01110102 CIBUILDINGDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS'. PERMIT NO.
10535 FELTON WY A PERFECT CLIMATE 01110102
OWNER'S NAME: APPLICATION SUB DATE
MATTHEW SOMMER 10570 S DEANZA BLVD 11/21/2001
ONE: (408) 861-9545 SANITARY NO. CONTROL NO.
O ARCHITECr/ENGINEER: BUILDING PERMIT INFO
U G BLDG ELECT PLUMB MECH
I L--J L=7
5=so i LICENSLD CONTRACTOR'S DECLARATION Job Description
5z_e 1 hereby affirm that 1 am licensed under provisions or Chapmr 9(commencing p
nw ximScmion7000)ofDisian3afthcBusmeaso PmfessmmCoada ni license CUT IN FURNACE & A/C.
u in full fame unJ in
a wa Lieen elan. Z � tic.. � � CENTRAL SYSTEM, PREEXISTIN WALL UNITS .
p 3 a`� Dine 2— Contmaur
u. J_ — k?sRH41TECT'S DELLA 410
O 1 unJemm�d my plans.hall he used as puhli n
T
7 d O O Licensed Professional
tri. OW NER-BUILDER DECLARATION
1 hereby arBrn that 1 am morpt from the Contractor's License Law for the
f- < following reason.(Section 7031.5.Business and Profession,Cade:Any city or county
E o wM1ach requires a parparmano construm.alter. p dersolikh.or repairany structure
�3 pnn tot c q m ppr tf ch pc.it I.flea g d tatemeno _
mmn dp-rsano0ep n aforeContractor samPrfeLicense Professions
•.t.y S ..Fo .IoorAreaf`1a t aluation
(Chapter 9
(core is
ni Sat orn an fD Division J the l -na. ndP f yvi Codc) s .Il ,`1,. 1'".f} •„
or that io a 31.5 therefrom and the basis forme alleged dcmpt on Any violation
-
trisection a duce s any applic.fl fora permit subjenz the applicant to a tlril penalty
'arnotmortmanBvenunat<aaanarsasoo). umber Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation, _
will do the work:and the".arunure isnot intended or offered fit,sale Sec.TUC,'
Business and Pimmi lonz Code:The Cartmel,',License Law does not apply to an 3 03 - ROUGH M��piP'&d1QSA49[ions""` --
owner of pri Who builds or improves mercon,and who does such work birnalf
ar thgh ms awn employees.provides that such improvements arc nor maeneed« _ 3.04 — ROUGH ROUGH_ELECTRI CAL
.'a fm sale'IL how th building pro .t sId within one year of - ---- __ - --
completion,meownerbuilderwill have the burden ofpassingthat h did matbua -11---
build 505 - FINAL ELECTRICAL, "'s "•
improver°`°atpaseacme.). 507 - FINAL PLUMBING
- _._..---- - - -G-.
Laeowner ofthe p(Sec.704m. .usinesslycomvningns Caftena ive Criactnrsro 508 - FINAL MECHANICAL <f� t
construct the project(Sec.]to a,Business and any who Code)Thc ses traetor'x
License Law Jas nm apply w an owner of property who bulien or improves Hereon, '
and xha ,,kens do-such projars-with a commcmrts),IicenzW Wrsuant.to me
1 no a s !arse -—.--
❑lamaemptorder Sec: ,B&P C for this reason ,. -- ;T•iJ'I, r
Owner. . ` Date -
- WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of pequry one of the following destinations: fl' is W �®
1 have and will maintain a Certificate of Consent m self-insure for Worker's
Campcnsmion, as provided for by Section 3100 of the Labor Code, for the MAY 2 8 2002
-., pcrma
rfoanof the work for which this permit is issued.
❑1 have and will maintain Woder's Compensation Insurance,ai required by Section
3100 f the Libor Cod f the perfomunc of me work( which this permit BUILDING issued MY!Ed s Co lesson ami/e/a '•�(pJe�acor;�
Caen Al N:PoIieYN ./ t V f-J NG -_ - . ... --- .-
e ,�. 'its•
CE 1ICAT10N'OF E%EMPI nOw FROM WORKERS J'. t R'. k t,`. S t y' C^� ', �'„} a. ,•
COMPENSATION INSURANCE;' ”' '
.. - . .... .. .. .„ .... .__-. _.__..--._-_._-.... __
(This samimi ncW not be,coin lcted if the(5100)or IessJ p permit is for one hundred dollars 5.� .Uil r• :J':.:1;7:" 1' �'
;hall n
Ic ri fy that n er pcm k f h'n _issued,I
PI Y Y 1' inn any net be object
ctt t 'h th Workers
Com .ps t n Li - .1'Cidiforaiii.Dom
Applicant
,�ICE hOmm,he NNklf C agth�`ifs of Lzbm Codeo et.mind '-
on o Nati must
0 (oehwnncomply with such provisions or this pcnmt shall bi deemed revoked.
CONSTRUCTION emivacLENDING AGENCY
C 1 hereby off ren thath ice issued
tact e. 010.C agency for heperformance
Lr of the work.which mrs permit i'issued(Sec.3091.Civ.C.)
❑ UndnsHama'- -.._ ....__
7 Lender s Address'
�sv1 agree thin 1 have rcod this application and vainances that a dabovestat laws relating g
0 U tobuildin agree to comply with all city and county ordinances and store laws relating
> the aildingnmtioned n.anay,fori authorize urposenmtives of this city to enrnr upon
� L>a the above-mentioned indemnify
for ify and
purpose.
[.. d (W)agree to Nisave:indemnify and keep harmless the way
of onto.,.I against
h liabilities,judgments,casts and expenses which may in any xvy acerae against said
U Z City in conscqueitd of the gmniing of this permit: '' ' '• '
PPILIC I ,NDERST DS'ARD N'ILC COMPLY WITH ALL NON POINT '•
SOURCP P ❑1 N Issued by: Date
sig et r k ,ismct t D t : Re-roofs
HA MA R1 LS DISCLOSURE
Will ppI canto future bu Id ng Pat ver hatWle henrde mate cl T e Of Roof _ \
as defned by the C pWI en M n c Code Chapter 9 12 and the Health and Safety yp
Codi Section 2553 (a12 t t' - - 4\ ..,7( Y -. -`^I? 1-, //t• -
t
- -- - All roofs shall be respected
prior-to any,roofing materialbeing.installed.,.
Will nd he it contaminants
l' t o a t building' c p t A ea equipment li devices e met If a roof is installed without first obtaining an ins ectldn -I agree totremove
mIt h v d e Dora n un a deleted by the Bey Area ip Quality mem g p
i,m
o�Yas ❑N _ _ all new materials for inspection. Applicant understands and will comply with
M all non-point source regulations.,,
I ha cud ihe.h dos materials req mem under Chapter G 95`or the „
Cala. to Health&Safety Cd have ana255U5t itis yrespin41 untlemand Chet
ifthe Wil of
he miquirmentses not currentlyhave
must
ont,thetinsmYssuanc siofa to notify the -
'&enpam of the require en¢which muv be'mn promo issuance of a Cenifcate of
Signature of Applicant _ Date
sorer aumon:e .gen .1. - Data All roof coverings to be Class "B"or'bettet
OFFICE -- -. . -