00110092 CITYBIOFNGUP"RONNO PERMIT CONTRACTOR INFORMATION:
BUILDINGAD) 949 PERMIT'N0.
cl��b' SHELLY DR PHOENIX HEAT AND AI 0a].] 0092
OWNVIVS NAME APPLICAI'IO2,� DP
PHILIP NGUYEN 1.725 RODGERS AVE /2
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PHONIi: (408)487-0390 SANITARY NO. CONTROL NO.
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u100 ARCH]I'ECTIENGIh'IiliR; BUILDING PERMIT INFO
HI.OG HLECF PLUMB MECH
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LICENSED CONI'RACI OR'S DECLARATION
'o S 4 1 hereby animl mut I:nn Ranw,l under p,oss000s or cnap,er 9(eommenaing Job Description
p_�- ,vin,see;...7000)„foicia„n3nnhenu.iac.,,ad Isfe.ann,Code,radio,Icen.e FURNACE CHANGE OUT 1007 000 B'fU
�V ,,in lilnhave and mreCt 6BIf,l4
License Class CYC_ Lic.0
o u Dam I/ous!at con,mc0r
ou ARCHITECr'S DECLARATION
j
C'a—' = I un,ol,, J n ..yrATc n.v.J a>Public mcuN>
ce p O LlccitvaJ Prolcs.ianW
c OWNER-H cane, Lo DECe Conno(nN
1 reason.
.(Sect that 1 am eBusin from,he Gonion ,'s License Law fur the /
F[< .1hichingmmol.(Snoio, 71UL5,Baine„and
vvvfderion,Cao: of city lir county
€o uM1ich y pe 1, c It p J I'.h p Y., Dort v
C priors , I. l dapplicantil 11 0 flsigned.n,men,
�5-a ,bun l l Is]-saiLat aI th,IF I Ill,( , 'I :License I lCh-ptnr9
F,on nencng wm section 700())(it DiM,o,n 3 of be lwsn—andlnles.,rte Co,ml Sy. FL Flool'Area Valuetio I.
ouhat he i,cxcmp therefrom and be basis fnnhe alleged exemption.Any violation
of Seduto 7031.5 by any applicant ba.permit,object,the applicantto a civil penalty
of nm more man live hundred dollars($300). Ap,NN9u "N'2 J^ as Occupancy Type
❑1.a,owneroi the Pn,pn,y.mnry miy,loymn w llh wugcv nv heir suite,.... aalo;n, 5 711LI
will Jo the work,and o dm sI...a is bat talented m ol'l,mo fur rale Nev.Vaal, '1
Nnvinc,s and Professions Code The Coatracwr's Licenw Law dcvs not apply m an -`a 1 — ROU&P n17C�11.SUCC ISUis
r of pmpeny W ho build,or inpmvcs thereon,and x'ho Jaes such work himrelf J & F rL ITL R L Nb
orthrough his own emN„yce,.provided that such improvements are nn intended o, l? — ROUGH MECHANICAL
offered or sale.IL howevef,the building or improvcmeat is sold within one year of 303
im,t let.....heowncaboilaer std nave he bnrdenof proving that head!not build a' - 3a4 — ROUGH ELECTRICAL
prove lot po,o,c ol's;dc.>,
01.aaownoofheproperr,amemit,ioelycomment,withlicensedcontracmtao 505 — FINAL ELECTRICAL
onstme the project Nov.7044,Ho,mess and Pnle,sion,Codc:)'Mc Contractor, 5a7 — FINAL PLUMPING
License Law does not amm
,ly to an owner dpropeny who builds or ,powes thereon.
andwho contracts far such projects will,a wntoloor(., licensed pu uan,m thu sae — F I IRI_ IhF_CHRN S CAL
Coamai'a,Liam..Law.
❑I ant exerup,under Sec. ,B&F C lar his nv,un
Owner Dale '
WORKIiR'S COMI9INSATION DECLARATION
I woeby ulTl'nn;nJ0'poral y of Isar eery ono of lou following Ldunllanv'.
• O 1 base and will nall rin a CcniHcam of Consent ,,self-insure fur Worker',
Coml,emminn, a, provided for ny section SIl00) of the Latin Qac, for the
pclinmmnec of the work lin which this purmil is issued.
❑1 have and will mulnmill Wo6,C,Cbn.pvisa, 1.houran,c,a,regained by Scoiol;
3700 of,he lalx,r Code,fm the parkarmm�ce of the work for which Ibis ron,Is
sued.My W'orkIer's Compensatio
//n Insurance carrier and Polio her are: 1
r:— CaR tillL#,Nl'1�policy
No Ik Vc �RSO�
COMPENSNOON INSURANCE
(This.section need not he completed if the Wont is for one hundred dollar,
(51(1 or les,.)
I acrody thud in he pedom,anec of the work far which this permi,is issued.I
,lull mot c;npiny any p„ any a tie ,,ha
e ,Ioo sabjm,lo doe Worr.
ke '
Campensunon law,of Culiiu.Dom l
Applicant
N01 ICI: AI'I•LICANI:It.after making this Cenilicate of Exonp,ion.You should
Memnc subject to the W'orker's Camperoation pmvisinns of he Labor Code,you must
Q O forthwih comply will such provision or this permi,shall he deenmd revoker. -
CONSFRUCI'ION LENDING AG12NCY
I hereby notion that them is a convection lending'91ne)'for dle performance .
,if he work for which his permit is issued Iyer.3007.Co.C.)
❑ Lender:Name
7 z Leveler's Addocs,
V Q 1 ondy,ho I have n-ad his applicalion and,00v that the alaw,ial'ormoiuin Is
;. P emcn.1 agmc In v ods with Lill city and aunty ordinances Lind sane laws Nlaling
Q V to building can.amedon,and hereby authorize reprexinmives of this city to enter upon
the aMwe-mentioned property for inpeetion parpwes.
Eos M. (We)'give in savq indemni I and keep harmloa,the City,)]Ca,do a agai list
Vl F"hili;ien,ludgm,al..cons and espanms which Lary in any stay accrue again'said
U 7 CII Punnil. , 1
J SOURCER000LATIONRr'nation,ollhis \�\`•—I,
AI'1•L.ICANT UNUHRSTANDSAN W�OMPLY WITH ALL NON-POINT Issued by: Dale
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signmum fApplic'nVenn¢oFilm mc Re-roofs
HAZARDOUS MAniRIALS DISCLOSURE
W.11acv:,pie„n or let..lmdding aecalaml 11111c or hanna lnv„nloas onwehh "type of Roof
o dcrned by the Ct Noin,Municipal Coale.Chapmr 9.12.an!he Deahh and Smey
Cole,Section 25532(a)^
❑Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will he appli l to,mnln•I"Iilding occupant use ca influent or Jcvice.when If a roof is installed without first obtaining an inspection, I agree to remove
can lljaoloa,air c....U halls as defined by the IFy Alen Air QuAlty Manngc;neuil
Dis,rie,7 all new materials for inspection. Applicant understands and will comply with
0 yr, 0N all non-point source regulations.
1 have read the haazNnu,mmerials reyuirenums under Chapter 6,95 of the
Cul ilomia Heahh&Safoy Cale,Sections 255115.25533 and 25534 I under.land the(
if he Is dla,docamotclinical,hweaImmo,nal,i,is any c"onvlhiiry,o nallt'y lie
occupant of,he ri ui¢mem, bwhy� be mm prior to i,auunee nil'a Cenihnnu or
(kcupancy.
//�/f 00 Signature of Applicant Date
ownem:amonacdngenl >ate All roof coverings to be Class "B"or better
OFFICE