02030212 OF
CI BUILDI C DIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
19780 DRAKE DR ATLAS HEATING 02030212
OWNER'S NAME: APPLICATION SUB DATE
SABTYBA SINHA 155 SAN LAZARO AVE 03/28/2002
' PHONE:
(408) 739-0516 SANITARY NO. CONTROL NO.
0 00 ARCHITECIUENGINEER: BUILDING PERMIT INFO
E L, BLDG ELECT PLUMB MECH
S v=b LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under p 'cions of Chapter 9(commencing P
'yta°�, with s«tion mo B)°r°i�i.in acne enxmexx�Prof scions Code,anc license REPLACE FURNACE/ ADD A/C.
I rs in fuLL f�rce end a at. '^G
de O n U Lien as Luc.p kY 5
Dat a 10 to
Conveno
ARCHITECT'S DECLA ATIO
1 understand my plans shall be used as public records
�so
i d dd O Licensed Professional
OWNER-BUILDER DECLARATION
w' 1 hereby aRrm Nm mm
I am exempt from the Comcr's License Law for the
t z< f°untying reason.(seetinn mJ1.5.Ba.inex,and Pmleti°ns c°de:Any city«county $3500
rc F O which requires a permit to construct, wrc
ct,alter,improve,demolish,or repair any scm
tpri° t t Iso req rtd¢ ppl,ant f«such pe nflai8ed statement,, _c �xr ,�JOp �rq
Nat hqrased p'manxwjt off loaf the the
wn '.Lttnsela (Chapter' � S 3:15®�.�Z'U-1 L,.'l7V `
.,,(commencing with gen ]vera) f Division 3 of e i Bur ss end Profess ns Cade x 17;• 3K Tx\y f.3`. Valuation
or Nat he s 31.5 b Neid,uli and the bun fns the allege)a pliant to Any l penaoa
°f Section 78)15 by any vpplicam for a permit subjects Nc applicant to a civil penalty-
ofnnt mnre Nan five nandred douara($5uou 3 01'4PN�UftrH PLUM9IN3 Occupancy Type
❑l,as owner ofthe property.or my employeas with wages as their sole compensation, _
-will do'the-work,-and Ne structure is not'intended or offered for sale(Sec.76 ,- -
TB°imesx and Professions Code:The Contmcmr's License low does not apP,an an 3 04 — ROUGH E1F4WRcVV&kGtions I•' '
owner of property Who builds or improves thereon,and who does such work himself
or dint h his own employees.pmsid!d thin such impro,cram s ora not Intended or 505 — FINAL ELECTRICAL
-
:offeredid sale:v:hnwever.the Waitin Orimprovementno --... _._.__.._....._...._...----------.... ---
completinn,the ownenbuilder will have thehardenofprovingthat hedidnmbuld r 507 - FINAL PLUMBING -
improve for purposeofsale.). 508 — FINAL MECHANICAL
rn , exclusively contracting
_ ❑1,as owner of Chep pe y, ex y gwiN licensed contractors to
Licnseconstruct the does
n (Sec.]OCC.Business and Professions Code:)The Convenor's
and,wc Law docs rot apply wan owner of pmpcny who builds or improves 1.the `
-and who convects fo tech inaJ ts.with.. . t t r(s)licensed pursuant.to the
❑I am exempt und1.er Sec ' ,B&P C far this reason sa xaii����(, - - _--
Owne Date " p�/
WORKER'S COMPENSATION DECLARATION N1 AY O ad rf002
I hereby affirm under Penalty of perjury one al the following declarations: 'YIF1 J L
1 have and will'aainmin a'&mficate of Current ro self-insure for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for the BUILDING
'performance of the work for which Nis permit is issued. . .
❑1 hays.nd`wili mainmin Worker's Com'lien4aiion Insurance,as iequured by.Section
c 37011 of she Labor Code:for thc performance of the work for which this permit is
sso d M W k li Compe uo Imurancc cam rend Pol y u be rc
,. N ,,.. ._,. f �J
.�a L t f .PoLcy .. .141 �J/ d 1 .. .. SS
CERTI EXGMPT OM/'\ O 1 5 x.{- t♦ f t fir l fi Fit 4114?�:� 1 z's_•y i'.try in.i
50MPENSATIONINSURANCE.1
P Permit is far one • dollars
-._. ...... _. ..___.__ -__. .__ .__.. .....
il 'J I(Thrsseci,on rieW not tie core lmeE tithe hundred tlolleus' •• •�� t"�
(SI00)or less.) _ ��� � �� - �`
any
Person
in my rimna r, ork f r when th sem i steed l - - -
'stiall not roan L any pe on m any mann r,so as 1.become subject to the Workers • + -ac } .!'!^t
Compensation Lawx of California.Dare'
.Applicant . ..'.. ..% . .
NOTICE TO APPUCANTI' Q ak ion Grin fE Exemption,youshouldmost
Z bac° a subject i thesuch
Worker'sC o pe '1 Provisions of the Labor Code.y you must
0 fonM1wnh comply with p rasions or Nu permit.M1JI be diderand revoked.
F2ti - -,'CONSTRULTION LENDINGAGENCY -'-
' I h by off ,h t there t .edea I' d g g'«Y f th pedormm,ce'
of Ne kfor h'ch the - �''
permt ,.su d(5 309]'C C) '
L•Q Lender Name_ .:..a. ..,.'...,....: st . .:..:.. ... ..
E. ,,._ 1«mry thot I have reed thc aPPlicatian eW sum that Ne above information is ,.
. csmece 1 agree m comply with all city and countyprdinances antl sum laws relating
Q r) mWilding conxo,inion:and hereby bultiorixe represenufives of Nib city menmr upon
[� thc above-ntcmioned pmperry for inspection purposes.
. ,M (We)'figrec m save,irdemriify an cep hawlexs'ihe City of Cupcnin'agamad
h liabilit mama.coca sod expert h h y n any way accrue ag nst xaid
V ,� Ci n con c Ince of the guns Ag of perinn '
PL'fCA DER$TANDS'AND ILL COhIPLY WITH L "• I
)URC N '�2 Issued by: Date
ire o APPlican ortramm Re-roofs
' HATARDO M ffERIALS DISCLOSURE I�
wnthe p6leant«f ebi1 in paatstore haWl haxara s at m _'I)rpeofRoof
as defined by th C pemn N Code Chapte 917 od Ne H It d Saf ry
Code SnY 25532(7 ) F ❑ \ t a:>, i`. I l: x 1 Ta \' ; .`:•
to
r r, a .i _All_roofs shall be inspected pnor to any roo_fing.ma[erial being installed.
. , verath pplcantM r ca0n g«c p .Ai t or c wM1en If a roof Is installed without first obtaining an ins ecnon, I agree to'}emove
enut h rand co tam ant dgr W by N B y qre A Q al ty M agement p
l°ix!""❑Y .(ybC,' all new materials for inspection A licant understands and will comply with
e hoe d-u .mater sl r wres,mnu sea - - all`non-point source regulations "PP - - -
m _
so ad
edl od Chapte 695 of the
Californiau Heal, afay Code;Sea Ons 25 5 25533 and 25530 1 under.tend that
ifAd buildi nmc rreally have a tuna tatht mnr
y.,pobJtya. oufythe'
.cup f gairtroad u whwh must nal p .w arse C Tia eofoce
Si nature of Applicant
-g-- _. PP ... Date
° . .°rxea agent D toA ll roof coverings to be Class "B" or better
._. ...OFFICE.