02060059CI
OF
BUI DING DIVISIONN�PERMIT
CONTRACTOR INFORMATION:
'T'&I}JG4AjjDRF,$$._Y AVE
ATLAS HEATING
PERMIT NO. 02060059
00
Y1V l
155 SAN LAZARO AVE
AUECf CTnbUL
PHONE:
(408)739-0516
SANITARY NO. CONTROL NO.
ARC] IITIiCUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3
L7 I I
LICENSED CONTRACTOR'S DECLARATION
IherebyaFrtnOat Iemlicensed under provisionsofChapter 9(commencing
INSTALL FURNACE�o�D s��pt�tCTWORK
with Section ]1100) of Division 3 of the Business end Professions Cale, and my license
is m full force en (f
440,
License las.' Li'. p
- Data Co'm
ARCHITECT'S DECLARATION
I understand my plans shall be used ex public records
.
J Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affim that I am exempt from the Contractor's License Law for ,he
following reason. (Section ]031.5, Business and Pndeasions Code: Any
$8000
city or county
o which requires a permi, In mnswa, alter, improve, demolish, or repair any structure
$pritnnits 'ssuance,also «qures the upplicanl for such permit 10 file a signed statement
_.__. ............ ._... _.-..._ ... ...... _-_-
that h "- licensed pro v the 'provisions ofthe CmurecorsLmnseLis. (Chapter 9
3��]1�Qifl(�DL.®1Qa
Valuation
(c
commercial, c ng with Sect 7000) of Division 3 of the Business an,1 Profess ons Code)
or that he Is exempt therefrom and the basis for the alleged exemption. Any violation
p
1, i t - j t y lr ' j.l 1 _'; ^ ,
"
of Section 7031.5 by any applicant for a parmil subjects ,he applicant to a civil Penalty
of nor alm. than five hundred dollars (s500).
30aAPNRQfiLGH MECHANI
AL I: ,,... , Occupancy Type
O L as owner of progeny, or my employees with wages as their sole compensation,
304 — ROUGH ELECTRI
AL
will do the work; and the 'swmure'is-not Intended or oAered for sale (Sec: 7W;
bUb _ F
Business andProfessions Code: The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
5 0 8 — FINAL M C I Lctions
or ,hough his own employees. provided that such improvements are no, intended or
o cred for sale. If, howevh the is withn one year of
o
l have t e burden
,he owns balder will have the buNcn of pronng ,ha, he did no, bald or
roving that
'
impnov,i for
improve for purpox of sale.).
..
❑ I. as owner of therogeny am O., mroc, ng with d contractors's
p
... .. ._. ....._• . _._".'.
w ethe grown (Sec ]040. Business ad Professions GmEc:) The mtem.'s
License Lawdoes not apply toan owner ofp p ,in xIds or improves,heron
. onJ who contracts for.such projects with .e conmeors) licensed pusuem to the
.._,_._'....--.._.-__,....--.._ ......._._.
Cunt ns cense Low''
®�..__
'
❑Inurexempt underSc tBIkP Cfr,hsreuon
:l"' .. -ppr
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm mMe` ppahy of perjury aocof The following declensions:
C
r O 1 have and willii.iumin a'Ceni0cate of Conxn, to self-insum for Worker's
Compensation, as Provided for by Section 3]00 of the Lebor-Coda' for the
s%
c?
4%
performance bribe work for which ,his permit is issued,
e
',1/
- 01 ha < d 'II mi Wok C m iin Insurance s y Secton
9^
r�
37M f ,he Labor Cale fo , pecfann (the work f which ,h s rat t s
.. pe m un¢ a P
i u J M W kers mCOMPEN
V11
Card
Crl PIicy Nii
t ,RTTFlCA EXEMPTION FROM WORKERS J "
EXEssiNINSURANCE'
..... .. u.. .. 1 .._. _ _ --------
i i' B lk t .. LI 1.,(P
t_ 1 "• t ( r„ til v t 1. t;. I:; Ul 1, r s
,t , .
.._.....
s•' I Y (T" cfneed n rmit,.• ....,tits
s onm be'completed if the pe Is for one hundred dallas
....._.. ...__,.. ...... .... .__ _.._ __........_..
tv,
ISM or le.$)
modify fy that In the pert ^dance of Ne 6111 f which this ii - t is issued,
es to become subject ,o the Woikei%
oLoss
C-irmpneon,saetmiopliso
of Crxelinloin iaa.nData
..: -1 iatsn'.n'."a
NOTICE TO APPLICANT: If, afrer making this Comfiea,e of Exemption, you should
beiome subject m the'skimmes'Computat ion provisions of the Labor Cale, yd. as,
foohwith comply with such provisions or this permi, shall be deemed revoked.
r.r
-'•" ''CONSTRUCTION LENDING AGENCY '
e
whereby that isaconed(Se,. lendingagency for the performance
which
work (m which this permi, is issue) (Sec. 31N], Civ. CJ
lacmi
Lethe
Lender's Name :� .�.:. ..,.-: ... r.-... .u, .tits: ..�..
_. ... _ --_.„-... ... __..__ .._. .... _. _- ...___....... ....... .. _._._ ...-... __.
f.ehdtt's Addiass l"=
1 cenify ,n., I have read his epplica,ion and state that the above information is
corten. I ngree In comply with ali city and courtly. ordinates and state laws relating
Io building,mmonition, arid h 'd,ulmon, reprammmives ofthii city to enterupon
thea mm-ni'mioned umpeny ori speetion Purposes.._
IWe) agree w save, r emei and keep harmless Ne City of Captor no against
liabilities, judgment, cos. ad a a,. which may in any way accrue ageins� said
City in consequence or the in g of this permi,.' '
APPt,ICUNDER
T STM is NO WILL CO 1PLY WITH pLL NON POI 'T-''
S 'C i N
Issued by: Date
(
an re A,I,cao at
Re -roofs
AZAR MATERIALS
RIALS DISCLOSURE -
, Will the can, o f building g occupant ,ore o ha dle Inliam us mat ed
P
Type of Roof.
asdefined by ,he upon o M p l Codc Chapter 9 17 and the Health and Safety
_
!-1 '
, r f M
1
.
1
et' ! !.,
All roofs shall be inspected prior; to.any roofing_ material being Installed.
., Will Iii' cut
am nd f wre bu' sed the BayA
coin haMnaa vv
' taminants 'ed by Bey 9v
If a roof is installed without first obtainingan' ins ectrdn; I'a ree.toiremove
p g
nn sed' the ,Air
Aron Quahly Medegemenl
ii Manedwnent
Dis nt^ ' '
all new materials for inspection.Applicant understands and will comply with
all non -point source regulations.;
1 end the ..'rd.',.!materials 505. remcnta under Chapter 695 of Ne
at
inm Heahh&'S,fety e;Sections45505: 35533 and 35530.(understand
-if)he ilding docs nota IYha"as"nom. Net it is my mponsibilirymno,ifY the
he
tither
---”' —'— '---' - ---- -- --------_--
occu of Ne'xquireme. xhich muni be mei prior ,o issuepce fit Ce ifieag of
'
Signature of Applicant Date
All roof coverings to be Class "B” or better' "
a ,nndred agent' o„e ;
.,
cu c
._.) .. .. _ .. OFFICE