02030213 TY OF
CJ
BUILDING DIVEISSIIONNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10335 FARALLONE DR ATLAS HEATING 02030213
OWNER'S NAME: APPLICATION SUB DATE
BRUMM CHARLES F AND CLARE T 155 SAN LAZARO AVE 03/28/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 739-0516
O ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
1= L7
i LICENSED CONTRACTOR'S DECLARATION
i z 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
:1=E�
with Section 700o)o �m<a,and Puexmv
mn,Caaan license REPLACE FURNACE & ADD A/C
is
II torte and 0'e
o wc.V L' t o �- Lic,x
Dm Corqlttmy1
A H1 Cf'S D_p5LARATION
] O 1 understand my prone ahali l e used as public recmds
i e p O Licensed Professional
es OWNER-BUILDER DECLARATION
u =' I hereby affirm that 1 am exempt from the Contractor x License Law for the
C < fallowing ream-.(Section 703 1.5,Business and Professions Cade:Any city or county
Sa SC3 Om
which
requiresa pe ut to l7 thew pint It improve.
vCe ondtcmmnoors of mystructure
1'..•i�.k:.lJ
� __.... $4000
OO.._0
..poor Wits ssa c 1 requires the applicant for such pemoutntofile aannt
License signed
(c.novencing
ithSaion]IXI ofDivision Valuation
....._.huf
or that be rs exempt
therefrom end the basis for the alldged.citemMron Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty-
of not mine than fi,e hundred dollars($500). c IgH 3 01APN PLUMB IN �'' " '•" Occupancy Type
❑1,as owner of the property,or my employees with rages as their sole compensation, _
T.
will do the work,and the snucture is not intended'or"offered for sale-(Sec:7)a0;
'Business and'Profn,imns Cale:The Contractor's License taw does not apply to an 3 04 - ROUGH EB1PMFJI1 kf[ions I'
owner of property Who builds or improves Inerton,and who does such work himself
r thmagh his own empmyeer.Provided tial each imp...myamem:are atil intended or _ _ _ 505 - FINAL ELECTRICAL
oft Zea r I If.n < to buli g o p ,i sow ll year of __ -- _ _ ..-..__ .,. . __ _ .. ._
<mmPleunn menwnernnmerwuhave mennmentirpro,mgmmneaanti�baueor 507 — FINAL PLUMBING 1' ' - -� ..
improve for purpose of sale.)' 508 - FINAL MECHANICAL
❑1,u^caner of the ro .am exclusively '—
. , P Pent y d Pme11ng with dc:)The Cminors to
mnswm the project(gee.7000,owner of and Professionsilds or improves
Connector's
License Low does not apply m an owner of progeny who builds s improves thereon, - ' -- a.
.. S _and vectors License
for such projttu..wilh.a.comrwtogs)licensed ..._.__.____ __._ t
Contractors Liccnu Ww..., _..-
?. ❑lam exempt under S«:. :•:I'' ,.•:e'&PC Tomtits reason .. .
_. .
FMALE®
. .. Owner' ,., ...,-., :.rDate'. .. .:
_ - WORKER'S COMPENSATION DECLARATION
I hereby affirm under For ally of perjury one of the following declarations: ❑nn 2 5 2002
❑ 1 have and will maintain a Certificate of Consent to self-insurt ror Worker's APR R L L
Compensation, as provided for by Section 3700 of the labor Code, for the p
performance of me work for which this pemsn is issued. BUILDING
S' ❑I have and will initiation Worker's Compensation;Insurance,az
3700 of the LaborCoo for-tis required by Semis
pert rmance of the work fo which this pefrmt is
d M k rs Cu p al ion canIter a d Policy be ar<
1 i
"Policy
u
CERT( A ON OF ExE OM WORKER w r] )
COMPENSATION INSURANCE
(Thu union need'nbt be completed if the permit is for one hundred dollars
(5100)or less.) _
1c nlfy that intM1e perf of theworkf hrh this pcoinsissued'I ,,t tiT q •" -'
shall not emplay'ary'lmoscon in any manner w es to become imp,,,to do,Workers
Compensation Laws of Califomiel Date.'
- , -....n
Applicant' ,
oNO❑
'
CE TO APPLICANT:.If, ❑ ak' g th C n fhle of.Ex
zbeaume subject to the Worrikee,Compensation Provisions of he Labor
uCoand yoyu
"p.vh_mo-"uu
lsdtOOforthwth comply wiWartichpnostrums or dmixproun,,mll bed reedreoked
CONSTRUCTION LENDING AGENCY
h by that Nimeifa o lnd ng agencyfor Neperomance ....... .. .. ._.. _ ... .d_1s,f1ne w which this permit Sce 309]6v C)
LendName':
l
-
-
...v.,.. .... . : .. a.:...- .. .. ......._ .. . .__ 9A"r,
� �, Lead sAad
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,,. I<emfy Nat 1 hav<rtaa stirs vppbcai on and stem I above information is k
E.I coarcts.I agree to comply with all city.and county,ofd' nc end stain laws relating
O.fJ labuilding<mndomedon,and hereby an mimicprese at sof this cityto enter upon
the ebovemcmionctl property for inspection Pu
ly' (Nc)egrz to save,indcoon and keep h- as slit Coyof Cbpciti m'. t
y r dg nta costs and 11 nus whit yin any way accrue a inst s d
V. City in cons cit^f Ih< enting of this ii_ ""
S UH CAN' E 5 N'f LY WITH' �'NO Issued b
Y Dale
gmam Apps.m tic tin 1 - Re roofs
HAZARDOUS (AIS DISCLOSURE "' .
:. can Ne ppl ant w r tare Ifu la «xvpanl sta<or R male naz;uam, mverw Type of Roof
az defined by she C pent Mu c p 1 ode Ch pt 9 12 d th H ahh d Sof ry -
Code,Sar n 25,532(,)? ,.. . .". .. _.
.•OYes t t N
_All.roofs shall be inspected-prior to any roofing.material being installed.
. call Ne appl tem o f rc Id nB« sent a gmpm t devices which installed - - --
1P If a roof is without first obtaining an'inspecUon;I agree to remove
mitM1 - doses roam fed by thrB yA A;rQ Quality Me kemem
g
D51npoY N _all new materials for inspection. Applicant understands and will comply with
t, all non-point regulations
: ',
1 h r d,thanerar on, crisis ,qiaremems'm de Chapter 6.45 of me '
Ca' Ih"&Safety Code «ions 25505,25533 and 25530.1 understand that
m
e bu g aces scat tutu 0 ve a rcnent mut o u}porn.1.1.tY to y the
«<up t fth requircm t eJl p' alis < @ f
must be met t rm
Occupy y
Signature of f Applicant Date
99pm^' .r...:e- All roof coverings to be Class `B"or better
OFFICE-. .