01100120 CI BUILDINGD
F PON
ERTNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7422 FALLENLEAF LA A PERFECT CLIMATE 01100120
OWNER'S NAME: APPLICATION SUB DATE
FORSYTH MYRON G AND LOUELLA M 10570 S DEANZA BLVD 10/23/2001
• PHONE: (408) 861-9545 SANITARY NO. CONTROL NO.
GWOO ARCHITEC IEiNGINEER: BUILDING PERMIT INFO
E w BLDG ELECT PLUMB MECH
`G.
5 H 2 LICENSED CONTRACTOR'S DECLARATION Job Description
_C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencmg P
m{_W withamfionT"If Divi' 3ofthe Business adProfessions Code.and mylicense FURNACE CHANGE OUT.
g is in full 011e and 15
3 O d u License Class Lie a
Data Cohoacmr
�lra.O ITECrS DECLARAtUbW
I understand my plans shall he used as public records
T
i a O LicensedProfessions]
a OWNER-BUILDER DECLARATION
U
I hereby off nn that 1 am eschpt from the Contactm's License Law,for the
Iz< following reams(Section 703 IS,Business and Professions Cade:Any city of county $3590
E r owhim requires a Permit to construct,alter,improve,demolish,or repair any structure
a
treir3w .Four to its issuance;also Requires the applicant for such pemuuo file a signed stetemmt - - --. .. - ._...- _ - _ _.
tMt he is,licenud pursuant to the provisions of the Commetofs Lactose law(Chapter 9 _
(commencing with Section 7000)of Division 3 of the Businesf and Professions Cods) E�1�j'ipgIq�2- "Q O ITa!-*�'�' yy ``'y( P, ' Valuation
or that he ii cs!mp t tkrefiom and the basis for the elle d exem tion.An j•K"t'�I d -�'
p g p iv violation 1
-of Section 7031.5 by any applicant fm a permit subjects tk epplicanuo a evil prn9ry
of nm ream than five hundred dollars(SSW). 301APN H PLUMBINT Occupancy Type
El 1.as owner of the property,or my employees with wages"their sole compenation, 3 QI - ROUGH M CHANI AL
will do the work,and the structure is not intended or offered for sale(Sec.7014,
Business and'Profesoons Curt:The Contractor's License Law does not apply to an 304 — ROUGH EI &d 4it 3ec[iohs'"
.ism,,tough his own mployeessRr;reidedtatsuch.Rod mproveme«asemtintwork n;moor 505 - FINAL ELECTRICAL
B employees.Provided or
such improvements art not imcnear or - _
-,Rfferdron.tthe.If.however,dwell hav thor improvement n sale within Rae year or 507 - FINAL PLUMBING
dmpinion,the oxner-builder will have tk burden of proving that he did not Wild m
completion.the 508 - FINAL MECHANICAL
-- _
--:;{ OLas owner ofine Propany,am eaduelvelycontracting
sions oricki icontanorsto
c
License
the project(Sm. to a Business and Rdahoes Code:)The improves
th nco. "
Lice me Law doe not apply man owner of property who Wilds or seimproves thereon.
- _ and who contracts for such projects with a conmemgs)licensed pursuant m the
s �
Contractor's Licensely ... I
❑1ate exempt undcrs i B&PCT this reason .t
,.,Dat ` .. .,• ,
WORKER S COMPENSATION DECLARATION
1 hereby affirm under perulty of perjury one of the following declarations: 7
O I have and will maintain a Cenifcate of Content m self-insure for Worker's /
Compensation, as pmv;ded for by Section 37W of the labor Code, for the
peeformime Rf the work for which this permit is issued..,
O 1 have and willinuirmin Workers Compensation Insnianec,as required by aceeon
37W of the Labor Cdc,for the perfoi cs of the work Tor which this permit is
is d.M W�rker'sC pc- t Insua artier\fand lPNo�l y tube a
Camel .. ERTIF�oEAIPION MCMV KE4� .- � tNo
ri
n need riot be ENSATION INSURANCE
„ frio sea completed if the permit is for one hundred dollars
(51 W)or lean) r.
as I twify that in'be liformovi of tk work for which this permit is issue-d,l _ - � - - _ "• •_ .. '.." .' .• .
shall not employ any person in any mann r m as to become subject to the Workers
Compensation Laws of California,Date
NOTICETOAPPLICANT If 0 k gthsC n'fcam o(Exe t - _"� - -
p -
z Qz bet the Worker's C pe ton provisions of the Labor Code,you
m'uilsdl
forthwith comply
with such props ore or this pc n shall be,doccressol revoked. '
CONSTRUCTION LENDING AGENCY "'-`-
tYi;PWI hereby which that thereconstruction' Icnding agency for Ne penoimance f
Linos,'link for which th pc issued(Se 309].CC)
a 0 Lenders Nae-.. - iv :
Q m .. ....:. _. .-
..`7'z l.cnder'k Address..
1 certify that]have read this application and state that the above information is '
' fist'F;,x toren.1 agree to comply with all city'and county endurances and state laws relating
'�`U to Wilding construction,and hereby tormnia'iepresmue6ds of Nis city m enter upon
.'•;,w the akve-ramuond�.yprupenyyfor inspection purposes,(W)hgreeibsave.indemnifyandkeepharmlesstheCityofCupcmilegeinst
m liabilities,judgments,a.,,end e.pi which may in any way seems,against said
[) ti city inI consequence R theg t g D this - ..•. . . / G/
APPI ICANRTO DE]7RDST�ASN,D DWhLLe,COMPLY'WIlO/N}P�OI T'n Issued b Gr"Z —ll
A SYLII/A �r117k1 1r �`/SII y' Date
S wt re o APPI can C t "'T, ,Date�C Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
WWI.the applicant
a future W'W'ng occupant com or hathadhi hazardous mmenal Type of Roof
To,defined by theC pen n municipal Cdc Chapter 9.12.and theHealth and Safety - yp - - -
cde ova .,". )r Ej No t .iS fi .t'' C`d 3.'' r ri ;t IT I?;:� '!..S i7rn-; ( 3'k
All roofs shall be inspected prior.to.any roofing material.being installed.
co',hazardous
I,cicn t rfmurebuldingoy heBayART.upant use equipmentotdanceswnch If a roof is installed without first obtaining an inspection;I'agiee[o'iemove
mit hero d s air tom na a definer by th B y Arc A Quality M agement g
Distinct? dN all new materials.for inspection. Applicant understands and will comply with
J fir: ., l all
non-point source regulations. . • a .. ,
I edNe Iwzardous mat al the
CaliforniaHealth&Sof ryCode,Sections 25505,25533 and 25534•l tndersadfRou
df1lhc,J,ihbrq does not currently have o tenant.that it is my responsibility to nadfy Ne'
d m of the requiamcnti'which most k met poor to issnanac (6 CeniOcate of
1 o Signature of Applicant
Date
w err anon= agentA oat II roof coverings to be'Class "B"or better
r ,
OFFICE