02090026 OF
CI BUILDI c DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
910 FERNGROVE DR ANDERSON RADIANT HEATING 020900726
MY2` RICHARD E AND SHIRLEY 207 S . LEIGH AVE . APPuc0I�N��B5Yh02
• PHONE: SANITARY NO. / CONTROL NO.
l (408) 378-3868
O O IT
ARCHECT/ENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
a� o u o u
y i LICENSED CONTRACTOR'S DECLARATIO JQ� p p
of«o IherebyaRrmthatIamlicensedunderprovisionsofC ter9 momeneing REPLACE WATER HEHTE eri [ion
Fy Fu 'with Section 7000)of'ivision3o(Nc Business and Profeszio andmy license
nc s, -; it in full me a / / FI ���®
eC z z 6 Li;ens Lic.
a U D to Cannon.,_
•+�3^•in ARCHITECT'S DEC
O and Mand my plans shall be used as lic ools SEP 0 9 200
ne 2i 6 p a Licensed Professional
ca
OWNER-BUILDER DE RATION
`- I hereby affirm Nat I am exemq from Cractor's License law for the
h BUILDING
' ®I NG $960
z a following reason.(Section 7031.5.Business and Professions Cade:Any city or county
2 S which requires a permit to construct,alter,improve,demolish,or repair any structure
i
3 prior to is issuance.also 9 arc.applicant for such peri , fk signed statement - - _.... _ _ _._. ___.__..________
Not tar Al,rk-gted pars ant tQ the protions of the Co meo License La (C'haps,9 'k P' 1I3x7 B"�t0�0ot(dl(gea... t Valuation
aomroenenB wuh Soci 7000) f Division,3 or Ne Business d Professions Cade) C%t F.4 Ales. IS 910.000r .y a.(cy f•�^ A E.�'
nr mhos he ak eatempi,herefro,.and,he basis for the al Ieged exemption.Any violation
-of Sermon 7031:5 by any applicant for a permit subjects the applicant to a civil Penal,
of not me to.Eve hundred dollars($5101.
502ARNPIJ1IJJ%r PLUMBINC ENERGY Occupancy Type
CJ 1.as owner of the property,or no employees with wages n Nair sole compensation, 506 - GAS TEST
-wHI do!Btuincs,and
' pomend',hc Imp,mu,:bureThe
C not intended ore Lawcred fardue sale(see:to
n 507 - FINAL PLW Ta(gyspectiotis l"� " "'^
'owner of propene s Who
Cede:The Cans theocs Lams Law dun nm apply,o if ..
owner of property Who builds or improves Hereon,and who doer such work intended
or 1
o�h d fo his own employees.provided!that such imriem- ns are no imm�dcd or -
"oRcmd'foi Sala lL h.weer.,hc tiuildmg or imProvcmcm is sold-wiNin one y.;:of
oinplei for the cr-buildcr will have the bunko of proving Net he did not build or s'a -'
fO` TI:fl
improve for puryu'anse of sole.).
. __ .—___--
OLasowneraRbepmpenyom exclusivelycontractingPrazssions Noe:)Th Contrmtors T-----"-'---,';;", "— --;�,-(---"—"
newt,the Project(app. to a.Business and Professions Codes The Contractor ::I c. !il.;:e
- License Lew mall no,apply to ct,w th propcnY who builds or improvestram.n dre
does „
an4wbo.rs Liens Law. .projeas.w N.a commJ ;f0.licensca pursuant w Ne _.._.... .. _._-._... ._...___.
... Ca , ,o License Law. .. .._... . .__. .. _.._ .__ .__.._.__. ._.----------
0
.._._..
❑1 m pi der Sec'' ' '\ 1” ',B&PC for this reason 4,;;3 i.- '1 P; m.:
- Owners - ''•Date"'' -
WORKER'S COMPENSATION DECLARATION
• ' �1 hereby lfrm d r Ire hY of petlury. f Ne following de larar'ons
GY(1 d 111 t Cenifwt I C . nim self-insum for Worker's
Co pc a,mo, as Now ded for by-Section 37W of the-Labor Cade, for ,he
pert n/ f,he work for which this pconit is issued
(3rd tl ill maintmn Worker's Compe i 1 'run -as ieq irtd by 5«tion
37W of rh 'Labor Code.fiar.thh&Smmctij.f he vo f h'h N's G= ,is
Wn`
s frhe�i neeJCOON OFbe Enmplet OJNf he mu,is < D/
T Pe t� rancec a E
1 fl CBRTIPL NATIIIfl�1PTION FROM, r _ ..._ _ . V
�n l� 1
-. _
(51Wl urksx.l s for one hundred dollars , .c., �I!;❑, o
is 1' N lm ,n me f -' frhe N. pears m rs. d l
Loll no,a person an unY manse c t io Nc Worker.
j . w e
a( m y
,
Comps ado a n 'l
n sofC 111 'IJu__I
.'N t. _
1NOTICHTO PP ((ager g! Cn ct fE pto y should -'
O ,� Scorns! b ,he Worker C net P o ofth Luba Cod y m tf
Q im uch p N peen t h 116 dre d ked.
.. { _. .,. .. .__....__ ...._.__ _ ,_.. ._.__.. .. ..___-- _ .. . _
'CONS U�1'IbN LENDING AGENCY , . 1 _ a•
a> I he by 0' Nat a co st et lend'g 5gency f th perform ce ,
... f ih o k for1ch th pens i ssuc. (Sa 3097 Civ.C) `
0..Q ,..nd N' ..� / s.i ._.._. .. ... .._,. _...._. _.._ __ ...
Q.,Z Lent dre. � a
.,tl 1 R(y,haflh JNi appli ,on and sus Nath bop of neon is
- � aorrtn 1 g e,g4omply th all try sa,ad c0 t Ninanc��,atl�,ate 1 's relating
Q' b bu Id g o Vucl�Aa a d h by amho repf,h'.c ty to enter upon
'� (y 1 (K 1a ur p rMemnifY out ph Ie theCry fC peri no 6r said
W liab ens,co, and s h ch n any y uc gains said
(.) .Z. CiIY r1To ' of th ng of N s pertnu -'
iAPPLiCA ER NDSA\D WILL COMPLYWfT IvpDINT OL-)
Issued by; Date
SOURC G ONS ,i'( 1 -
Signalneopplican Re-roofs
v„ I .H RDOpShIATERIALS DISCL URE - `, `
Ilrhe apphcan aro biilan6 o�cupani sae or handl harardous material _-_T eof Roof...
as fed by th pup n Mun a ppl C,oJ Ch pm 9 13,end N He hh and Safety yp
C" Seno 255 a) .. .' 1 (
oY' / _°tt'trN t ;g T All roofs shall,be inspected.pnorto.any roofing material being installed.
wn m applicant p r, n-lawn cap.,.t eq-p ,o a stn If a roof is Tnsialled'witti'out first obtaining an'inspectiori,I'agrec`[(i remove
muh d rem ue, abvm By Are.A �M germ
_ all new materials for inspection Applicant understands and will com I with
❑Y p Y..`. ..
T. all noir-point source regulations -. , , ,- tlrl ; -
1 M tread ih azardmr mmerii req- nts and Ch P 695 T the
Calf to Hcahh efnY Cody8�umns 25505,_5533 and 25534.Lundeuand Na,
if the wilding note- omly have a tenem,that a is my responsibility'.tlmity the
ens which most prior,o issuance of Cenificau a(
Deco' ,of rcqui ,
c an
,__, Sigp4ttrepfApplicant-.
„. -„ Date
DaAll roof coverings to be Class B"or.better
—OFFICE - ..-....._ .... _. .-