02010079 .. c-f_ ... . . .
CITY.of corExTlNo CONTRACTOR INFORMATION: _
BUI DING,nlvtstoN. ., PERMIT"'-'
.,-
BUILDING ADDRESS "- - - - -
_ ' PERMIT NO.
'10540 CHACE':DR UNITED AIR' COMFORT '` - U ' ' v'i't'0.2010079
OWNER'S NAME: '- " - - - - - _ APPLICATION SUB DATE -
ASAO ICHIRO' AND•AKEMI ,., 5819 N ANDREWS WAY. 01/18/2002
•IONE: (408) 771-8967 SANITARY N'O. CONTROL NO.
O O O ARCHITECLENGINEER: - - BUILDING PERMIT INFO
U C BLDG ELECT PLUMB MECH
I_J I I
�yZ LICENSF,DCON6IACTOR'S DECLARATION Job De$CO tion
I z_ 1 hereby of rm that 1 tet 1,c...d under provisions of Chapter 9 kommencing p
In with Section?Boo)of Division 3ofkaBtamcsaandPmfcaaim,Code.and any B<ense •FURNACE - 100 000 BTU
m W= Is In full fo¢C un �S S r
z s a Liar. Cla s . Lk.p -
3 16a, Date i i 'Commaor
u.O ARCHITECT S DECLARATION•
I understand my plan,shall W used as Public records _ ��y'p -A�'„-•. MweD ;
i E: Licensed P f natal
Ko,pi, OWNER-BUILDER DECLARATION 5 ZOOL
m 1 h by alfrm that 1 am exempt from the Contractors License Law for the [v C fl O '
L z< follox' g .(Section]031 5,Bunncss tl Prof aaipas cod Any city nr county ... S Cr. $'2 3 9 5
E x a h ch r qu r _pe tit I cu t o II r Giro a tato 1 h reps
uny swat
u 3e. poor tot uatwe elsa req the ppl cant ro s ch pc a fl< grcd n"cmam - _......
thath Ice icdp ne", hep s s fthCon'
on
sLi L IChapte 9 F 3�6F1t3 � b
(com i g .thS -t on]OIXq ofD la 3 f"B iwisand Prof.
f- 'oats Code) •'.'v -1 (Ij(} '.q Valuation
onhe,be is exempt therefrom and the bas s rnnhe a11egW dcmpuon AnY stolen n
of
Set 7.31'5 by any ppl t for apemitsblas " ppr tat evilpenalty-
nrlint m re man B-
barmaid
d n (ssoB) PN N � 'Occu ane .Type
30R 9H' PLUMB G ts. P y.' yP
❑I,mownerofthe propehy.yrmy employ th ages as Nay sole compensation.
-will'do the work:and'tM1c'xtuchr is,no,intended of oRem fm sale(Sec:']BJ4,
-. Bavmeaa t 30 ROUGH MEC
oes Prorea.;daa c ae:Tot ennvanor,u2enae raw tat oat apply to an 3 04 - ROUGH El�a$GJ�iILfs}& tions'
owne
rot progeny Who Wilds or improves themon.and xh°dtes such work himself 505 - FINAL ELECTRICAL
to through his own employms.provided that such improvements are not intended or -, __
°rfen for sale If.however the build n8 p mem is.oIJ ih n one Year of - -" - - - "- - -- - --
nmpininnmenwnnWdanwhnmemeWa rprovmgmin ad n Wild or 507 - FINAL PLUMBING
improve mrputpose ofame.). 508 - FINAL MECHANICAL
El 1,as owner of grope.,ani exclusively contracting with 1lccnsed Comctors rs -
conswa the project(Sec,]Ota,Business and Professions illsCrelor The improves
moor's
License ,co toes not apply to an owner or progeny who builds seimproves thereon.
.
Cad ommences
License
for such Projects with.a conuacmr(s).licenaed pursuant to me. _-
1 p - .. _._ .. _...... _.
_ Convaaolx License Lew. _
❑lam exempt gee: ' ,B&PCfor,thisreason �;.• „ •,'i
I '
Date
- -WORKER'S COMPENSATION DECLARATION
1 he¢hy eRma undeapenalry of f<ju,one of the following declarations:
Ir� .J I have and will maintain a Ccnificae of Consent to self-insure for Worker's
!k,s CroTer,mion, m'providedrfer by Se1tion,3700 of the Labor Code, for -performance of of the Work fee which this Permit is titanic.
h
, and will Worker's-C pet ltjr Csu a2c Zs required¢by3Se:-c1 ti
oyn
_- -.
••f d LAW,Code f the performance f me work f which this tat
issue Pc
t 1 . mat carrier and Policy number 4licyNuCam ' 'i TEMPTIDN FROM WORKERS
a g COMPENSATION MSURANCE
rte a ta ma be comp)t d if the permit is far hundred do[].
- t t
15100). le ) - _ 'i ' I g '(•, '
P-. 1 cerl that ithe Performance f M1 k for which this perm i is'. used 1 -_~..~•. . . •� -- ,..,_._,—, „•s
hall not employ any person n any manner so as to becomd bleat to the Workers -•--T- -
Compensatmn Laws o(Cabfomia.Date
.:
Applicant _ ... .. _. L
___..
NOTICE TO APPLICANT.If aft making Cit 1 t f Exempt . Wools r
OZ bechmets comply a the Wok C pe sat .p 'of the Lebo Cal y Gun -
z a --"- - "
Q with s p h p thisA t shall b deemed ked.
CONSTRUCTION LENDING AGENCYI hereby affitran that thc - .Ito t lend ngencf th - -- - i - " '-
permit issued(Sec 309] Cie C.)Y p,f ince
of the work for which that .
Lenderi Name ._.. i _ ._ ..n :. . .., 1 .. - .... .. .. .....__.
Z Lcna< Add e a - - - - - -
V Q I 1 -
o•,,,. I c g ee thatcomply
d m applicationdstate that anew boa-ata ton is
QU nen 1 gree to omply with all city Mand In dines M stat laws Iupon
W hbuild g t tin, dh bin petition, 1 c' moves n(th'x city to enter upon
�,. Lr] the drove e i W save:my f inspection fyand
p hay e
F., a (We) greet ave ndem per d ke<p harmless s the City TC om.1am g said
V) babel it judgment,Inst d xpcn.e which y' anyw y cm g nsaid
U z City i consequence R thegranting of this perm i
APPGQANi UNDERSTANDS YD OMPLY W'1 IIALL NON INT �' / 1 Uv
soaRCE REcuLAnoNs �J.' Issued by: Date
Signature ofAppl c UCn t teD t Re-roofs /
ear
HAZARDOUS MATE IAIS DISCLOSURE '
'.L w n th ppr ant metre W'la g«e p t m m� n al ata:an.mita at Type of Roof
d f d by th Copeni Municipal Code Chapter9 12 and the He Ith a d gat ty yP ----- -, - - _ -,
Codi,Section 2553 ( 1' st _
- oY .All roofs shall.be mspected.prior to.any.roofing materia] being installed _
Will m applicant,o r t n la s occupant q p t o won If a roof Is Installed pwithou[first obtaining an:inspecnon I agree to remove
lh d contaminants died by Bay Q It Management
ci all new materials for•mspeenon Applicant understands and will com I wt[h
❑Y all non-point source regulations. P.Y..„ .
>L:' 1 has,read the'h mrdoux namnals qu eri under Chapter 695'or the _
forn a Health&Safety Curie Sections 25505.25533 and 25531.l understand thate Wildingy. does not cume ndy have a tenant,that it is my responiibiliry m notifythepas of the regmrem nm h ch oust be met p t ", a e of Cenlfi te'df
upanc / ZSignature ofApplicant Date^ar°rat'"°na, �,Date — All roof coverings to be Class "B"or better
OFFICE