02080018 (2) CI BUILD NG DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21597 ROSARIO AV TOM ' S PLUMBING 02080018
OWNER'S NAME. APPLICATION SUB DA
PEREZ RICHARD L AND CHERYL B 112246 SARATOGA SUNNYVAL R 08/06/2002
PHONE: (408) 867-6010 SANITARY NO. CONTROL NO.
µl00 ARCHITECTPENGWEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a,i r—I LJ LJ I-I
5 H i LICENSED CONTRACTOR'S DECLARATION Job Description
pZ-0 I hereby affirm that l am licensed under provisions of Chapter 9(commencing REPLACE WATER HEATER
rntw wit Section7D0Xo of Division J of the Business and Professions Cale.and my license
is in full force and ellen.
on m< License Cloys Lic.g
w a LL y Dale Commner
ARCHITECT'S DECLARATION /�
t-O g 1 understand my plans shall he used as public mooNs 16
on <E Licensed Professional
°'o.t]z OWNER-BUILDER DECLARATION
"4-u. 1 hereby affirm that 1 am cscmpt from the Contractor's License Law for the
t-Z a following reason.(Section 7031.5.Business and Professions Cole:Any city or county $500
f F o which requires a peril to construct.alter,improve.demolish,or repair any noremly
urej 3C$ .prior to its issuance,also requires the applicam for such penniva file usigned smumem
tat he it lieenscd purstuse to the previsions of the Contractor s Licane Lars.(Chapter
9 oaf,,�ftt��[n�r �ppa,,.. :.•- Valuation
(commnicin Ih Seclion700 (Division 3 of the Business and Professions Coda
• _I
or tel he Sse imps teiefrosn and the basis for the alleges e.c.Io on.Any violation (' --'-• -- r.• { , ,q
of Seen.7031.5 by any applicant for a permit subjects den applicam m e civil penalty
t of not mom than five hundred dollars S500). 502AP-Nti24qXi, PLUMBIN ENERGYOccupancy Type
01,as owner of the pmpsrt.car mY employsm with wages as their sole compensation. - GAS TRST
will do'the'work.and'Ire'structure is not'intended'or'offered'for sale Sec 70LIr - - 507 - FINAL PIRgk�Be�tAditspec[ians""' " '• '^
Business and1findessioru Cale:The Contractor's Loa nu law does not apply to an
owner of property Who builds or improves thereon,and who does such work himself
or trough his own employees,inn idnd that such improvements arc nor intended or
-
offered for sale:If,however;to building or inlpmve,oenf is sold'within'"one year of _I_.-'.._._._...-.
omplelion,the owner-builder will have the burden of proving that he did not build or
improve for purpose of tile).
._...._..... . f th* ..._. ._........._._._..__ .._- ._..
1:: -co Lps owne(of the pmpcny,um Business and
ns licensed conrtvots m --- _ -- - 'n '--PV f
construct theLaw
does
no(Sec. to a.Business and Professions Carica The improves
Contractorthereon, y ;;.;.; ,;- ;� t
ad-who
Law does not apply m rc owner t property,who builds or improves thereon,
_dna wbo comae se L such projecla_wit a commcmr(s).laenxJ Pursuant to the .. _-. ___ _.____....__ _,_..._.. ._.__t�n _ _ _ .......
._..__ _... __...__...-.
i Contractors Lncnsp Ia Ubu MAL
E D. �.
lam 1esmpt and 1, :BPe Jnr this reason CTJ Qu dui lgts..t'
O ` WO SCOMPE TION DECLARATION S[r O J ZOOL
„I hereby affix under penally or perjury one of the following declarations:
❑ 1 have and'aill maintain a Certificam'of Consent'lo self-insum for Wmker's BUILDING
l If iL D'ptrv,
Compensaion, as pmvided IJ for by Section 37W of the Labor Code, for the NG
- - performance of the work for which this peril is issued. _.
1 have oad will maintain Worker's Compensation Insarsomm.as required by Section
3700 of the Labor Code,for the performance of the work for which this peril is
iss J My Workers Compensation Insurance rti and Pith,nhe rc: -
cd kct1l t'il 't". .:Poly No. In i"r}�).
CERTIFICATION OF.EXEMPTION FROM WORKERS,
' COMPENSATION INSURANCE; '
(This uciion nota nm be cumpincd if the permit is fm one hundred dollen
(S IW)or less.)sha ,i tt,
' than n Ih ri in any
uof the rk for111 object
b cern is
Coll
pc 1employraw1 �van�jyppfC i f y 02 bl a terve rkcrs
N C 'sAPtSLICA It aft k, g this C nlfcale I E pl you should, r`'• '' " - s
Z themo ubjnctlo the Worinei C.marrandum istruskimo,arm Lata Cut you as,
Q onth ith comply with such provisions.,,his permit shall be donnod mocked _
_ - - . _ ._ .. __ .. ..
-zI CONSTRUCTION ENDING AGENCY
Thereby offir that isconst Sinn lending agency far the performance
W"^ ofte'waN --
for which this Permit Peril iss issuca(Scc.' Civ.C.1
CL. Lnrodnra
LaJ Address
V'Q 1 my that;M1 JN.city
and ,cath bar the bo oii r,on is
ter.F 'Fa"r I gun to comply i1M1 all eery J coumv oN, nc d slam laws relo,ing -
Q V tab Is'ng co st nth ndh by Ih p nmtive.9ft city to enter upon
} (T] the bo 1 Js pcnyf pees purposes.
/ la
H S (Wjudgm mss a lnddexpeefinnify dke i hams s they ayarcy 6f o en against,
aid k^.•1'lV
-W cnst
liabilities,J al costs ri expenses which Y ,any Y c e gain.(said
V.Z City m aonseq e f IM1 granting f t Permit. f-.
"d PI LICANT UNDERSTANDS'AND WI LL COMPLY WITH ALL SON IN Issued by: ! Date
SouN.RI/JT_ATIQNS. r. fGl
.ignamscgf Ap ,wcammaor "� - Dale .." Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
_ Wills pplic t Farm Wilding occupnot.tore orhandle ha;aaoe,mat 'al _Type Of ROOf._ /ng
asdfned by lheCupinns Municipal C , Chapter 412,and the Health and Safety 1 ., (_. f ,•_:g n25fd21al .tvl - ls TOY: -`,2 4 ♦. Na. 54. II' ., YJ t \ i All roofs shall be inspected,p�or-to any-roofing material b . nstallcd. ,,,,,_„„ -•
Will the,applic Ior future Wilding oncupsnt use equpm<nt or de ices
which If a roof is installed'without first obtaining an inspectionrI'agree to remove
n n,hazardous art cimtm,nams os defined by the Bay Area Air Quality Management
D 1 e, all new materials for inspection :Applicant understands and will comply with
°Y' No
all non-point source regulations, . .
1 j 1 h ve read he haaallous meunals ugarcmem under Chapter fi 95 of the ,
it me mil ing dws
Na of cu Cuse.ave mount.
that
itis and 2553x.1 uy or roof,Thar _
-iftc Wildinge mquirlcurres which eust the met it myssuanc siofa oronficat the
dcdupant of to requirem5nd which muni W and prior to issuance of a Certificate of
Signature of Applicant Date
6-ot -.. - _.
All roof coverings to be Class"B"of better.
o thadaea , ,Dae J1 .'
s
_.
-OFFICE