01060024 CITY DGDFNO
BUILDING SIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10072 SENATE WY ASTRO HEATING & AIR GOND INCO1060024
OWNER'S NAME: APPLICATION SUB DATE
GEDDES, SHERRY 338 ROYAL AVE 06/05/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 268-8877
C of z ARCHITECT?:NGINEER: BUILDING PERMIT INFO
!00 BLDG ECT PLUMB CH
<=
�N= LICENSED CONTRACTOR'S DECLARATION lob Description
I herby uffon that I n 3Ilfilm B sin er provisions of Chapter...d(commencing
wish f,.il move of Division 3 of the Business and Pmfeusion>Code.wd my license
,Vlx ) REMOVE & REPLACE FURNACE,
s Liccns Lic.p
;O a Dom Comnnnr
lie � ARcsniscr'sDECLA ,rn, ADD AIR CONDITIONING.
4 1 understand my plans shall be used as public records
1 p Licenced Pmfessional
OWNER-BUILDER DECLARATION
r 6 1 hereby affirm that 1 am esenmpt Itom the Contractor's License Law lin the
I-z� following mason.(Sean..7030.Business"red Profusions Code:Any city or county
O which«quimx a permit m consmsa,altar,immve,demolish.or nepar anv struaum
of3;� prio t 't c Iwrequires- t applicant tt for such perm file. 'Ft d t mem• - - - - - --_ -
a. 'Eminfirlionowlillunsticuri L Law tcl pmr9 Sq-.Ft. FlArea .,• Valuation
komfon
mmnng with Secl]000)of Division 3 of the Bo mm,and Promfo ons Code) t ) 1 ', m Floor , 1
or that he iv eiempm therefrom and the basis for the alleged exemption.Any violadin $5970
-of Sevier 7031.5 by any applicant for a permit subjects the applicant to acivil penalty
of not more than five hurdled doEan(550 ). APN Number Occupancy Type
01,as owner of the pmlierr,or my employees wish wages as their sole compensation.
will do the work..and the structure is not Intended or offered for sale(SCQ]044.-
Business and Professions Code:The Contnaor s License Law does num apply to an Required Inspections '
owner ofpny,crtyWho builds ornnproses thereon,and who does such workhimself
203 -_ UNDERFLO.OR .MECHANICAL
or through his own employees.provided that such improvements arc not intended or
affcmd for sale.If,howevef,the buildingemin,is soldwithinone of
orurdena year, ,
ompletron,the owner-ndd<,will nage the harden affirming that he dm not(.tato or
303 — ROUGH MECHANICAL
impmve forpamnaeol sale) 503 FINAL MECHANICAL ENERGY
01.as owner of the property,am reclusively contracting with licensed contractors to 508 - FINAL MECHANICAL., '
amwa thp (S
Ill.project Ser.7044.Business and Profesemns Cade:)The Contractor's „
License Law does not apply loan movneroTrolaorly who brailds or improves thereon,
and who contracts for h p j t .witM1 t tor(s).licensed pursuant to the.
Contractor's License Law.
0 a pt order S t, _ s ,B&IsCfor this reason
Owner Date
- WORKERS COMPENSATION DECLARATION
` I hereby vRinn under penahy of perjury one of the following JMuations: /
❑ 1 have and will ;nsinmin.a Certificate of Con.sedt in self-insum for Worker's O /
�y. Compensation, as provided for by Section 3700 of the Labor Code, for the
perlomunce of the work fur which this p.if is issued.
❑1 have and will innomin Worker's Compemation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which his .it is
issued.My Worker's C pe olo m Insurer carrier and Policy rummer _ -
n� 'N -..
No
Camcr m r CERTIFICATION r
N OF,E% KION FROM WORKER -
COMIENSATONINSURANCE, .� ..-. . ... .._.. .... ..... ._ ._ .... .
(This" ctiommneed not b,cumpined if the permit is for one hundred dollars - t
IS 100)or less I
1 certify but'n tM1e performs rte of tM d f 1'cl this permit is I..0ed,I
shall not employ any person in any manner w as to become subject to the Workers
Compensation tows of California.Date
Applicant'.'
NOTICC TO APPLICANT.II,n0at making tai,.Cenilicam rel'Exempdnn,you should
become subject to the Worker s Compensation pmv stuns ur the LuWn CW..you must
Q O forthwith comply with such provisions or this Permit shall rte deemed revoked. _
Fyt CONSTRUCTION LENDING AGENCY
-' I Inbell,aflirnm then them is a smoracuor lending agency for the perfonou,¢
of the work for which this permit ii iisocd'(Sec.309],Cr,.C.)
Lender's Name— ..� .- . ._ ...... .... .. .
p" Lender's Address
UJO .,..,.s ...e .
1 certify by I have rcaIt this application and sine mom theodolite laws at inn is
k. F coned.1"gore to comply with all city and copntyprdinances and state Taws rdaing
Q V mlem1diollemr,roction,and hereby authorize representatives of this city to enter upon
the ahwe.mentione d property for inspection paryosea.,-_„cty of capcmiino ai2a
Fra-y (We)apo:<mnavc:mdemniryondke<nharmless to< ag
AIiabill nes, ad mos.costs and expenses which may in any way accrue"gaunt said
U'Z Cit sonscq mocem the grants (this,permit.
.^ A . 4 T \DERSTANDS 'I COMPLY WITH ALL 'ON� OINT Issued b Date
IC; r ) Y
_ S amreofApplican mracmr ate Re-roofs
H RDOU. MATERIALS DISCLOSURE ".
wul mea�Pra future Ailing occupant store or handle hummons material _.Type ofRas defined by the Cupen no Municipal Cotle,Chapter 9.12,an,]the Health and Safety ., . .
Cade.Scntoo 25532(;" s. - . . i s - ..
ore:"'; -' • '.,ono., p''" ' ^'''S'�rr"`. _,_A1Lr shall.beinspectedpdor.toanyroofing.ma[eriaLbeinginstalled._
'.Will the apereantorfuture building occupant use equipment ordevices which If a oof is installed without first obtaining an inspection, I agree to remove
emit naaamna.air comaminanu nk germed nr me say Ar<a arf]aahty Manag<nm<m
niatrmI . , � • . . all new materials for inspection. Applicant understands,and well comply with•'ores : ❑No" ...all
non-point source regulations.
P ndvureait he M1azatim,n,n,iiN mcnimm,ol,under Chapter 6.95 of the
Caliromia health&Safety Code.Sections 25505.25533 and 25534,1 understand that
if "Wilding does not I, my h`
or nam,thinotify g is my responsibility m nthe
ace am If requiremems whic a b<mei prim to issuance of a Certificate of
se a
�j — Signature of Applicant Date
wncrorauthorizeJage t D <ol All roof coverings to be Class "B" or better
OFFICE - ..