02020036 CITY
DVSONO
IiiPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6
OWNER'S NAME: APPLICATION SUB DATE
DON PHILLIPS 661 SINCLAIR FRONTAGE D02 08 2002
PHONE: SANITARY NO. CONTROL NO.
(408) 934-8844
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
paFFO BLDG ELECT PLUMB MECH
c 0i 2 LICENSED CONTRACTOR'S DECLARATION Job Description
z_O 1 hereby effort that 1 am licensed under provisions of Chap
IS ler 9(ctmmencing
_Cu with Section 7"�)of Division Sof the Business and Professions Code.and license
xcel_I isNmnNmes. °If_ f ELECT UPGRADE 100AMP TO 200AMP
re"< L1ran"QW Liaa 2� FURNACE C/O 80000BTU, ADD A/C 4 TONS .
K O Date /�D'ai Comreaor
+m LL LLO rn —�- ARCHITECT'S DECLARATION
g 1 understand my plans shall be used as public me
xta att
al
u n p O Licemed Proreommil
OWNER-BUILDER DECLARATION
1 hereby aT n thin 1 am exempt from the Contractor',License Luw for Ne .
following reason.(Section)031.5,Business and Professions Code:Any city or county
as,ISO which re,im,v permit to Conswct.vlmr.improve,demolish,or repair any strucmte
n3 (ro 't. also req the applicant fmsuch perms to file a sigrcd statement
minim l:ex trs a sedmeP�ahaionaonheconhactota(.antelaw(cnapttt9 ,Sq.Ft,Floor Area-}ry ;•r p- I a[ion
u r o s ssuanca.
or
" vu
g with Sent n](100) f Division J of the Busmcss oral Professions Code) �i}� �� r� I_ s' , �'1s-
li lhcicl and use basis Entire e11eSe8 exemptiod.Any violation '!Y I"Y /.t.l ;1. . /. .
-of Section 703L5 by any applicant fora permit subjects the npplicam toe civil Penalty,
1 or not more than five hundred dollars($500), b f:'.+,';-', Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
-will'do the work,'and the'Structure'is not intended'or offered for sale(Sec.]044; -- -'' - 304 - -
(Busincss'am!Professions Code:The Contractor's License Law does not apply to an p$pPttlpp,S. 11
owner of progeny Who builds or improves themon,and who does such work himself 501 - F INAL E IRE L'.1V ERGY
or throe his awn employees, rodded Nat such improvements arc max intended m .S 0.5--- F-I-NAL- ELECTRICAL_. p u .__.,. . ...p.-._. ... ---------.. ._
omoplefficird for sale:owner Wilder
the building or improvement n sold within ane build of - - i :o i -
nprove on,the lof sale.).will have the burden of proving Nm he did not build or
improve for purpose of sale.).
-..-........ .-rz .___ -...-- .
Q i stoner of one property, xclusively contracting w th l coved car nmions in '.! I
y4 a
onions,the project St 7044,Bde
[business send Professions Ca :)The Contractor's
-'- License Law does noir such
m an owner of progeny who builds seimproves thereon,
..and who mLicar,for such projects w;th.e.conwnor(s)licensed pursuant to.Ne... ® _
- Contractor's License Low.
NA��
- _ ❑lam encmpt und<r5k," r B&PCfor this rcaaon
.. 1pp..gg�� 7 q q
Gwnr- ..Date .r _� MNR Q • LD0L
- - WORKER'S COMPENSATION DECLARATION
;• i ill maiIherchy affirm under penalty.of perjaq one.of�the to lowing declarations:
El1 hf�
ave and wntain a&hffise
cute'ofConnt to self-insure for Worker's
BUILDING
Compensation, an-provided for by Section 37W of the Labor Code.for the
_ Performance of the work for which this permit is issued.
ICISave and will maintain Workers Cumpcnsaiion Insurance,ai required by Section
J 00 i f the Libor Code:far the pcifarmaatt of the work'for which this Permit is
soom
pentaid
,7 F;'CERTIFICATION OF EK�c N&L and Policy 0dr rbc
Ce d M/fVl/L6 m9-To/l nPdl yNo.Z�'3-r10' - - '.,.:. ..:...._
t. a . ,yet Y i q y r
EMPINSURAOCE "I'E g...l�) � I.. .�., i.n-,qa t-4 �„3(',I.- ..:V 3 Yj.4 4.A:
COMPCNSATION INSURANCE
:tet DYphisaecdonneed�noi M'cumplcl�d if the permit is fm one hundmd dollars
(SIM)orlc S.)
I
Icnfy Nm in Nc pedrm sof the Walk fr whip thmpermt n ismed.l - - -- - .i.i -- - -?,, - ...... --
shall noremploy any perwm
n m any Pnner .'a,to'become subject no the Workers
Co c t e .. ,
•.
NOTICE TO APFLICANPIf offer teak_ _ _ .. ._....-. ... -. .._._.... __. .e........... .___. ..
p Data
g the Centralia of Exemptio s,you sliouhj „
Q 0 hecame subject the Worker's Confirmation provision.i of the Lubar Code,you must
fhnhwith comply woo such provisions or this permi tshall be deemed revoked,
'CONSTRUCTION LEND ING AGENCY
F' 1 he by alliin Not there rs a sued(Sec kntling vgc cy( the performance <' ., m
a' ods ofnework Nione which Nlspermit is issued(Sec.J09],Civ.C.) '-''
k7'Q Lentltti Names .... _ ,.: ,..e..->_:.: :,✓,_�. ..,v u....�_..-_: i.... . .._
�'z Lentl rs Add
U.O
I certify that 1 have rcvd this lty ad and nine that the above Iw.s refining is /v
kT+"U torten I agree,t comply with all city nod my a datives and si to laws enter
upon 1111
Q (� robuilding nswcunn and hereby authonze rcprese t rues of the aryl enter upon
k] the abo a me ti ncdz
peny fo aspect n purpo a
y' W)agree'toa and mni(y nd keep hp mle s fhb Ciry of Cup nlno eo aid
y liab I seen judgmentsst and expenses h¢h mry m my w y ec m geinst said
F.).Z Ciry c sequence e gra t ng permit- - i
APPLICANT UNDEAND$ D51' LCOh YWITH ALL M1r Issued by: Date </
SOURCE S i � '.�` �,I ,• o'�'m n <: rDa Re-roofs
ARDOUS MATERIAI S DISCLOSURErftrcN'Id'nga pont stoic ser handle hazard smSafety- Type Of ROOT..n Mun c p I Code Ch pt 9.11 end Ne H uhh and Safetyj i� I line.,f7t(}tm.f.�. 1.( v ._ �° , _--Allroofsshall beinspected poor to imy,roofing material being installed.. _--I fW1lNeappoe, .,am WJdngocc pant use equipment ordcvmcswhich If a roof is ins[alled'without first obtaining an inspectiori;'Ilagree'to remove
cmthazaid s ter commems as dcfihetl by th BayMaAno ahryMagcmemDuni I, all new materials for inspection. Apphcant understands and will comply withim . ; ° i' '' allnon-poirit'sourceregulations ; Inthend thvzv d nts maierivis mi mmnrcu sunder Chapter 6 95 of NeHealth&Sty Code/Sections 2550.5,15533 and 25534.,1 understand thatIf the Wilting doe nurrently hoe tenant thattis y respombityto notify Neoccup t mf th rtqus xNch run be t poor tb iu price of Cep ins hecepa �/ �a 7 gnature of ApplicantDate
Dx a li maser . Dame, . All roof coverings to be Class 'B"or better
OFFICE . . .. .. _ .._. .. . .
I.