02020062 '"-
"
i -.>" nDILDING D,I.V,IS1oN ,. ',CONTRACTOR. , ; r a INFORMATION:
, 'PERMIT, -
—
BUILDINGADDRP.SS
: _ •.I. .. 1 J'C..'.':.41't r.r jl.).1;;;':'h, �.•rL.
:,'. .:.'.i . . PERMIT NO:
,r.m.. ,..� .x.., ._... ..•-t. . . _ 1: ,.. ..r'i- .ly:.. r'it•s_O
li. .,i , ; < ,-, ,•, -'_ 2020062
PERFECT
_ — - -
,w OWNER SNAML:,`�_•�.'r "''.. '^. _ _ .- APPLICATIONSUBDATE-.•"-__._. _.._
tPORAT:, ELI AND -HEDVA: <., 10570 S DEANZA BLVD ;02/19/2002
PHONE: .. SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITECTIENGINEER;'. - - BUILDING PERMIT INFO
V- BLDG ELECT PLUMB MF,CH
Fa { U I_- f-1 LJ
LICENSED CONTRACTOR'S DECLARATION - job Description
-
Z 1 hereby affirm that 1 licensed der pro,sions of Chapter 9 kommenemg - - •-- - -. ..
1-be vh5 a n7")ofOv I 3 ftheB nesse dProfess Cod dmylcense TO HEAT PUMP SYSTEM
p s n('ll force vq� '
x'ir s6 Li n CI,uS Lcx� CT�I'J-(7
a LL m0 RCHITECI-S DECLARATION
-I underslnnd my Alun .hull be use as public records
¢c O .Lie .eJ Professional
OWNER-BUILDER DECLARATION
Ii C 1 hercny firm,h,1 exempt f m the C 1 e s L L for Ihe'
w
z< loll srcaann (S ct 7I3
1.S.B soJl f. ' sCd Any q or countyi
�F❑ wh I equr. ape it nmcL'nlm inPsed bh -mp @Yswnurc
a.3$ rli' yu res lh u Lena fo h permu fl a g cunt me,ll � ._ _.
th rho Itt.e -h alt W VP e a inesL ns L onsC r9 x S ._Fit Floor,Area xT >• sr Valuation
t , (cmm nen w'di,Sep ]( the sena Professions Cade? yy'f i��I I It a tS,`i Fgti t ••�„ '
101 6f ,IC h _
p p n. m ftheC qq
g Mj rD , n3anh 356270Q2,i,00
rtit rM1e Is empi Ih k! mand,n b est nhe allege tempt n A y,m1su n .. _
C f Secuon iO3I 5 tiY Y opPl c t f perm t subjects. theapplicant to-i civil penally; - _ .__ _
-rnan,ommanfian ,a �adrsHl5oa) 'APNNumber t. l) Occupancy'lype .
Cplso neo of Chep'peny'Lr my'empl ye uh wages es their sole compensation.� 301 - ROUGH .PLiJMBIN v: tlol TI l 4
1 'twill 6:t or',-and Ihe stn cl re is.noi mmaded o,.1fored.for sale(Sec 7044 i
s ,Bos n nd'Piofess o Coda The Contractor',License Law does no,apply,o a QW;'y K�DDeeCh
" owns if prop ny:Whn h las p seuh d who does such work himself ' 30`4 '-- ROUGH E 1'.122 HL
?, 'or thro gh h s own employ pm we rb i n imp o emems am no,immrd d __.SOS- ---FINAL—ELECTRICAL-- —
g or mopmvement is sold within one year o!, ---
:...•, o t for,xis.IL hbwcvcres. vidiv ,..4a•- -- \. 3..
dmplelion,the owner.builder will have the burden of praying thin he did not build or 507 - F I NAL PLUMBING
I ye f«puryou of mleJ.'
------------5.08_ _...F.INAL._.MECHANICAL._ _
„ ^s ❑qas owner of me prrrye.7 ,exNusiss and Professions
Coal
Commons to h' r L: - ;
j cinerl the project IStt.41/14,Business and F'rofcisions Code:)The Conuanor's !
Littnze Id'w d«s not apply,o an owner of property who builds or improves thereon,
who commas fora«h.projttti with a,comennorrs)licensed pursuant.to the'
Conuanor's License Lew. .,,• -......
� '_;;;.' ❑Iamesemp,under Sec." ,BAPCforIt.this reason - - .::1'fi1. , ;:
_- Owner •,Dare - s ""' "' '
WORKER'S COMPENSATION DECLARATION C /� I C
the
❑ I he and II a
• .a b by affim 'i penollyofpelry soIii 1fn-I.o If1.n ar Worker's f
l gdeclarations:
i t' _. . ...
mide] C notet f C meo „ •,, n , sir ,
Comps t u. p< 1 1 f by Section 3]00 off the Labor Cod
puR rm n fthe s kf h hthis p t rssuW far the.
•b APR
% p l brell will'inaimunlal Closisenia,lon'bommoma,us requ,rcd by Section _ v
3700 of dhe'Lc1wr Cotl findfinde performance of me work for wh ch this permit s
.Issued MyW rkert'Cmn tsati ulnar ce carrier and Policy miteam:, i UILD NG ,
_alI
1 '
Cent rl.�Jl��l�'Poliey No.:': ,a,l f. y ,lz ,� rJl�k�e l�l'':ie �w t -3: a
S CERTI A ONO Estill]ON FROM KERS t }, t a> I, f IUl I nS !
i' " COMPENSATION INSURANCE 1 .:„ a -M -,- -
1 - r -
I `(Th cl ova ed rite impin difthe perm nsfr tie hundrtd dollars - I-•
lt
I >
_4 1 cendy'ihal in the pert ani nee of th work f hi h th k .......
pumaeWme'1 ... ._ •... •• _' ,' _ by
so as m become-subjectyo the Workers - ' i,
...?� shell not emPl Y'anY.K �n enY'mah .• ..
• )
Compensation laws of Cul fomia.Dale. '
-,.
,. ._App]cam. ., .. :;-. . . .. ..... .. ,; :
7 I NOTICE TO APPLICANTIf hcrmaking thisrtitiosof of Exemption,youshould ,
become subject tit W°rkcfr Cision, rIn.,Provisionsbf thesaber Cage you man '
Q 0 fonh th mply 4th such p talons or ms pmnil shell be described metal
. ► - 12 coNST ucrioN LENDING AGENCY -_ --- t !• , - - --- -
, I hemby (firm thus,here rya wroxhin,filin lending agency fo the m
perforance e t
a -/'
y o .Leth o k f whim th permit issued(Sec 009] Cry C)
,Linder'.Address •
U � xl, 1 certify that 1 have d thisapplication and tae that the ab information is -
correct.Ingres m comply with.11ctry and county ordinances and state laws relating
1.hlcontraction;and hembyamhmire representatives or lhii city t°emeruryan
the above-mentioned properly for inspection purposes.,,, -
t: A. -, (We)g e to s vc code ify end keep harmle s the City of CLpenin'o'agamsr
VI liabtl t c )udgm ms,cost and expenses which may,n anyway gains aid
U ,Z City c q ence In the ga ting of Nis perms
APPLI(A UNDERSTAND NO WILLCOMPLY WITH ALL N-N'POIT'' ' ri ✓ v
duan crs r s 'Issued+by: " "'n : Dat :
illi nam c Arpfdanvcd, t I Dam Re-roofs - ' -
.,IfAZARDO S MATERIALS IS OSURE l'
'Will the applicant t r fonA b Idit g ce pan ol to hamrdotia,ra a' Type of Roof
at dein the Cup room Mum c pa Code Ch pt 9 l2' d the Hwlth and S f ry -
C on ssen 'Irt h I Ora4'}z.
All'roofs shall be Inspected prroi to any roofing material being installed._ _
i,,,i W'lltheappllczni r miebuld'ngttepantuse equipment devices which. If:aroofisinstalle&withoutfirstobtainin an.ins anon I.agree.to'remove
air h Nus nr<omeminams def ed by lh Bey Arca kh Qua lby mnmg nrmm g Pe
Dial n , cs , all new materials for inspectionl. Applicadt understands and'will comply with
QYes
: f ''al]'non-point source'regulations -;r _. . _ ..
111ma rtud'.the h aardaua me tensit,,rcquiremenu'a der'Chapter 695 of the - - '--
Camie li(oHeahA&Safery'Cole:Scctiom?5505.25533 end 25534.1 understand that
Brimbuil r d notcurren0y ha a tre not that liy reap°m 6l ty to dfy the. .
up f N req Imm h ch ni be t ptins'sua tt' f a C fen of
` Signature of Applicant Date
w , sic
r a or the sen ag til All roof coverings to be Class "B" or better '
i,
..., OFFICE .