01120102 (2) RTINO
ct BUILDING my SSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7573 WATERFORD DR AQUATEK PLUMBING INC 01120102
OWNER'S NAME: APPLICATION SUB DATE
A V. BALARUBRANAMANIAN 1716 STONE AVE #E 12/28/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 295-7767
0 e5 p ARCHITECTTNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
z m LICENSED CONTRACTOR'S DECLARATION me Job Description
0 Z-0 1 hereby affmt that I am Iiccnuit under prov'xiona of C t 'ng
with Section 71X)(Hof Divrsm Syr the an.iness an P arta yli GAS LINE TEST
aY i is m fall force an m._ b
E c z S Licens<C1asI Lic.p
O y u Date, Contract
to u 0 i'Aft ITECT'S DECL I N
- 4 1 understand my plans shall be used as public records
9ai3�
a d a O Licensed Professional
OWNER-BUILDER DECLARATION
w o m I hereby affirm that I am exempt from the Contractor's License Law for the
z_Z< fid also,m n.(Section 7031.5.Business and Professions Cole:AnY city or cnunry C O
cx Q which reclaims a permit m construct,alar,improve,demolish,or repair Unix structure Y
a 3$..prior to its issoame,also requires the applicant for such Mom to file a signed statement
- thatheislicensedpurananuothepmxisumsoftheContractor''.sLicenseLaw(Chap¢r9 iF/�OF2 ,.�I Or ea- Valuation
(commencing with Section7090)of Division 3 of the Business road Profusions Code) f+•`\ 36h
u,, ,`t. a ,'i•, 6
or that he is csempt therefrom arta tine basis for the allegbd ammpuon.'Any violation
of Section 7031.5 by any upplicani for a permit subjc,ts the applicant to a civil penalty
of not more than five hundred dollars(5500). 202AP_N 5hFLOOR PL BING' ' Occupancy Type
0Loaoww,ofthe proper,. my employees with wugrsm theirsole compensation,
will do the'workt and the'worcuum is not Unfunded offlmd'fc,sale(Sec:700 1, -- - - '-
Business and Professions Code:The Contractor's License Law does not apply to an 502 - FINAL PLft+IB11Fi4(1IBsEt1Bt1F'�Y
w
oner of property Who builds or improves thereon,and who does such work himself
or through his own employee..pmnded that such improvements art not intended or ....-----506 ___GAS._
"offered for sale:If.however the Wildm,-m-on oweram,osold within bine year or 5 0 7 - FINAL PLUMBING
Completion,the owner-builder will have the burden of proving that he did not build or
improve for purpou of sate).
msr
wp d hi
con tact the project t(Sec 7074 Business d Professici Codc:)Tht tadsm'ss
License Lawdoes not apply tomiamcrofpsimMy n Wldimprovesheeon
and h e mit f h proJccis with,vcontractors)licensed pursuant to Ne
ContractorsL Law, BAPCfonis reason01 am exempt unser See
- �— — -
... oar.......,
•" WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of'erjury otic of the following declarations: i l
..7. ❑ I have and will maintain a Certificate of-Cono ni to self-insure for Worker's
Compiamadmi. as provided for by Section 37W of the Labor Coda for tnc
performance of tb<work for which this permit is issued.
01 have and will maintain Worker's Compensation Insurance,Us required by Seeman
3700 of the Labor Code,for the perform Of tin work for which this Most,11 f-s ^
Ca r-I l° :.tuc tmm cy N mc�a'nI f r he . 7..v.V
...._...�....._.____
••CERTIFICATION DR hlPl'10, PROM WORD KERS" - 1� S.'• ii `x t sf Jct, r'• I f`�5, ✓%• ,�'"9� •,1
..... COMPENSATION,INSURANCE + _. ,.
_......... __._ _ _.. ..� .-_.- .
_. . ._i . ..._ .. .. . .. _....... ........_.._._. ... . __. _,.._....
ti
(Thix union need Bot lv 6mplded if the permit is for one hundred dollars
(SIM).1 less.) ,, •.b. ,,.
I m(y the-i tin PCrf «of tin-work for win htE perttii sis.ucJ"1
;hall t employ any person to any manner so as m become subt)ccm the Workers
'c.aKniation laws of C I f 'a.Data
,Applicant ..
NOTICE TO APPLICANT Ifafter mak' g the Certificate,of Exemption.you.should `
become subject to the Workers Compensation provisions of the Labor Code,you must
Q 0 'forthwith comply with such provisions ur this permit shall be deemed revoked.
.. _ - _ .. -. ._. _. _._ .. ....._..... .___ _
FIn ''-t °'CONSTRUCTION LENDCIGAGENCY
wihreaffirm that there is a conswetign lend,. agency Lar the perfommnce
W or the foi which this permit is issued(Sea 3097,Ctv.C.)
ers Nano,
....... ... ... ... .. _ ..
S ..
s Address- it;
V Q 1 antsy that 1 have read this applkation and state be,the above information is
liE., /cored,.1 agree to comply with all city and county.ordiwnce,aad...m laws relating
.� I to building constriction.and loodw'avthoria'representatives of this city to enter upon
the above mentioned property for itopectiory p,irifoes,
e}.,L (We,a,rcm,ice:indemnify anal keep Larmlcis,be City of Cupctiinougainst
-VI liabilities,judgments,costs add expenses which may in any way acerae against said
U.Z City in consequence of the granting of this Permit
- APPL'IC'ANT UNDERSTANDS AND WILL COMPLY WY H'ALL NON-POINT ' j� - Dale
30U .m
IfCEREGULONS. .. .t ' Issued by:
Sill fAppliea be t t '. Date Re roofs 7
HAURDOU$MATEkIALS DISCLOSURE
wtn di applicant fn atm gacc pam,mr,o handle,n atone .y _ _Type of Roof .__.._ . ......,,...� - ., ....... ._.. . ._... . ... .
a,iiiinnodby the Customs,Municipal Code Chapter 9,13 and the Health andSafety
Code Sect on 255 t2( 1
oY ' �" • ' A. II roofs shall be inspected prior to,any-roofing_material being.mstalled.,_
._
Will thoppiLantor_I t building Occupantaseeq it t a svmxwnen If a roof is installed without first obtaining an inspection, I agree to remove
' it hazardous fircurtiontimanx as defined by the BoyArca Air Q alh,Management
District? all new materials for inspection. Applicant understands and will comply with
0se, oNa all non-point source-regulations.
1•.. I haveCad the haaardcu,materials requirements Under Chapter 6.95 of the _
�Glifornia Healthr
s Safety Code,avea 25505. itis and 25537,Iunderstand that
ifthe nuil of
he manutcurrcndyhaveamnam.thorns to responsibility is notify the -" -- - - -- - - _ -
occupant Pf the requimmenu which matt be met prior to issuance of a Certificate of
°"tap'"`y' • Signature of Applicant. Date
owne�or aantod.<a agent .,Date All roof coverings to be Class "B"or better,
:. - - OFFICE