02060140 CITY ot DING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22251 BITTER OAK ST SOUTH BAY REFRIGERATION 02060140
OWNER'S NAME: APPLICATION SUB DATE
PAUL DIAS 461 PERRYMONT 06/24/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 279-1911
u O C ARCHITEC)ENGINEEW BUILDING PERMIT INFO
u E BLDG ELECT PLUMB MECH
n« I_7 r -I 1- -I LJ
Z y i LICENSED CONTRACTOR'S DECLARATION lob Description
O z_C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
F=Fta with s«tion]OW)of Divisionlof line Business a9d Professions Cnde.andmylicense REPLACE FURNACE
_YfJ is in full lorcc t(f. ,/' ,/� TU
�pau Li<«xCas :4 V INSTALL BTU CONDENSING UNIT
a N Doc Comma r
Z`cARCHITECT'S DEC ION
1 understand my plans shall be used as
rcw
pu is nes
to or pz Licensed Prefirmimul
c.
6e n a OWNER-BUILDER DECLARATION
1 hereby eRmt that 1 am exempt from the Comtncu,s License Law for enc
F a following reason.lSecrinn 7031.5.Business and Prcressiom Code:Any city orcomny
Y F C which requires a permit to consumer,alter,improve,demolish,or repair any structure.
to3C -priortoks issuance,alsu requires the applicant for such permiva fibe a signalsm¢mm�t.s. _
that_hp6liaa)edpotsshrpt0.Lkpm Lr onso(Oc Centmtoes License Law(Chapter 9 �t s,*,t tSq..Ft. FlOto((��Area-sz i,` ,},,, ua[ion
(comtnencingwirh Section7000)of Division 3 Off,Busjnexsand l'Sofpssions Cade) `;l�t� l�::.' t.h.0 afll'+.a:;�1��tGJ...
or that M1e'is ezetnpt therefrom sere the basis for Ne a1Rgbo a<cmgtoyl.Any violation - 1
of Saturn 703 1.5 by any applicant for u Permit subjects the applicant to a civil penaltyOccupancy Type
of not more than five hundred dollars(5500). m o._❑ 'r
❑1,as owner of the pmpeny,or my employees with wages as their sole compensation. ,
—will d theandthestructure's not intended or offered for sale Sec']6f4,- --- -'- - - --- - - ---- --- - -----.-----
'Bus : -d Professions Code: lin c nnacmr's License Law does not apply to an 303 - ROUGH M $ =ctions - -. ',+•.
Owner of propeny Who bo Ids or improves thereon,and who does such work himself
orthroughfor
his awn employee.:',provided tort suchmpr improvements arc not one
or _30.4ROUGH__ELECTRICAL.._.__._._.
c crt Tbf stheow howevere thele hav t or int en of prnl is sold within one build of „L,�t.. ., ""...
'-
<anpmoon.the owner builder will have me Harden of proving that he ria not build or 505 - FINAL ELECTRICAL
improve for purpose or sale.).
_ 507-_- FI_NAL _PLUMBING
"oearact her project
propery Isv ly roa'gwlthlcenmhe Cardorsm 508 - FINAL MECHANICAL o t
cmnwa Nc Pres«t(S ]1. B .Hca a property
f..'ons Code)The Conttetries. 01.."
License Law docs not apply man owner of a corny who builds or seimproves thereon. 1 ' "'' •'
< _and sea.<omraens.(sur such Prol«lsxith.a conuacrorts)licensed pursuant ro.Nc. ......._ -. ___ .. _. .__ ..-__..__ . .. . .__.... ._ .
L : .. Commcmrs License Law,
__.._.; _.____...
_ ❑lam exempt under Sec. " ' + " .B,&Pcfor Nis reason
Own<r .Dain
W . .' _ F=1 JALE®
a r WORKER'S COMPENSATION DECLARATION
ARATION
�'=• I hereby affirm under penahY,of perjury one of the following declarations:
❑ 1 have and will maintain a'Cenificam of Conant to self-insure for Worker's JUL 0 3 2002
Compensation, as provided for by Secrion 37W of the Labor Cade, for the
performance of the work for which this permit is issued.
❑Ihave d will'maim Worker's Compc' i Insurance, riglydbySection BUILDING
l]IXI f th Inbor Code [ th Horma [th k f n n rh. pc t
J� 'r CBRTIPICATION FE EMPr10N FROM - .-� •• 41 -- p .. _...,-. .• '• .-,secs . ..,.... . ._...«..................
' aunt c c andOP
WORKERS �, .�." LI4. i4,
s . Cl as\i STla t1.71 ai t�.,; r
' COMPENSATION INSURANCE���+"t ' '
L'•ts. 'I Crhissenitinnced not be'nsmplaed if the permit is for one hundred dollars � 's t --- - - -', •-_ - s •�...w. -
(SlW)ofless.l - -
��
If III th',in th.pct _. fth kf
r _
ball
not ediplay any person in any mi so as to become subject to the Woken'
Compensa nn Laws of Callum v.Date
.Applicant' - t .- . .._.-.-._. ._. ._ .. . ... .. .. . . .. .n
NOTICE10 APPLICANT If,after making this Cenificam of Exemption,youshould
Z become subject to the Workers Compensation provisions of the labor. ___ _ . _ _ ._-_- _ . .._ .
Cale.you'must
O fnnhwhh comply wire sten provisions or this permit shall ere d<emca revoked.
..-_ ._._ .. ._... .. - ._."___ .
P IZ) t . . ::'CONSTRUCTION LENDING AGEt it
NCY' I ...- __-.. _.-__ ._ ._-..
-1 heresy affirm that there b construction lending agency for the performance V
or me work,fhichflhi,pc.itit issued Sm.3097.Civ.C I
( 1
1 candy that 1 have rued this city andu counandty orate that Nc above inaw,mia i is t
�".E. correct.I agree to comply with all city and soupy ordinances dna muse laws relating
the ala e-racrunned ,andnerehymbinfirs,iO"e'd.it'at"Osentatives of this citymenmr upon
he ab c C -d sur p ny f p aro p p j
E.. d fW)-g i JC Bn fy mlk ph.uml snceCty fC pen oagamn
VI liabil r ify(t /'(thy pc y n any Y c against said
f) Z Cry 3 d �caidA 1g) reg ftnsis pe ht V V
SOURICIItT L' Eli AtI SA\DR'ILL COMPLY WITH ALL\t\t]I\T' Issued by: Date'
a Of Applical UCnnao<mr ' ' _ ate . '
HAZARDOUSMATERIALS DISCLOSURE
Re-roofs
Will the applieam of future buildiitg occupant score or handle hamrdoils modal
' der er16 th.c Type of-Roof..-
'a,
Y. p5 r M pal Cwt Ch chapter 9 I d the H ITh and Safety
ty
Card Simian 155111' 11
C]Ye", I-fiM.
All roofs shall be mspected.pnor toy any roofing,matenal being Installed.
Will n teat r is a nefi ed occupantyA e4a D t ate e; If a roof is installed without first obtaining an inspection, I agree to remove
D st t air Pp t in r defined t the Bay Amami Quality Management
emltn lore _have Iwd m� F3*es all new materials for inspection. Applicant understands and will comply with
.-.0 Yea; - i - _ - "' all non-point source regulations. -
h ardousrn racial
rements micia,Chapter 695,Of the
California Hwhh&Set Code S Jit s 5505 25533 and 15534,1 understand than
-if Ne no. doe11ent 'rallymv t ant.that it is my nespermibilit mnaif flm -- - -
«capai t of tt term ents x'h- 1 r -
i ,
a,e 'gnature of Applicant
1.Date _
All roof coverings to be Class `B" or better':
.OFFICE -..._ .._-.
Paul Dias
22257 Ntaer Oak Shed
Cupertino.CA. 95014
530.9360
June 18, 2002
Board of Directors
Glen Oaks Park Villas Association
Attention: Chris Hopkins
Chairperson, Architectural Control Committee
This is a request for approval for installation by a licensed contractor; a roof mounted air
conditioner condenser unit to be located at 22251 Bitter Oak Street, Lot #23. The
condenser is part and package of a new heating system, replacing the existing original
unit.
The condenser unit will be installed directly on the flat roof either amte or
next to the heater vent as is currently on other Villas. Electrical conduit will be installed
from the garage to the new AC condenser unit. The contractor will pull all permits.
lop 5ank y n a vance for your approval ofthis request.
y,
ias
APPROVED BY:
DATE: W-0
14 J