alTf t viZ, ;�a$Fj�S: I
of Sec io s 1;5 b Iany applicant
li and the basis for the cts th tl exemption..ny vlolm on 3 S 0 7'0 2 9 Q
-of not Section v any hundred
vta Tor v permit subjccte the eppliaata to a tivikl`mlvlly-
Inrnotmommmfroehanemaanllarstgsfyd7. APN Number ^If" Occupancy Type
❑I.asowactOfthepropirl ,,,tinymnpmyee.wiIIIage>a,ban .]amipenoli.n. 202 - UNDERFLOOR PLUMBING
-will do he wark.'md'the swrnme'is not intended or offered far sale(Sec.-]Qtr, R11 'C" '
'Basina,s•ane Profession.Code:The Connaear,U,rma Law does ml apply m vn - - 25 2)
2 — F INAL P g s lV �i'�iY n . .
..at of pm,.y who builds or improres meson,and who does such wmk himself
ar through his own employees.pr.vidnd mal such improvemems are a.,intended ar 50-7 -._..FINAL.-PLUMB ING
._.cur of __......_
"completion sale:If;howuilik,Fe b has. or improvementofprove soW-wiihid one completion, he owner-builder will M1ave he burdn of proving that he did not build or
improve for putlwse of sale.).
OI:as owner of jec pnlect.7 tan exclusively d Professions
with licensed convectors to
amsuue me prosect Elect.]Baa,Business and Professions Cade:)The Contractor's.eon. ,6 '.C' •,t ,.
Liccnu law docs not apply loan owner of a corny who builds or improves.crest,
._ ,. ...and whgconwclse Law.such Protects with a.commeorts)Iiccnscd.pursuant.to.Ne
Contlanse.pt.nse Law. - �.
Olvm exempt under itt.rl " l ,B@PCfm this mason FI,VA LE®
_ Own .l Daie'.. P�
WORKER'S COMPENSATION DECLARATION
• 'e IOnclay affirm under penalty of periary one,afore following declarrumns. FEB 2 5 2002
a 1 hove and will maintain-u Cenmcme of C`amenl'lo self-insure for workers Compensation.as provided far by Smim 3')00 of the Lnbar Gads, far me
k fur which this perBUILDING
__f performance of Ihe wormit is issued.,
s ❑I Lave end will maintain Worker's Cnlripeniaion Insurance,as raptimd by Section
- 3700 of the Ladwr Cdde,for the performance of me'work'for which this permit is
issued My Worker,C pe Ion Insurance e and Poly number are
wZ.l� :^�a�y_IlAIfL�t' c.W�1l� ••' !. I / ) a - .. ..
'art TT r't o11cY EE tl' 1i.i_. e t l �V�t�� W�
,I,CRR IFICATIO OF EXEM ION FROM WORKERS—
COMPENSATION
ORK RS <
COMPENSATION INSURANCE'S- ''a
L: t (Thi,xeiohneed not he compktN if the permit is for one hundred dollen
($100)Or less)
�is't Ii rtfyNt nthe.perbarm,ae ofmc work for which thism l
per 's,,s.c
hall not employ any Person in any manner so as to become subject to the Wmk rt
Conipcnsotion laws of Culifomia.Uele
Applicata: ..
.NOTICE TO APPLICANT:If,uflat mukinsihisCcnificae of Exemption;you should •' ,"
bemar bj- n theWok C pensa ,p a ns ofth Lata Cale you must
QO fodh' ih w mplyNsuch provisions or this permit shall bed ed reokd,
""^''ICONSTRUCTION LENDING AGENCY -
•r I hembyaffmn that N m ivii armixtruclumilea g gc cy forNe parfonoance I"
'fm kfo which thispermit ' d(Sou 3097 C C)
5'z -Links Name,._, , a . ss._. .- . 1_. •,a -. .. .._. .. .. ...
L,ndch mares, • ._
1I agree the 1 hely rtaa Nis application and semin ordinances
a above information is
Q(:)I-u 'tooriecd 1 agree constriction,cpmplY with ell out end county ordinances and xcity laws enter upon
,V (he ala.-raimioven,hereby les afmiscirymanter upon
.(he ebo(We) Toned pmpcny for inspersion puformats ,-
p„' 1 We)"agree to s ,i d<mnify end keep hamdesi the City of,ma a against
st aid
(n Cinj liabilitiesjudgmentsstn oar expenses,which may in any way mpme aga;nn slid vv
V Z City n co yucn 4f th I gra ng of th t r Tl
SPPLRIC�NTU RS VSN SAND wI OMPL N'ITH ALL NO -P01 - Issued by: ! D C
r ig m ApplicanU moot r' f Da - Re-roofs /
'r 1 RDO MATFRIAI 5 DISCLOSURE
.. " II ih appT t m f tort diit mg occ pant store or handle haurd' s material Type of Roof _ _ _._ _ _ _ _ _ -
es d ed by the Cuperfn M c p 1 Cad Ch.,,a,9.12.and he Health and Safety -„ -I•y, v , t I , ,
Code Oxon 2553$al „.N "y its I'I 1,' ..y v s f
\ . 1 �` n -_, All roofs shall be inspected-pnor.to-any roofing,matenal being mstall_ed,,
wum p�lia I -Tal building�occupamuseequpmcntordevices-winch If a roof is installed:without first obtaining an inspection; I agree :6 remove
mitt haalNous e t<om minis its defined by the Bay Aura Air 0 a1'Iy Management
p.t ,. all new materials for inspection. Applicant understands and will comply with
"Goya Np -I „•' . =', all noli-point source regulations. .'. - - ---
• 't 1 hive lead me b.i don maiefials mquiremenu Lader Chapter'6.95W die,
c4domia Health&Safe s Code.Sections 25505,25533 and 25534.1 understand that
if Itie building docs not only have a"a" het it is ny responsibility to notify me -
666up the req meats w"ch mus ,,et pr to issuance of a Cenifisane'of
Occupancy" ..,i-_ . . -
am of
• " . .: Signature of Applicant Date
>-. d,ca e - L ° All roof coverings to be Class"B" or better
"
_ - - OFFICE