02100081 CITY OF CUPEWI'INO
BUILDING DIVISION PERMIT 5 CONTRACTORJNEORMATION: .
BUB9f9(0sDg3ETTE AV ALLIED AIRE SERVICE INC PERMffNcp2100081
°WNS[Oh8TEIN STEPHEN W AND BARBA 661 SINCLAIR FRONTAGE RD APPLICATIJIU�Tp 2002
ON1i
--T408) 934-8844 SANITARY NO. CONTROL NO.
ARCHTITICTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
exOp LICENSED CONTRACTOR derp DEConsof hap T
<UcPi Iher ea)(B affirm twllam(fcmrsdinssand isionsof Cwpter9(rommense is REPLACE FURNACl�3 Rcs;5ription
yat wI Section]Id If , ivi.ainn Ltf the Business and Professions Code,and my license !!C
_`, in1uIII""can°df 20 b o0 80, 000 BTU
0Z;- DiaenseC .r�, -I Cm,
2 !3 � � 2, 5 TON)
p y_ Date Contfaztar�
Z;- Date
ARCHITECTS PGI"SDECIilienc ON
I unJcrnanJ my plans shall be used as public records
ipdV
�LLoa Lecused Professional
I-e. OWNERBUILDERDECLARATION
a�a y 1 hereby affirm that 1 ma exempt from the Conammor's License Law lin the
00 following mason.(Section 7031.5.Business and Professions Gde:Any city or county
stS 6� which esquires a permit to construct,alter,improve,demolish,or repair any suunurc $3275
FZvo print o its issuance,also requires the applicant for such Permit o rile asignedxlatercel
¢ that he is lice nwalpursuant nthe provisions ofdue Common's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
ai (commencing with Section]BI«»ofDivii"n3ofthe Businessand PofessionsGdclnr 36924046 . 00
y - that Its:k exempt therefrom and the basis for the alleged exemption.Any violation of
Section]1131.5 by any applicant for a pnmit.mlejecu the applicant o a civil penalty of APN Number
not mom than eve hundred dollars(S50(). Occupancy Type
1,as owner of them norm em Io aswith boa cess their ole cam 301 - ROUGH PLUMBI G
❑ t R Y Y P Y 6 .Business
will Jo the work,and the stm<Wrcis not intended or offered for sale(Sec. Business 303 -
and Professions Code:The Countries License Law does not apply to an Owner of IOnS
property who builds or improves Liberman.and whodoessuch work himwtfor thongs his 304 - ROUGH y �1
own employees.provided that such improvements are not intended or olfered for side.B, 505 — FINAL ELECTRICAL
however the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not wild or improve for purpose of 507 - FINAL PLUMBING
smc) 508 - FINAL MECHANICAL
0 I,as owner of the property,am exclusively contracting with licensed contractors to
convect the project(Sec.7ocH,Business and Ism essiuns CmR:)The Contractor's Li-
am Law does not apply to an owner of prnpeny who wild.,or improves thereon,and
who concocts for such projects with a conuacorts)licensed pursuant o Ne Contractor
License Law.
0 l am exempt under Sec. B&P C for this mason Y O 114"al kl-a- 1,�
Owner Date OCT 2 5 2002
WORKER'S COMPENSATION DECLARATION
1 hereby of irm antler penalty of perjury am of the following declaration:
1 have and wil l maintain a Certificate of Consent o self-insure for Worker's Cumpen- BUILDING action,as provided for by Section 3701 Of the labor Code,for the performance of the
work for whits this permit is earned.
I have and will maintain Workers Compensation Insurance,as mquired by Section
370al of Ne Labor Code,for the peRnrmance of the work for which this permit is issued.
My Worker's Cn c tion Jl«umnce canicrand
licylgcynumMram: C�
Carrier Policy FROM
CERTIFICATED O '%EMOTION FROM E WORKERS'
COMPENSATION INSURANCE
(Dissection need nut w complemel Robe permit is fmonc Immued dollars(g 1018
less.)
1 cenify that in the performance of the work for which this Permit is issued,1 shall not
employ any person in any manner sen as to became subjecun the Workers'Compensation
laws of Cahfnrnia.Date
APPlicam
NOTICE TO APPLICANT:If:after making this Ccnifeale of Exemption,you should
become subject m the Worker's Compensation provisions Of the Inver Code,you must
�O forthwith comply with such provisions or this pmmiuhall w deemed revoked.
Z'y CONSTRUCTION LENDING AGENCY
(-� I hereby affirm that there is a construction lending agency for the performance of
Qi the work for which this permit is issued(Sec.3097.Civ.C.)
1 Q Under's Name
5 z IxmIcLCAddmss
[� 1 cenify that 1 have read this application and lime that the above oftmomiun is
L4 F' cunect,l agree to comply with all city and county ordinances and nate laws relating In
C)U wilding consWclioq and hcmby aulhodm mpoacnmtioes of this city lis cater.,in the
awvetmc judgm property for i expenses
purpowhich may
Fy (Wer)agree to save,indemnify and keep harmlcm the City of Cupeni w against
q) Iiacomcsjudgmc he ma'andia,expenses which may in any way attrvc against sail City
U z in conscyucna of the Brantin6 of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON- INT Issued by: Date d
SOURCE REGULATI9 /p, /9�D
�3 SSA ' br " Z_ Re-roofs
Signmurcnf ApplicanUCon cot Date
HALA DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuorc building i..pam pare ur handle hanNous material
as defined by the Cupcnion Municipal Code,Chapter 9.12.and the Health and Safety
ode.Seminn 25532hdl
❑Yea Cpl / All roofs shall be inspected prior to any roofing material being installed.
Will the,applicant or future buildin Ieeu ant use e If a roof is installed without first obtaining an inspection, I agree to remove
pp g o p equipment or Jcviccs which g P
emit haaardnus air contaminants as JCEnetI by the Bay Area Air Quality Management all new materials for inspection.
District]
C]Yes
I have maul the haia dous materials reyuiremcnts under Chapter 6 95 of the Califor-
nia Ilcalth&Safety GNc.Sections 25515.25533 and 25534.1 redcrsuand Our if ai wilding
does sur currently h vc a tenant,that it-�my resgoolulay to num the¢cup nl the
rcyuiremcnl. mu. Mom prior essuancctufaCerulicatenfQcypy¢!O O Signature of Applicant Date
Owner or aumnri,cd gent / Date All roof coverings to be Class "B" or better