01100156 OF
CI BUILDI C DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS', PERMIT NO.
21640 EDWARD WY ATLAS HEATING 01100156
OWNER'S NAME: APPLIC TION UB DATE
NIVI PADHY 155 SAN LAZARO AVE
10 TI
PHONE:
(408) 739-0516 SANITARY NO, CDNTROI.NO.
Clr. ARCHITEC (ENGINEER:
w O O BUILDING PERMIT INFO
z d BLDG E CC _PLUMB MECH
yIto —
h 2 LICENSED CONTRACTOR'S DECLARATION Job Description
3zV,O I hereby affirm that I am licensed under Provisions of Chapter 9 mommemmng
„Cw wimsea6an]aro)arnmiamn3anwendaar rrofi,i sCode.and»yfeense REPLACE/RELOCATE FURN CE
Sxs� iamranmrceana e TO ATTIC & ADD A/C
a;e 2 a License Lic.R
-a O Dam s 1'r Contiaccar
ARCHITECT'S DECLARATION
,g 1 understand my plans shall be used as public records -
3 a p Licensed Professional
OWNER-BUILDER DECLARATION -
1 hereby.(Erle that 11. exempt from the Contractor's License Law for the
C?G following reason.(Section 7031.5.al,Business and Professions Cade:Any city or county
ca F
which acquires permit t emotional,olmr,tmpro.0 demon t or¢pau any strvnurc
63� ..pri t 'L s I q .th ppl cam for such perminofleesgnca smmment.
wtn 'ala seeps amminep i leaf the ConuactmsLrecnu Law(Chapmr9 }ylaai y aSq,-FtaFloor- �e p g t,, Valuation
(co g thSato 7") fD' son3ofthcBupmessar PmfessionsCMel t,. ,* d Ie, et_a:, ; tx• ' 'xr�. k
or that he s ekcmpt therefrom and the bats for 0e allaged exemption.Any,Won.n r.a..
-ar Section 7031.5 by say applicant for a permit sub sail the applicant m a civil penalty'
of not more than to,handled della,($500). APN Number i°� Occupancy Type
111:as owner of the property,or my employees with wages as theirxole compens.ion, 01 - ROUGH PLUMBIN
will do mewalk.and me summode:t.Th is nm'mmnded L cense Lredaw forit.sale
.0,apply
to on 303 - ROUGH M13�a Gik&etions" ' _t '
'Business and Professions code:The Contivmorthereon,and w Law Da,let apply m an
owner
r thrroughrh s owemployees.Who Wilds or improves hatsuch improvements
who does such not inteded himself 304 — ROUGH ELECTRICAL
gProvided Nat such improvements art not intended r or ___. ._ -..... ...... ... . ... -
coyeaforarae:R.howeverewiwadingmimenofprovisrolahedinnotyea:or� 505 - FINAL��ELECTRICAL
a-mpmeon,me nwner.bnaeer will M1ar=me burden or proving(stet he aid not wild or 1 ` ' '' •- '
impnceforpmposea(sale.). 507 — FINAL PLUMBING
__ . ." am .. . _,_ h.. . 508 — —" FINAL" MECHANICAL_.
coLaowner project
p(Sec.7,at,ndinessacomrazJngnsCocenud Contractsto ::.I'!,h .::J."
e naw.the project(Sec. to a,Business and property
whops Cade)The Contractor's �B 11�;
and who
co docs not apply man owner or property who) Ids s ,proves thereon, ��s FL
and who convicts for.such pro3ecm wnh a.comracmrts),I licensed pursuant m the. ._ 6. . Le�
Contractors License Law. , , � - - '—------ — -
❑Iamescan under Sec " B&PCfmthmmason •; 1.,•.,4 ,� , ,
r Own.,: ce ANR 1- 8 2002
- - - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty ofpcj.,one of the following declarations! BUILDING
i O I have and wmai
ill ntain a CcniGci,of Conserv 1.seIf cannot for Worker's G
Compensation,as provided for by Section 37W of the labor Code, for the
s performance of tM1e work.for which this permit is issued.
❑I have and will mdintain Wi iker's Compensaiion'Insuran ce,as required by Section
377 of the Labor Code,fair the performance of d e work for which this permit is
Iiiied.MyWorker's Conicamiation lnsumnce carrier and Policy number
Caintt % t EXEMYN .'FRQ� is' ! i ICl it yltj.?.y� ]] rr,. s *f`a' .. ,. t. ... ..
CC f1 qT ON OF,EXEMPTION M.WORKERS x f v.... : }1. { r'. a.�b 1..,:��_•{. '
-.. _ COMPENSATION WSURAN,CE
(This seclvan'oeed noir w completed if the permit is for one hundred dollars � ` •� �•h� r� � `s �u " 1•
' (51001 las.)
I mfychat'n th a,pe-rfmcclume of flan'winfl,f which this tx..t ..�� ... _�.� _ - .._.•••�. .^ _.. .
to - i issued
s km•J
shall not em v-
p y any person n any manner as m become wb cn m the Workers'
Compensation Laws of California.Date'
Applmann
'-NOTICE TOAPPLICANTthe Workir' hmakingion Ccnifcm fE pro youyou
Z ben subjecttothe such ll Compensation or
provisionstshall a Labe Cod you must '
Q Q fonhwnh comply with such pate r ons or th'c perms shell b deemed revoked.
CONSIRUCf10NLENDING AGENCY, .-
r w 1, I h (firth that there nsw
is a coaion lending'agency for the performance ,
�%.y of the o kk f.!o, hieA th perms s¢sued ISm 309]Civ C) - "
T
;,-Q ' Led Nme " .
ZLeadersAddlesw
1 n fy th t I ha e d this city
ad( u and st m that Ne d state
format on is '
F. corn t I gree w co. th all eiry end ry ordinances and t t laws relating 1
C],V In .ld ng canswetidn,andhemby fmonmhonsreposes. Lives of this city memer upon
�.,�] the awrc-memiodedx in forinspection,harmaa.
1�.yy L fW) grc t d mnifyenak i hamay "the Cty rCLp ono e8einst
1 I? Z
It-b I t j Og t t o parties which y' any y c gains raid
V;i CitY to cdrucqucnce of the if of this permit.
APPlJ UNDF.RSTANL AND WILL COMPLY WITH 6' �ieaT k` Issued by: Date cc)
SOD P• .r ..:., o
Signa .plaman can 7 .. .'..'., .'.. ... ale,, Re-roofs
HAZA OU fATERIAIS DISCLOSURE -
WII N pp-hkircct 6 utdre b Idin occupant store Or handle harasoia mat al Type Of Roof -
as defined by th Cupcm o M n p I Cod Chapin 9 12 a Ne H IN and Safery
Code, ionam5532( ` II s y^ ss
O Yes trs oN I cL,' q y R s •h f t1 1'`34 s. 1 1 ��ar�1. x gp a �V'. ;fill
] t 1 (+ All.roofsshall be.Inspected prior-to.any roofing.material.being_installed.
Wdlthe epphcent i tsa wudcalboccupant heBay c aAilQuality devices If a roof is installed'wi[bou[first obtaining an ins ection;'I'ag"rce'to remove
can M1arudo sten is as defined by N Bay Area A r Q ry h1 gemcm g p
°"'-'oY oN all new materialsforinspection. Applicant understands and will comply With,
all non-point source regulations. . - -
1 the hinialikos m mriels requirements on&'Cbapm 6.95'.f the - ' '
Califon cel ffi Saf ry Code.Sections 25505 25533 and 25534 I urnandinalthic,
ifthe a ing s not curremly have u renanL that it is my responsibility to notify the
ce t f c uircm ctk both must be mei p to issuance a Cell,i ¢of "
x .. ... .,.: ..
Signature of Applicant Date _
-:'-�
owner a est' Dme All roof coverings to be Class"Br' or better'
t r_ r -r' 1 . .r. .. : - .._ .t OFFICE