00080227 CITY
I B
BUILDING DIVISIONNO .- CONTRACTOR INFORMATION: .
' PERMIT
BUILDING ADDRESS: PERMIT NO.
00080227
OWNER'S NAW i HEAT " APPLICATION SUB DATE
08/31./2000
7WZ
ONE: � YU - SANITARY NO. CON'I'ROLNO,
C
RCHITECT'/ENGINEER: BUILDING PERMIT'INTO
_ BI ',ECT PLUMB MECH
_ CILICENSED CONTRACT'OR'S DECLARATION1 derdhy strain torn 1inn lieeased underprnvisinns ofCna,Iei9 mmnmecingJob DescriptionithSerion 7oQRufDi,00a3ol'the Bainessand ,Nessa odean mYllcen.ce
n full faroo and _cense L 1 ung 1 e tractor A/C UNIT W/ PANEL UPGRADE/ARCHTI'ECI"S DECUcO RAT
m ran 1 undnrwana my phrns shall he uscJ as punlic records
Y
iS..
o O License)Pride s.cional '
OWNER-BUILDER m the CaATION
W=' 1 herehy affirm thin 1 stn exempt from the Cumramods Llemwe Law for the _ - -
C X C tshieti ng rens a(Sermon]091 5,d.wirer land Professions Carel Any city m omnty ,
Edd�O wh shay ' Peru... c r a h f - J I',b rep Y,a mere -
� _ pat t t ': I. y eir jion tl Iperm t f1signedCmnanl
thathelicensed p Section .h p n In t t L I fico for9 Sq. Ft. Floor Area Valuation
p
ant thea, ulh Baan told heba n?nt the Business esa,dion.An ..hare) _
or thin he,, 31 5 by
tneefmm ana inn oasis Lathe cts th tl exemption.Any nipenaon -
of Sestina]03 n by any applicant for x permit srbJeets the applicant to a eivibpenxlty
- armmmmemaarvemooned ann.r(asom. � APNNurnber Occupancy Type
❑1,as owner ol'the property,or my etuployecs with wages as welt etra lua pem',nion.
thsoak,
will do e rk,and the somerne is oat intended or offered lir sem(See.]044.
Business ana Professions Code,The Gmtracmds License Law docs not apply le an C; -- Required Inspections
ownerof pepeay Who bund.or imp es location.and who does such work himself
otnr mugh his awn ample .......mre
ad arm.nah mtpmaaa»eat. re oant Intended m 303 _ ROUGH MECHANICAL
-
offered far sale.If,however,the building or Improvement is sold within one year of
nrmp.cforp 'oxer-mama will have it,n.N afpmviag that neeie ant nem r,r 304 — ROUGH ELECTRICAL
[m ,build).
❑I,asowner of the peperty.antexemsivelYcmttraetlngwith heenbedeortne, to 505 — FINAL ELECTRICAL
nnaran the innate,(sec.7044,Bir aerb rind Pro&bsianb CWe.)The Crn,tractor's 508 — FINAL MECHANICAL
License Law does not apply uoner og
,un wof progeny he bwldb or imro
pves thereon, -
and whn contracts for such pn,,jectr with a cmarroo.,$)licensed putsuam m the
Comrrars license Law.
°1a cmnin under Sec. R&P C rot this reason
_ Owner Date
WORKER'SCOMPENSATION DECLARATION.
I herehy affirm un der penalty tdperjmy ons of the wllowirgdachinnirns: s /®y `
1 have and will malawtn a Certificate of Consent m .elf-irra m for Worker's /10
,mpensmlon, as provider for by:
Seetmon 3700 of rhe Lubar Coda far the t.
ethn....e fthe work for which his permit ivisaued. ® _
Cl 1 of and ab r Code, or th er'n Cnmpen.mt f N workho,manf r rc ch til permit is -
issue of the Worker
G,rw far the pxrformnnce of the work for which tai:permit is - -
_
issued My Worker's , ttiron Inwrunce carri�Aer��imA�Po/lie�y nw�`n'b�er'are:'7��
erCertPol icy N'o.:✓moi/—�-0 ,
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
'
This onion need not be camp Wed if the permit is for one hundred doll... - •' "
($100)or less.)
I certify that in the performance of the wink for which this permit is issued.I ? _
shall not employ any perste In any manner so as to become arbiter to the Workers'. -
Compensation Laws of California.Date
Applicant -
NOTICE TO APPLICANT:IL after making this Cendicete of ExarnpdmL you should -
become sabject to Ore Workers Compensation provisions of area,the Labor'Code,you
O O fonhwiEn comply with such provisions or this perm't shall be deemed revoker.
V] CONSTRUCTION LENDING AGENCY
a ? I herehy afrrm that them is a construction lending agency for the prfomtsnce
W of the wuar
rk for is this m su
Nirvana,Is ised(See.3097,Civ.C.) -
0. ❑ Lender's Name _
� z Leal .Alles,' -
V O 1 canny that I have read this applicat instruct state that the Ulawe information I
W F carrell agree at ply with ill ',,and ' ty mahnarres and.tt In'ng
3 OCA) m'nakingvnsweirn ,nd hereby mtharec reprebentrivei of thisety to enn.rapor
y W
the abovearentionedp p ty for impectiou par,sises
rfy z (We)'gt indemnify dk pharmless,th City lC P t gamst _
ran Hatt I'f luJgnanu, h expe,ses which may in any y accrue against said
U Ary ICAtsagUND oft NDS AND W permit.
sating of thisp'�' ('J
U ILL COMPLY WITHA NO POI issued byar. : Date,�
set pace /Contractor '' Date Re-roofs -
IAZARDOIJfi MATERIALS DISCLOSURE
ill the up ream ur home building occupant store or handle harunmus material Type of Roo -
a.de red by the '.panni Munlelpal Code,Chapter 9.12,and the Health and Safety Cod.Section 512(x)?
j o, El No All roofs shall be inspected prior to any roofing material being installed.
wi nonpphcar,tnrfuture holding occupant use sq.iprnentnraeviaexwhich If a roof is installed without first obtainingan ins ection,,I agree to remove
mol rad',.,ser contmnlnant.acs defined by the Bay Are.Air Quality Management p
District? I . all new materials for inspection.' Applicant understands and will comply with
°Yea o No all non-point source regulations.
I have read t hazardous materials requimaams under Chapter 6.95 or the _ -
CallromiaHealw& urely Code,Sections 25511.5,25533 and 25534.l undersand that - -
ifthebull tgdn• at carremly have a formal that it in my sponsinil'tymnmily the
pan f the mem.which must rte met prior m'susfee of Cenifiane of
'y re Signature'of Applicant Date
or m. Iced nseat �Date All roof coverings.to be"Class"B" or better