01100161 (2) CITYBUILDI c uPEBONNo PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: '- PERMIT NO.
10275 VIRGINIA SWAN PL BUDGET PLUMBING 01100161
OWNER'S NAME: APPLICATION SUB DATE
RANJEEV SETH 28695 ROANOKE ST 10/31/2001
PHONE: SANITARY NO. CONTROL NO.
(510) 264-1113
❑O C ARCHmi..CT/ENGINEER: BUILDING PERMIT INTO
u❑ BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Z JobDesen non
Ihereby aIfrothatIamlicensedunder provisions ofChater9(commencing
to with Section]000)af Division 3 of the Business and Professions Code.and my license WATER HEATER REPLACEMENT O
i,in full force and eR<m
s of 6 Liolmo Clens " Lic.N
'O a u Dao - Caoic,mc
i 3 a.G ARCHITECT'S DECLARATION -
0 4 1 understand my plans shall he used a.public recnrdc �� 0 OOQ�
r L
c p C Licensed Professional
R:o OWNER BUILDER DECLARATION
a I hereby aRnn that I nm exempt from the Concern's License Law for the
following reason(Section 7031.5,Business and Pmficoon v,Code:Any city or county' ` {—`q q _
which ra uirts a permit to consumer.alter,improve demolish,or mWir any svunure y
3 m _pdior to ts isciance,also requires the applicant for such pemuuo file a signed nmement_
Naihq♦,1' nkat perpia lmlhe P^ ns of ti¢ConuactwsLv:ense lawfCM1apmr9 f_ ief
,3 f �Y'tlI�'VETR , .t ,, Valuation
..
(commencing withSection)WO> fD 'sion3oflotBacyn
rcardPredzdonsCoca) CL):`\
m. Y 4017Y'tl
or then Te v czempr thertfmm vnd rhe bas¢for rhe a11eg d ciunaoov My,i.htims
-- -'of Section 7031.5 by any applicant fore pelmir mbjens 0e applicant to o civil pcnalry' ,.p Ts7..,.,1�nn
� 'of not more than:five hundred dollars 15500). 502'PN 'L"'1'jtlnt PLUMBIN 'ENERG)Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation,
-r asinns rhCwaro;esidns Code:Tsmatureis-neiimewLcense Lawdoesred far ilenotaplSrm:Loan 507 - FINAL PRlri�BH&NGspectiohs'"I'' ''
owner of pro Pro@mous Code:The Cnct them's License Law docs not work
h m an
owner of properly em bode,or improves thereon,andmpr who encs such work himself
or through his own employees.provided then such improvements are not intendedor-_ -
,oB<mdfortale.-Khoo-ever,the buildin ire us Id thin ono-- f
completion,far ate ance of I leer will have rhe lwNen of pmving that he did nut build or
improve for purpose of sole.).
con;as nwacrof property,7 ore exclusively ntmnimgwith oiled ri contractors to
- onxtrvn the project(Sm.]Baa,Business and Professions Code:)The Camractor's � t : , r�i.(;' P,
and,wh Low trek nm apply m aci owner of property who builds ce impmount t .da,
'. _ana.who.conicess fLaw. Pmjecu.wilh.a cavvxsor(s)licrnrd.pursuvm m.thc. _.__.__.__.__ ____ -------___-_,____---_-..
Contranor's Liccmc Low;.� . ....., __..__._. __--.._........ ....._._.__._._._ _
❑lam exempt under.Sea; "' B'&P C for this reams
O;aer* Dai, a. -
WORKER'S COMPENSATION DECLARATION
" 1 hereby affirm under penvlty,of Pe.qury one of the following declarations:"
❑ 1 have and will mvintsin aCmificate of Consent to self-insure fm Worker's
Compensation, as provided fur by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. .
❑1 have and will main id n Worker's Compcnerion Insurance,of acquired by Section
-�� 3700of the Labor Code'
issued.M W.rker's Com nation Inmt�ne l of e, work which thin permit is
.for Be pada ,,,,•
..' � y. pe ,mice rSnicr and Pdlicy number artS,n,a-( _ -` V _ _- _ _ ___...-•- _..._..- _ ..
Carne Y 'S.- LlYl fir Poli yN ,p r_. " Jh1 t�..,_cJ tq is:' T, -- %'. II Ji'sL
Y'CERTIFICATION OF,F.%EMPTION FR M. OR RSA \ a t.t •.. 1�'-'i; „
COMPENSATIONINSURANCE;)rt. ...
.r
flltis'settion need rani be annplercd if the permit is for one hundred dollars -
-
("her less;):u. •.. , . :,I ..,�. ,r.. .. ' , ._ -... . , ._ .,_._...__-._...... ...... . .. ..... _ ...._......-��
t lcer4fyrhany the perform race ner as
cameshspe_. t ssue '-
,hall not employ-mny perms m any manna w u m becomersub3ar ro the Workers'
Ccinjainoafitnt Laws of Calf tat.Date '
..Applcat'. _ _ .. - ._._. ._. . ._ .. .-._ _. .. .. - ----- ._ ..._
rNOTICC TO APPLICANT If.after-making this Certificate bfE cmplion.you should
timomc sub3eei to the Workers Compensation provisions of the Labor Code.you must
Q O font lith comply with such provisions or his pemd,shall be deemed revoked.
("` "r'•t:. ' CONSTRUCTION LENDING AGENCY
hereby affirm that pelshcoaueddingagenry for
epefonnanecVdiewrtkfbrdtiieh this' fmii sissue (Sec.
3D97.CIV.C.).�.0 v+.:.:c re.a:
L0 -Lenders Namc":_.,.,..,..a._(_r(..�.o-r_, -_�_.._' _. ._.__ .__.._ .
linde'rn Address,.
\
U.O1 n fy that l have d this and state that N bo information is
_ `;orrect L agree to mply th all city and county ordinances and state laws relay ng —
O:V to building out,trUctimd herebyaudience"p m
emnves of N¢aty to enrerupon
Be abo rN p pend far inspection ur,oves. /fss/_// I r0//✓
. -`.,y es,jagreetssave, and
whiharmless the Cnyofcose a aiat said .. _ - _ .. _ .. ....
W liabilities,judgments,cosy and expenses whichmry.in any way accrue against said
C.7
Citpp ca sec UND ofth NDS-A DWI
APPLICANT UNDBR$rAsOS AID WILL C011PL1s'W'ITH ALL(NOtq:PO1NT'
sovRCE 1t.-GULATIONS.I '" " - Issued by: Date
Srgrmture fAppfc.UChmmnor .' . 'Dtc,r-` Re-roofs ..._. .
HAZARDOUS MATERIALS DISCLOSURE
`F"'i wBlhc 61icam or'f tarebutiamg mcupara store or handle liantackinusmaterial .Type of Roof_
as
d.fired by rhe Cupcn Municipal Cad Ch ,d 9.12,and BeHealth and Safety l
Code:Sat on 25532(e) -�
ork ( 1,1(rti
-' , .on 't7 •` All roofs.shall be.ins ected.pnor_to,an roofin material.bein installed._.-_
,r,. ...•. _ .... _ P Y g g
wntne applicant err future wilaiag ocrnpam tike equipment or aevirea wnich If a roof is installe'd'without first obtaining an inspection;'Pagree:to remove
emir hvudnus air conmminanis as defined by the Bey Arta Air Quality Management inspection.
Di,v;<n err - _ all new materials for,ins ection,_Applicant understands and will comply.with
ora No 1;: ; all-non-point source regulations:
'.1' ' I''1 him:mud-thehaivNoui,`metedals requireandos`vndcr Chapmr 6.95 of ile
California Mouth,&safety Cade.Sections 25505t8533 acrd 25530:1 undersand thin
If the building tees-not curremly have aronant;Our it is my responsibility fin notify the --
oliculiant of Ne fequirtmenta which must he me,prior to issuance of a Ceniftcam of '
a`"panty( .. tit - _ -_ '- _ Signature of Applicant - „Date_.
L All roof coverings to be Class "B" or better'
Owner rhmimd agent i Date
I '
OFFICE