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CITYBUILDING DIIVIISSIIONNOPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT N0,
21286 RUMFORD DR
ATLAS HEATING
01100054
OWNER'S NAME:
APPLICATION SUB DATE
J K KIM
155 SAN LAZARO AVE
10/09/2001
PHONE:
SANITARY NO. CONTROL NO.
(408)739-0516
ARCHIfEC"F/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ LJ C LJ
LICENSED CONTRACTOR'S DECLARATIONJob
Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 700B)of Division 3 ofthe Business and Professions ofga�dAy license
-in full force and a It
License U� V/
��ttaaII Lic. p
REPLACE FURNACE & ADD CONDITIONER.
Dam _N„[, Comanor
RCHITEDE AT[
used
1 understand bo nd my plans shall d as public ¢cobs
,
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affnn that 1 tees exempt from the Conuucmr's License Law fur the
following reason. (Section 7031.5. Business and professions Code: Any city or cowry
3a� $6000
which q permit iconstruct, Iter, improve demolish, or repair any structure
.phi. s 't Iso req ues Ne applicant forsoch permits. Gba ngsmd stammeno
thin h ': liven,ed pmunint tothe provisions of the Convectors License law (ChaLner 9
Section 7000) of Viviano 3 of the Business Frufeass.ns Code)
tt �(` �.a �ar� pfg t f
f.. !•e �, .i 1329641;d,_1, 5,Ab6a3, 1AT j(1.."
Valuation
'
(commencing ,ith am
or that he is accent thcrefmm .rad the basis for the alleged lemydmi, Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty
'of am mom than eve handled dollars (s51)o).
3 01APN hMr S$ PLUMB IN
j•' Occupancy Type
❑ 1, res owner of the proper& or my employees with wages as their sole compstamaon,
will do the work, and the sracture is not intended or offered for sale (Sec. 7044,
Businei. shad Pmlbsstons Code: The Contractor's Liceme law docs not apply m o
304 — ROUGH E lB9G1fI R(1 UA,etions
owner of pmpcny Who builds or improves thereon, and who does such work himself
501 — FINAL ELECTRICAL ENERGY
or through his own employees. provided that such improvements are not intended or
ousted for sale. If, however, he wilding m improvement is said within one year of
_
502 — FINAL PLUMBING ENERGY
completion, the Cd' will brave the burden i f proving that he did not build or
impmvefno(ba
503 - FINAL MECHANICAL ENERGY
dl.mownerofineproperay. am carload klycontracting with licensed contractors to
504 — FINAL BUILDING ENERGY
criminal, the amject (see.'MaK Bull ... and Prafessimu. Cada:) The ConI.Wa
505 FINAL ELECTRICAL
Lice ase law does not apply m an owner of property who builds or improves thereon,
—
and who contracts for such projects with a contractoos) ucenred pursuant to the
507 — FINAL PLUMBING
Contractor's License Law.
❑lam somas older Sec. .B& P C for this reawa
508 — FINAL MECHANICAL—
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aRnn under penalty of perjury one of she following declaations:
❑ 1 have and will maintain • Cernficam of Conant m selLinnum fm W.ker's
Compensation, as provided for by Section 37W of the Labor Code, for the
perfmmwee of the wart for which this "t is Issued.
❑ 1 have and will mainain Worker's Compensation Insurance, as required by Section
3700 of the labor Code, for the pcdo... of she work fm which this permit is
issued. MY Worker's rap nwtlon Imumnce cnrtier and Policy num
'47
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Csrier: + folicY No..s
-
`� s...t r� _^ift s
1'v "•!�; 41.{J..
1 CRTIFl ATION O'= E%EMOM R ERS'f
-.^'t .'i
__. COMPENgAT10N INSURANCE :'
.. _...__..__ ...__. .._. __ '_- _—_-_.,. ,I
(This radian hood sol bo cosnplesed ifthe permit is for one hundred dollar
n \ •'1: j`.m,: s
($I W),, IstssJ
1 certify that in the peAommnce of the work for which this permit is issued, 1
shall'mn employ any person in any manner so as to become subject to she Workem'
Compensation laws of California. Date
Applicant
-
NOTICE TO APPLICANT: If. after making this CeniOcam of Esempti.n. your should
Isecome subject o the Worker's Compensation provisions of the Labor Code. you must
faMwi h comply with such provisions or this permit shall be deemed revoked.
' CONSTRUCTION LENDING AGENCY '
I hereby mfrm this there is lending agency.C.)for the performance
'
s Maned scan
of the wink for which this peimii is issued (Sec. 3097. Civ. CJ
1
Lender's Name -
-
Lender'sAddress
} tips a
1 certify that 1 have read this application and slam that the above information is
correct. I agree to comply with all city end county ordinances and stem laws Plating
m wilding construction, and hereby authorize representatives of this city to enter upon
the aboveaneauoned property for m.pectma purposes.
(We) agree to save: indemnify and keep harmless the City of Capistrano against
liabilities, judgments, costs and caftan which may is any way accrue a ainsI said
City in rouse f the gmntin6 of.x permit.
.I_LCOMPL WITHJ", "P
Issued by: Date
SOURC I,NDERSTANDSAN1)
alsi 1 11
Signet o pp icenVComrunm - Dam
- HAZARDOU M TERIAfS DISCLOSURE
Re -roofs
'Will the applicant or fmu boil ng occupant stow or handle h us material
C
Type Of Roof - -
asdefnedbytheCoastline.Mun Ipel oda Chapter9.12,and da Health aM Safety
Code. S❑ecY 15532(.)' •..Otho. .. ., t.I,.jn
. _ All roofs shall be inspected prior to any.roofing material being. installed. _
Will the applicant or future Wilding occupra use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hazadoY, air conamintu ts as dstfned by the Bay Area Air Quality Managenmm
District'
all new materials for inspection. Applicant understands and will comply with
❑Ycs ❑No
all non -point source regulations.,_
ITrve mad the haaad.us materiels requirements under Chapter fi 95 of Ne
California He61th & Safety Code. Sections 25505, 25533 and 25534..1 understand that
if the building docs not currently in atshrou'harlonnyho"woi', blliy"na-dfythe
a perm n the requirements whi must be and prior to issuancea Ce tif""ca a of
isiA
Signature of Applicant Date
All roof coverings to be Class "B" or better
ow a. gent D c
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OFFICE -