01090021 CtBUILDINGDov SIONO
SINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7540 MC CLELLAN RD A.T.C. SERVICE INC 01090021
OWNER'S NAME'. APPLICATION SUR DATE
LUCCHETTI JEANETTE E TRUSTEE 111 ORTEGA AVE 09/05/2001
PHONE: (650) 968-1100 SANITARYNO. CONTROL NO.
Q mzARCHITECTBINGINEER; BUILDING PERMIT INFO
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BLDG ELECT PLUMB w5j
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S N z LICENSED CONTRACTOR DECLARATION Job Description
1 hereby v1Emt that 1 am licensed under Provisions or..Code9lmmmenense
with fallSection
rce and efect. on3 of the Business and Pmfcesions Cade and mylinnu MAIN WATER SERVICE.
in full fore,and ellen.
s a Date Class Lic.p
0 c Uo¢ SCounalmor
DELLA
I3 u v ARCHITECT'S DECLARATION
0� I umlcrsmnJ my plans shall be used as Public rt<oNs
I i O O Licensed From seinnal
z thatIa exempt from the RNI Contractor
,Ii o u 1 booby,(hero that 1 am.aloe.,from the Cession, o :A.,s Law fur the
F Z n following rtaon.(Section 703L5.Bmin¢s andov,dinndi Cade:Any lay .county $3000
= tion.i¢issmnee,also requiresw<,.(trot,improve,demolish,or repan any swmurc
which q pc n c ns
pSit PPlmnm fonuch crout to fild a signed statement. - - - - - - - - - -- --
�y,,�J pip ... ... -..
drn he 1 Ip .0 n N Po . ns nrlhe Conv.mnra L' 1 ... ode) 1s.' 1`35�11rl A k3Dr VVa . + i -"'y . Valuation
or that
cngwltn Seco from anofDvsonot thealeedes ndion.An violation
(, ) a _ ,• ,
or Shot he is exempt thelcfrpli and the beefs los the allege)euemptioto Any l Semon
-of Section 703 n v any dr d doll far v 500). subjects the applicant m o civil pewit,'
'arm.tmaretnanBven.ndrcaa.naa(asom' 106APN §ElBER & WATERI Occupancy Type
❑1,as owner of the property,or my emplo)ees is ith wages us their sale compensation.
willuine the wart:, ssi the ode:structure C not inmim2d eaeLaTor:me apply 1.an 301 - ROUGH PIR�eQIBrIti Gspeetions '
d as and work.
and th Coal:The is n t intens ed or offered Law dor no,(Spry to 4.
.watt of property Who builds or improves Sh,rcon.and who does such work himself 302 - TUB & OR SHOWER
.r tnr.ugh his.,on empinyces.provided that.such improve noels are nal intended or
-Nfeiea far sale.If however,the building or int eel Is.cold within one f - _ l - � - -
pm°<m >°ldo 502 - FINAL PLUMBING ENERGY' •�� '
�oprevtion,dm owner-Walmer will hoer She burden of proving SM1a he did not buil)or
mprav,mrp^rpa.<ar _. 506 - GAS TEST
I tnmprpey I�:Bro-contracting a tractor:t. 507 FINAL PLUMBING
_ I m p oleo is nNd Business
P t m Come:)Th Commemr's
License Law does not apply t.an owner of property who heilds or improves thereon,
i and.who. t so for much projms with a comwcmds)licensed pursuant to the ._ _.. _.. . . __.. . .- _ - .. ... . ..
Co r' Liccna W`. . „
- s rp and t .B is PC form"mason
arc
woe ONKER'S COMPENSATIO ECLARATION
IhercbY vlBrm under penalty of perm one.(,he following Je,laretions: �k
' ❑ 1 have and will maim(.. a Cendwae of Cdnsent to sel6lnwra for Workers f
;k,; Compensation, av provided for by Section 3900 .f the Labor Code, for the /
performance of the work for which this drounit is issued.,
- ❑I have and will maintain Worker's Compenmiion Insurance,as minimal by Section /
3700 of the Lubar Code,for the,performance of Sm work for whmh this permit Is
issued 0.M Wader's Com lion'Insurance carrier and Policy number arc: „
y pens, w_
r....r .... - .. .,-. . .. . . . . ... r .. ..
rI •.1�1'Polcy No.: is.. }...• .. i J '. . , 1 . .
CERTIFICATION OF EXEMPTION FROM WORKERS' •• s ' "
t COMPENSATION INSURANCE' -_: ,
.v,.. .,_._...... _ -,.�_ ,.... --., ._ ,.._._.. -. . .... ... ....... .... . ..._... .. .._
+t (This ses.S nn need not be c mpleted if the p.it is for one hundred dollen
IS LOB)or less.)
.. . , t - _ _ . yo-yo. ....... .. ........ ..... -.. ._ . ... ... .. _ __.� .
p ,1 stiff,thin in the pe,nimmence of the wad for which this permit is Issued,I ,
eliall not employ tiny person In any manner sora to become subject m the Workers
Compensation Laws of Calirornia.Dam
Applicant
NOTICE TO APPLICANT.If,afar making this Cenibcare of Exemption,you should
Q
necome subject m the Workers Compensation provisions of the Labor Cute.you most
Ofnnitwitb'v ly whhsueh r u,mictsnr thin perms, Ion be deemed revoked. '
.. ...- . - _ ..- . . . _.
F 'CONSTRUCTION LENDING AGENCY'.'
> I hereby(Rum Shan icrFis q edestmaion lade ing sgemry for the perfom once
�.> time ismsfwhichth pe 'Ss issued'IS< 3T7,Civ.C)
._. .. .. .. . .. .. - ..
0..0Lender's N - ......
U'Z Lenders AdJrest'
t ..
U' I certify @a l have uad Shis applicaion and stem thvt Shc above information ix
Gomco.I agree to comply with all city mid counpgrdinances and state laws relating
Q.0 to building constmel ion,andhemby omhoriie representatives of this city to enter upon
W the above-mentioned property for inspection purposes.,
0. W gree to save.indemnify and keep harmless the Cryof Cupcnino against
ro HisBitl judgments,case.and expenses which may in any way accrue against said
U.Z Ch c D gmn
nuqucnor ling of this L CO _ -"
r A IC NTL'CE ANDS A, WILL COMPLY WITH ALL 'ON-P INT' -"
S ,Rc,11'GL. ONS. • , S- sued by:--•— Date
m'of plea isComruabr Date '. Re-roofs
am
- HAZARDOUS MATERIALS DISCLOSURE
''r.Wil the applicant or future building occupant mom or handle nvrallous material Type of Ro -
- us defined by the Cmdminn Municipal Code.,Chapter 9.12,and She Health and Safety
Code,Section 25532(x) . .:''t. [I :..,• •..,f 5 .. I
'.
_.All ofs sliall.be inspected prior.to.anyroofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree'to remove
emit lbsurdous air c.nmmm an,as defmcd by the Be,Area An Quality Mmm"nocul
Dlatiien _ all new materials for inspection. Applicant understands and will comply,with
r - -.Yes , ;r.ol:o� ;,', all non-point source regulations.
. 1'have read he hamrdom materials mquitcmm,s under Chapter 6.95 of She
CAIlfllmlb Health&Smfey Code Scai.ns 25505.8533 and 255an.I undetsmnd tha
'irthebo' in"g docs not core,ytly have uter,im;that hismyre...mibilhy ruchaythe
oceuf t r tit require ms lvhich must he met prior to issuance of a CeniGeate of
° a r Signature of Applicant Date
- 9-3 -a.�
r.,a ,mLw(gem Dam Al] roof coverings to be Class "B"or better
;^ rr . , CE
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.._ .. .. _ OFFICE