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corEltTltvo CONTRACTOR
INFORMATION:
NG DINISION PERMIT
PERMIT NO.
RESS:
A B S HEATING & AIR COND
010900
DERBROOK LA
APPLICATION SUB DATE
E:
MURA SHIZUKO
FF7777SANjTKRYNO.
334 SHAMROCK DR
09/10/2001
SANITARYNO. CONTROL NO.
(408)238 -7178
BUILDING PERMIT INFO
NGINEER:
BLDG ELE CT PLUMB MECH
O - I J J
LICENSED CONTRACnOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licenxd under provisions of Chapter 9lcommencing
EXCHANGE FURNACE.
0
us with Secion 70001 Division 3ofthe Riomess id Professions Cade, uW my licecom
is in roll romc and eR ^� ,,1111/n� "f0
�l F Tl Cie. p
S License C
Dom s•10 .CI GaalraCA'R
�'�
ARCHITECf'SDECLARA IO
ALeD
g n I�s,14 nro shall be used o public records
l.r 200 •f
OCT
menxd Profession.,
OWNER-BUILDER DECLARATION
from th< Gu'anin'e law, ror the
I in smal from m
w I greasy n(Sar tat I am.
P4. 1 5 Q
Busir Code:
a following mama. ISecdan TDJI S. Smitten and
mli Code: Any cloy or county
__ _ -Val
improve. de
whmh requ an v perms m eoxuun. alter. Imlot such demolish or repmr any structure
$.pnorm its
- tlivinid milmrt to the the apphcum Bauch permit mfilnse, Low(ssmeme9
nicdhSectinlalneofDimsion3eCOnuanols
-- -" --
(k51!'3Sw11'ii.3.7�r.GP@a, -e , 'N/� Valuation
I:�:�!
Ralhelsl&
adlafissmahapser9
fcthathe inGwnhgenitaftA'0)afhe baionlof the Busneneadero(eny Code? (�•y,
[ ilVi l•It_IVi ;+s .'1`+ �7
vi
TO that he i5 ezempi thertGom unJ IM1e basis far The alleged ekLmpuon. Any violation
- ofSxtion7031. Sbyury applicant fora Permit subjcaslheapplicant ooa cis ilpewhy'
In �,,p�,
PLUMBIN
" "''' Occupancy Type
io(nmmumb Eve hundredda11cart( 0),
301APw1AIu+asiwH
iVOIIS
❑I. as owner ofta progeny. or my employes with wages era their sole compensation,
-wmdo'NCwaik;' and' thesuunum is not intended or offered for xmefser 7044;
-
304 - ROUGH EII�G141'f1(IG2l1Qctions:; ^.. ^, .'`..
Business, - d'P ofess on. Cole: The C t t 1 T 1 tl of apply m an
owe fp pert Who buldsor memoriam] n d en .,k himself
505 - FINAL ELECTRICAL
o Ibro gh h own employees. provided that _ such improvements _ net tended or
,offered
,. _ . _._ -_ . - - - -- - -
' '`'
w.,de ion, the ownenbuildem will have the banded i f pmving that he did not build ter
508 - FINAL MECHANICAL
improve fmpuryose of sole).
❑ 1 v der the p =Iasi ly c rev etmg r m
,^
_
r, Wa:) he Conte
r e . 7 Bu red s Cade) The
the pro. (Sin 'Ito thereon.
_iiyxvun
i who improves thereon,
a net who builds
Linnse Law Joys rem apply man net
0 p
.._ ..._ ..... _.., .._- ....... ..
se prommu
conuans,f ch,P jets. w th a conwaor(s7 licensed parsnum m ohs .._
' ,and who with cony
_ ...._... .__. - .. -..... .. _ , .. .. _ .._ . __ ......,.
o O -
C mrenns Ltc.la t' • ,B' &I C fart his reason
❑ 1 vin exempt under Sec. � .,.,
Date
WORKER'S COMPENSATION DECLARATION
Ilorebyalfimunderpenalty of ioy'on< ofthe following declarations:'
�L 1 have and will maintoin'v' CeniEcdie of Cuminii to self- insure for Worker's
Compensation, --as provided for by Section 37M of the Labor Code.-ror the
- 'performance o(the work for which this pemmit is issued
❑ I have ono will ma la n W 1er's C sap m' lAUm C teq ired by Se Lion
-
' 37M of Labor Cod far Ih per( n< f the work f which this perm t s
- d MY W eess��Cro�m(pttarl��'em�n,ally�o�.pws�ktvme run red P 1 y numbcrare- all, I
ee
ff "n =y NO.: ��J <
'3 C s +
set .1, ty It,'r' $h \ '
{}
"� -'
I I^ CERTIFICATION OF EXEMPTION FROM WORKE
'' 4"
`1'( C•gki`
- "" — '- ' " "'-"
_ COMPENSATION INSURANCE
`•''(This• nn p<rmi
t ' red not be'completed if the t is for one hundred dollars
to
-
ISIODIIrIef)'tbau
_. '^�•
"y II Y K hchth nmtrs udI
to rf rte ce fine oikfi
I•; a)C '. t.
s h II n t eopl y a y pe any m der P, _ hi ogl e sub e u th e W k rt
C pc sal,nn gf Qahj'�mto D''�1, [ 19'DI a.
h°'1,
- APPI L
NOTICETOA L ANA ,If af¢rmk t s CenlGcam of Exemption, you
Z becomesubjec to the Workers not ran ti pmvsionsoflhcuiiorcmi.,y urnall
0 fmhwith'inmply with Bach pmvisionsar this permit shall he deemed invoked.
,- _ ,_- -, -- __ -__._ •. __-
CONSTRUCTION AGCNCY
real lending glsYf the peifo ae
'' IhiebydfOrm thatth i'"con vtrct
,,71C
-n., of the ork forwhch the Penns_ ix dlSe-3097c +e7
.. ... _.._ -_ ._..._
'.Q Lend<rs Nine" -
-Z Cortices Adi 777
.� I codify th I I h read this city application d mm Thai the ass reformation s
tIg d tresmiatesand laws ser
'U
c ,tm uerg
conto,conlywthehcity
-.V to budding construction: and heresy'authonxe rtprtumauvrs of this coy to enter upon
W the above - mentioned property for inspenloppiposes. '
a a md'emnipe and keep harmless the City i inn
judgrcEm
accrat gains,
liabilities, judgmc t costs and expenses h may y ay a eme agar t sod
e
,.'Z. Cty vanscquenc fthe "sung n!thsp t
z
"+ APPLICANT ppNDERST SAND WI LCn���/p�LY WITHALL'NON:PDINT'
S <' I
[SSUed by: Date /O Q
SOURCE REGULATI p (
Apan/o 1-0,01
Re -roofs
pl inConinctol Dt
nr, - CLOSURE
ER
t N'llf Ne re mom orharrdleh6allomlwtedal
applicant hold
Type.of Roof --- '••-- -"---- - "'
III it
d he Health , and Safety
Y.
Caddef rm b 'M53 pen
I'
Y'^ it '; r a
4., + S ! FY l 1 r : t) a �sl.
dAl1.000fs.Shall
ci l
S coo 27532(al . 1 ,, I f : x ;� I
❑Ye- + � Na i +,
� p cted prior.to any. roofing.material bemg.mstalled.
b @In$ B
p. i r. .....
iii he .,4 art {t� s ue= d t sI, pmemt r'devicet which
. r
If a roof is installed' without first obtaining an inspeetion;'I agiee'.to remove
.
th. -'iwm nnL fcdbyN ❑YA Ai,Q lty Mang -t
�
all new materials for inspection.. Applicant understands and will comply with -
Dismal? ..
pYe
all non -point source ragularions: ml'
have toad �Ihe hararT m5tends mq ocmeuts undcrrchepter 695 of the
1
cWifamia HEUIth &Safely Cddcl Stations25505125533 and 25534., 1 undentwdthat
if the building does of wmtly hay tenant, thtit is my pod ;btlity to notify the'
'
oec pant f th -requ rem m t5p must he met prior tot u e of a Cen f am of
Date
j`I
Signature of Applicant . , ;
lY
All roof coverings to be Class "B" of beiier '
or aenpde d gi, t I' Dam,
t is
j
-- 'OFFICE _..... ....___. .__..._