02020098-r_., -..-..._......
OFFICE-
CITY
FFICE-
C1
BUILDING DIVISION
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT NO.
10486 ANSON AV
02020098
OWNER'S NAME:
APPLICATION SUB DATE
GURIKAR MAHESH AND SHAILAJA
02/25/2002
PHONE:
SANITARY NO. CONTROL NO.
CO
ARCHITECOENGINEER:
BUILDING PERMIT INFO
E
BLDG ELECT PLUMB MFCH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby.RonaIlial I am littnad under ions of Cha or 9lcomme
prorix p hung
P
wtn «a.n]iwo)ornivni}.nneH.sineasanan.lesmnsC.de.anamyfeenae
to risme and�«o
REPLCE A/C ACE.
�n ��',��f'$�7
Dme Convector ,� _
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9g
T•Sen�ifdTny plans shall Ebe used max publranrcc�Ms /
O 1 2002
p O
MAR
Licensed Professional
o
OWNER -BUILDER DECLARATION
to
1 hereby affrnn that 1 am exempt from the Contractor's License Law for the
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following mason. (Section 7031.5, Business and Professions Coac: Any city or county
which requires rt m criminal. he, impmre, demolish. or repair any
BUILDING
$3000
pem,I, stmcturt
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-pn.n I also regmrea the applicand fur such permnm flea ngned statement.
� 3 � __. Y s SO-�p [i]pp�r ny`�eart 1 /
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Valuation
that h I d p rsaaM I9 the Provisions of the Contractor's License Ww (Chapter 9
(cora ne saMivii. ions Coati
mpt Theefrom and the also the
or IM1m he i exempt thcrefr.n and the basis for the all<5ca exmnpnmt Any violation
--•{i�53'Z5:'O.b•U':',V
rof Smirm ]0}l.5 by any applicam for a permit subjects the applicam to a civil penalty
.r t.tnmrt Nan Bve harmed annars lSS00).
30�PN '( ,H MECHANICAL'
- Occupancy Type
❑ 1, ox owner of Ne progeny, ur my employees with rages m Iheir sole compensation.
will do the work, and the structure is not intended or offered for 'sale '(Sec. ]04f, -
505 — FINAL E$ a�°'�JUA45tlons '
Business and Profession, Code: The C.mramnrs ueense Law does not apply to an
0 caner of progeny Who builds or improves thereon, and who does such work himself
orered hhis own howeviemployees . huldidIlialsuchmpr elomismaarenonalreyerded or
:m
o&red' of. sme If, however• will hav t or i n sola within bh<year or
of
508...= FINAL MECHANICAL:.__._
--- - -
Burden
crampletion. Nc owner -builder will have the burden o! proving that he did not build or
prow
improve for purpose of, aleJ.
❑1: of the property, exclusivelycontractingi lhlicensed tt Comma t
C.do The tmao, s
consLicense
the project (Sac ]to a, Business and Proeny
r I,
-_
Low does nor apply to who
owner of progeny who builds improves
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"-
and who
. and who such projects with a.contncmor(x).licetved pwxuam to the
of teimproves t tofir.
. Licanve L
Comractoia License Law.
- ---
❑ 1 am esempl under Sea ; B'& PC for this recon
„
Own Dale
'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe jury one of the following declarations:
'
❑ 1 have and will maintain a Cenificale of Consent m self -insure for Worker's
Compensation, as provided for by Section 3]00 of the tabor Cure, for the
of the work for which his permit is issued.
��per�formance
X. have and will maintain Worb a's Compensation Insurxtice, as requited by Section
1]00 of the labor Code, for the performance of the work for which this Pennfr is
"ued,MyW
'
kers Co nxi 1 ran arrie and Policy number are
Cam JL-c\lP fAn C'.' PolicYN - ��1. •'
-.. .. .. .. _ .._.. ....n ._a. .. .. .. -.
._ _ .._ _.; ,-- . _' COMPENSATION INSURANCE a� ' '- u' •' •
(This section; need not be cora Ined if the
p Perron is Tan dna hundred dollars
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fS100)orlf")
.
I candy that m th pert ,mance of the work for which his permit s .sued, l
- - — - - •W" -' ', „
shall not anon L any peon n any manner so as m become subject m the Workers
Compensation Laws of California. Dam -
Applicant.'
this of of
-
Z,
tothe Worker's Compensationprovisionsflee Labor
Labor ud.youmust
peovil ha
�
Tenn. ithao.,IY such
fonhwiN nrmply'wim such provisions or This permit shall be deemed revoked.
m dhin 11 revoked
•" ' CONSTRUCTION LENDING AGENCY; e
CONSTRUCTION
,h,
1 ton lending agency fw the pedonnantt
which that is a [sued
e work for
of the work Tor which this permit is issued (Sec. 309]. Civ. CJ
S
'
Name ._.:_. . . ._:.- ...,:..:....
.. .
zLender's
Z
Leneer'a ndarors'
,
1 cer ify the I have read phis application end some that the above information is
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cones. I agree to comply with all city and county ordinances and state laws relating
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to building conslmnion, and hereby sumornzc neprtientmives of this city to enter upon
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the above-mentioned progeny for inspeumn purpose.
pis t
(we) agree m save; indemnify and keep harmless the City of Cupenino against
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liabilities, judgments, costs and expenses which may in any way accme against said
's
City n c q of the gam g f pe l -
APPLICANT E A jyv W
f's
LCOMPLYWITHALL NONPr,INT'
SOURCER u
I
Issued by: Date
S'gnm YA plica V ra t
v
Re -roofs
::' will the ppIHA]orl%turtWilding occ Ldsmrt or handle hazamous matetial
defined
,Type of ROOF_
as by the Cupenino Municipal Code. Chapter 9.12, and the Health and Safety
Code Section 25532(i)? m:
'CI Yoil i'1...
'.a r (}1'.^. 1 t Y'
1s I t7 . t{..; .... .
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All roofs shall be mspected.pnor to any._roofing material being installed.
WIT the pppl tarn futurebuilding g ` equip ` t devices which
emir hazadouv' e r [nolo n ms as defined by the Bey Area Ar Quality Management
If a roof is installed without first obtainin an'ins action; t -agree to remove
g p
On
is
*a �� .
all new materials for inspection. Applicant understands and will comply with
. . " '''" '' r . "•
all; non -point source regulations..
1 have read the hazardous matanals requirements under Chipar'Tif5'.1 the
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Califomla Heals BGas Safety Code, Sections 25505. 25533 and 25534. 1 understand that
Mt
if the buildingd currcnly have a tenant. that it is my responsibility to notify the
Occupain of Ih r quio, entfl.hi�s ba met prior to issuance of C<nif,me of
,pan y. "
Signature of Applicant Date
G•^'"en ..Dale
All roof coverings to be Class `B" or better
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OFFICE-
CITY
FFICE-