02060180 ct B BUILDING
DONPERTPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11180 SANTA TERESA DR ATLAS HEATING 02060180
OWNER'S NAME: APPLICATION SUB DATE
SINNOTT ANN 155 SAN LAZARO AVE 06/26/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 739-0516
ARCHITECOENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z 5 H= I hereby affirm mat I nm licensed coder powi:inn,orChapmr 9 aommc«ing Job Description
F°—=t w with s«don moomr Dimismn 3 none ausmess ana PmRssipns code and my license ADD A/C
G Y y in full force nna eff I
a 0 w U License Ia Z'V I.it,M Z.� C
t�r 3 ou n Doc Comr«mr
ARCHITECT'S DECLA A'ION
F.
a O g I understand my plans shall Is,used ax public records
ap Licensed Professional
OWNER BUILDER DECLARATION
u�^_a. 1 hereby aRren mat I am exempt from One Compactor's License law for the
r=z a following mason.Section 7031.5.Business and Pmfersmns code:Any city or county $2500
-€O which requires a permit us construct,altar,improve,demolish,or repair any improve.
a,a. ce prior to r6 issuance.also requires the applicant for such pomeit to flea signed mmcmen -- - -
11i111ialirensprlpursupn(td the provisions of me Conuecmrs License Law(Chaptcr9 r ,}.�,3'5' 1 0 2p 8'FFary y a \, i Valuation
mdonbe iogwim S«tion10003orebasisor t the Bicki4mdlmi,Any
Cade) `.f t LLQ- t1Vj so ya:•x ,JL).
or that ion 7 exempt mc¢rrom'and the basis for the subjects
the applicant
in Any violation
of Section]Oi 65 by any applicant far a Permit subjcctn the npplicnm m a civil penalty
of not more than 9ve hundred dollars($500). 3 0 3 APN kTbeR MECHANIAL' Occupancy Type
°I.as owner of the proper,or my employees with wages as their sole compensation.
-will do'dar, rk:and the structure is not imended or mBcred for sale'Soc.'l0aa; - -- - - -' - --- --
Business and Professions Cola:The Contractor's license Law does nor apply to an - 505 — FINAL EL&QWBID([AgS ctions ' o '
owner of propcnY Who builds or improves thereon,and who does such work himself
on through ms own loo my«a. budded that such improvementsoma are not intended yaur or 508 — FINAL MECHANICAL
offered f ul' If h-w a tbe bu'Id n8 p e t IJ th Y v of
completion,the owner,builder will ham the burden f proving that he did not Wild orimprove
. r p W rsale.).1 owne of the P m sy ntr g with 1ee uJ ract ram
AL 7—
mens t o l t(Sec.7044.Business d m CW,) Convector
License W d t apply to pe h builds improves thereon,
and.who tracs f such projects with aApono(s) ca
E
Pursuant in mc_ :O
Coontars License Low. 90
°I am exempt under Sec " " ' BPe PC forthis as " 'i a'. C O
a"A .x
Owner' Date v `
- '- WORKER'S COMPENSATION DECLARATION
I hcreby affirm under penity mf perjury one or the following declarations:
O 1 have and will maintain a'Cei ificam of Consent to'self-insure for Worker's
Compensation, as provided for by Section 37W of the Labor Cade, for the
- performance of me work Tor,whi<h this permit is issueJ.
°1 have he will Code.ri Worker's Cum ance of t Insurance,es required by Seniors
. lith Labor IsCode,for me performance of me work for which this perms is
issue) My W ke's Co tau Ineum r and P hey nu Ger
Ctun Pcl y Nit. L /� �� t . . _ < — . — —_. -__.....,,.a,.. >.-.�.�.... .... ........___..._.....
I_
RTIFICATION OF EXEMPTION FROM WORKERS.' 1
' COMPENSATION INSURANCE.''.
a `(Thio seniors need not he completed if the permit is for one hundred dollars f' •' -- —! _-s
(511101 or Icas.)
1 ecmpl that in the performancenn me work for which this ct to a issued,I - -_-' ---_ I tc 1
,shall rim employ any person in any manner so as to become subject to me Workers'
Compcnmtion Lows M Calilbmia.Dam
Applicarnp
NOTICETOAPPLICANT:If.after Compeakingmh Ceniticam of Exemption .yshould
st •s •'
bcaomch comp y the Workers Compensation Amb ti vhs of the Warr Cede,you must
z 12 fon- -comply with such provisions or his permit shallad«med re.oked.
-Vi `I'' '''. -., 1,CONSTRUCTION LENDING AGENCY '
1 hereby affirm that men is a'conmrisction lending agency for the performance
mss' of the work for which Nis permit is issued(Sec.3090.Co,C.)
a'Q London's Namc-._ -. ._ ` . .• - _ - _ _ . .. . .. . .. ... .... ._ .._. ..
LD,z lend ABJrc; is _ ---
U O
1 certify that Ih read this applicationdstate muheh Information is
fa E. obun -1 greet ply heith b city int ry d red tare a enter
vioag
U toe la gc t d ah byxuthonu preti �a of this Crymrn¢r upon
ryj 'he'b mentionto p npenY for my and l P liposes. . -, _
We)agreesave indemnify and keep harmless the Qty nl'Cupenino against
-Vi City in a judgments amts ana expenses which may in any wuy,dc rve ugainat said
U'.� City in mnsequcnc the granting of Ihi,nick a w
APPCIfA.' " STANDSANDx'ILLCOMPLYN'IT AI .NO.'POINT Issuedby:
rat Date V��
SGD G Iaii , ZG �
sign orenfApp and cntmvmn'• gate Re-roofs
HAZARDOUS MAfpR,ALSD,SCLG,URk
w�li'me. prdamn,f.t.Wil4ing«cuM.,,..rrb.ndlcbaz rMousmaiefiaI Type.of Roof.—.-_ _'. _ '- -- -'---_ _ ... .. . . _ __. .
as Le edby',th Cupenind Municipal Crate.Chapter 9.12.and the Health and Safety ,
CrnIe.S 532(al"� I.�'ia ''. i•f 5. �; "�.( s.. •.;'Is. s•S�1 a >1�' '.' ..
❑Yea. '"; y'rCrr.,al:s . . .
-_All roofs sfiall be-inspected prior to any roofing,material being installed..
\\B m applicant n future No(ding c pant use equipment a ves which If a roof is installed without first obtaining an inspection, I agree to remove
emit h d - oro t. .defined by the Bay At•_e� Q ty Management
Dist m all new materials for inspection. A_ pplicant understands and will comply with
°'\ ' "^�'�' "all rion-point source regulations.
1 have read me hu�ayydous mmnnal rtq rt e is under Ch t' 695 of me
Cold He❑h Bsktd'[We,Sen airs 2550525533rd 2553) d t that -
ihhchuldin oesnot d dyham aterent,thit'tis mY r<spmoi d'tyton illy me no
up.nt b e
one
ems which mist be met prior to nes 1 a Cm c to of
Ov
m /��
2 e Signature of Applicant Date
n authorizedgen, Date All roof coverings to be Class `B" orbetter
OFFICE ..
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