02030100 CITY
DVSONO
IiiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
20568 CEDAR BROOK TER A B S HEATING & AIR CONE 02030100
OWNER'S NAME: APPLICATION SUB DATE
IMSUN KIM 334 SHAMROCK DR 03/20/2002
PHONE: (408) 238-7178
SANITARY NO. CONTROL NO.
'
0� ARCHITECT/ENGINEER: BUILDING PERMIT INFO
z u— BLDG ELECT PLUMB MECH
L_l L�
S LICENSED CONTRACTOR'S DECLARATION
y I bean affirm that 1 am licensed under fCha ter 9(commencing Job Deseri tion
ya provisionso p (c g P
!yF- with5wtionJ0007afDivisian3oftheBusinessandProfessioneCode.undin,heense FURNACE EXCHANGE/ADD A/C
is in full �'n �f�l r�t(Z10
zea igen class J.S_ Lic.«_�7q[ ALJ
O a O Oa¢ Contrdnor
ARCHITECT'S DECLARATION
Vg 1 anderstana my plans mall be area as public rcrnrds
i i O O Licensed Professional
z OWNER-BUILDER DECLARATION
6e, max
1 hereby affirm that 1 o empt from the Commnm's License Law for the
following reason.!Anion 7031S,Business end Professions Code:Any city county $3400
f—p which requiresPermit consumer,
ower alter,improve.demolish, W structure
rre
any
to 3 Poot to its issuance.alsoeq a the applicant for such permit to file a signed smucamen, _ ........... .. __
dial M1 's licensedpesusttothe Provisions of meContractors License La (Chapter9 Valuation
(co me c 6 th Secs ]OOn)of D 'uon 3 of the Butrnay arM P f s Code) �+ i S a3 Z.5 �'�,7V-•-IU,V t� s ..�C d`y`q
ar that he is m
exept them refroand the basis for the allegcA exempt tin.Any violation -
-of Section 703P.5 by any applicant for a permit subjects me applicant to a civil Pendlty-
tofnot more than five hundred dollars asu0>. 3 0 f''PN � ;H PLUMBING Occupancy Type
❑Las owner of me pmpeny.ur my employees with wages as their sole comcematinn. 3 n 3 _
will do the work,and the structure"is'nbf intendedor offered for sale(See 7(W4;' - - -
Bbsiness andAdfessions Code:The Compactor's License Law does not apply man 3 0 4 - ROUGH E$Fjs Tfd1lILgi&tiohs'�"
ocaner of progeny Who Wilds ar import themon,and who docs such work himself
r throwFM1 his own employees pros sed that n pro t. t ,noes or 505 FINAL ELECTRICAL_
-offered Gasale If:ho < th b Id' g P entis sold wthmoneyem of. -___....._ _. . .._._.... . .._ ._.._. _ _ ...._.._ ..
507' FINAL PLUMBING
completion,the owner-builder will have the burden of proving that he did not build or ' ` •.
improve for India.of sale.). _ 508 - FINAL MECHANICAL
°1,aspwnerofthe gjjx T,(Sec.7am Business and
t ig thoc doontractm -
-
consumer the Prodoes
(Sec ]to a Busmen d e Professions Coda)Thimproves
Contractor's F I N A Ila E®
1 `
and_wbo cw dos no,apply to an owner with
ceny who builds s proves thereon, '
omacts for such projecm with a conmaogs).liansed pursuam.m the.
License
ant t License Law. - -
0
1am
amralt code,See ' " ' - ':B&PCher his ma,an MARS 2 9 2002
Owne f Date
- "'s't WORKER'S COMPENSATION DECLARATION
Iherebyaffirnuad!,penally.oftsirjuryonetithefollowingdeclamtions: BUILDING
y ° 1 have and will maintain a-Cenificae Of Coined to self-intim for Workers
' Compensation, as provided for by Section 37W of the Labor Cade, for the
pedormance of the work for which this permit a issued.
p4 I
toe and will maintain Worker's Compati
enson Insurance,as requimd by Section
3')tIB of the Labor Code,for the pedminance of the work'for'which this permit is
sindMyWrmis Co ce itmi Im, 5 'a and.Policy no The
are
ie, rI .. _
cam IN J Ap bey
vie,
'f v. CERTIFICA�D J:O EXEMPTION PROM KER9
COMPENSATION INSURANCE-
''f "rlThii iectiori accd•not bet cbm lemd if the _.-_..._... ._....
p permit is for one hundred dollars '' "' t " `""
($10)or less.) ' •.
i t
1 cert(yy an m Ne ped ce of r, work for titch this permit a issued-I - -- -
shall ns employ wany mann as to bcdnme 63en to}hcWorkeia t i'J t,Y!.
Compeensation Lawss Of of Califoraid Date,
NOOK
O pti T APPLICANT:if aft k. .8h Certificate.of E Pto _y_ou
Zsubject otheWrke Compsmalinnp 'soflh L W Cod,yo
you hmust
Z forthwithe ply.with such provisionsmth c hall hedeemed revoked,
_
- - -
I _
'CONSem is it ON'LENDINGAGENCY „t
offirran h,,h thot pertisa eaut leadingp C) for th pe f.. ante - n -- _
dr of the k fo which th pe ti's soca(S 309],Ov.C) '
90 -Lanae sNdme
�:Z Lender s Addrtssi
U 1 n fy th t 1 M1u d tl ppl'aai d cele th uM1 ob ! tion is '
llui'E-t Carmel.I g t comply with all c V rind ty o d' nces add stat laws lacing
W toabove-mentioned!
holdingconstruction. d thereby thtion p coot of m s city t ere upon
.k meaW Wpmcenyf inspection purposes.
Fi M (W)agreet .e e.indemnify andkeep h h'Cty of Caper oikamst
Z1 liabilities.3 dli e t sna a ce es which y y way azagainss said
U Z City a nsequcnm ohh gent'g�fths ce L ..• f's D O •I —
AP C U.YD ST�y1.05q��WILL COMPLY WIN ALL NOYPOINT' 1 (/-
%0°FIhA V �' - �'2b •tl7 Issued by: Date
a Srgmmmpf AppbdanUContmemr`�', Dam?':.:
HAZARDOUS MATERIALS DISCLOSURP` Re-COOTS
" Y W11the pplicanto f t rcbuld'ng upaniat ttb handle hoz Mous t n 1 ...Type.Of ROOT_..
C77
defined b m Cu n Mturt bu]din occu s C. '- -- -^Code.S uon 255321a - - -"
Y Pe P Chapter 9 12 and me H Ice d Sof ry -
P
.,rove, r1i, 'io .r fnl.rt +II t`r If'3; tt f t .r y P
All,roofs shall,be ms acted nor to any roofing material being installed,_ ,.
Will th ppl'am g w tas- qu;p equipment ae �' when a roof is installed without first obtaining an inspection; I'agree'to remove
cmIt h ardo it comam ic t n fined by d Bay A.q Q al ty Man-agement
Disina all new materials for inspection. A Meant understands and will comply with
°Y r' ° 'r n. i `all nob-point source regulations PP. _ _- -_.
I M1 cad then d atenals - -
q uemcnm under Chapter 695 of the
calif mm Health&Safety Cod,Seasons 25505 25533 and 25534 1 understand mm
dmeb ad gd sno,c mly have a cereal:he,it my rcspo.tifty t ify the
occuph t of the rcquircm i which must 4 mct prior m issuance f Certificate of u
Ostiapan y
Signature of Applicant Dale
owne m see,age,
Ent,
All roof coverings to be Class "B"or better
I, ,
Zir
.. . .. . -O
� ' FFICE- -