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BUILDING DIVISION PERMIT
ICONTRACT,ORINF.ORMATI,ON
BUIL DING ADDRESS:
:Z20 RT_R1_TRNq
CAL -AIR INC
PERMIT NO 03070037
OWNER'S NAME:
1555 S 7TH ST #K
PERMIT ISSUE DATE
E`
(408) 283-2300
NO.
SANITARY CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB Mn
LICENSED CONTRACTOR'S DECLARATION
]b Description
I hereby affirm that l am licensed under provisions of Chapter 9 (commcncing
pQSCOP
wish Sec ion pip of Divlaion3of the Business and Pro(cs¢inna Cnde. end myliccnse i¢
in fulif anacf act.
Loren lase 6efae Lic.a� �f
Date GUmrac
REPLACE 2 A/C UNITS
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ARCHITLLTS OE RATION
I understand my plansshall M used as public ecolda
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'3
OCT O 1acd
LiecnProfessional -
OWNER -BUILDER DECLARATION
1 herehy, afire that that 1 am exempt from the Contractors License Law for the
following mann, tScef un 71131.5. Business and Professions Code: Any city or county
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which requires a Permit m cnnsomel, alter, improve, demolish, or repair any structure
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prior to its issuance, also Requires the applicant forsuch pcmiLto file a signed statement
that he is licensed pursuant tNe provisiovnfshe Commetios license Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Profusions Cost) or
that he Is exempt therefrom and the base for the alleged exemption. Any violation of
36902031.00
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to &civil Pcnally of
nal more Nan five hundred della. ($500). -
0 I, is; owner of the property, or my employees with wages as their sole compensation,
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— F wed $r
will do Ne work, and Ne ancone is not intended or offered for sale (Sec. 7044, Business
and Pro@ssimu Code: The Contractors Limas law Ares MI apply to an owner of
tFions
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property, who builds or improves thereon, and who does such work himself or trough his
301 - ROUGH PL BIN
own employees. provided that such improvements nee not Intended or offered for ale. If.
303 - ROUGH MECHANICAL
however. to building or improvement is sold witin one year of completion. the owner.
builder will have the burden of proving that he did not build or improve for puryox of
304 - ROUGH ELECTRICAL
talc.).
505 - FINAL ELECTRICAL
D1, as owner of to property, am exclusively contracting with licensed contractors to
construct to project (Sec. 7044, Business and Professions Code:) The Contractrs Li.
507 — FINAL PLUMBING
Cense law docs not appy to an owner or pmpeny who builds or improves lemon,and,
SOB — FINAL MECHANICAL
who contracts for such projects with a commetor s) licensed pursuant to to Contractors
Law.
Laempl
514 - FINAL PUBLIC WORKS
0 1 am under Sm. . B & P C fcr Nb meson
Owner Date
WORKER'S COMPENSATION DECLARATION
hereby affirm under penally of perjury one of Ne following slularnions:
W.
have and will maintain a CeniMam ofConsenuo self -insure for Workers Compcn.
anion, as provided for by Section 3700 of to labor Code. for de performance of tom
.,it for which this permit is issued.
0 1 have and will maintain Wolleri Compensation Insurance, as required by Section
37W of to labor Colo, forte performance of the work for which this permit is issued.
My Wmke s Co n,mosiion Inmranm cannot and Polity number
e cr: rt Policy N W %a/ (e
CERT FICATE OF E%EMPTION WORKERS'
COMPENSATION INSURANCE
(This Ycttn need not hccomplced if the Permit is for one hundred dollars (Slip)
_
nr Ics$.)
I wr ify that in the performance of the work for which this permit is issued. 10.11 not
employ any Person in any manner an a to Meomc subject o the Workers'Compensation
Laws of California. Dare
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Com pOnsalion provisions of the Ichor Code, you mus
fortwi th comply with such prnvisinns or this Permit hall M deemed invoked.
CONSTRUCTION LENDING AGENCY
I hereby alarm that them in construction lending agency bur the Performana of
the work for which this permit is issued (Scc. 3M7, Civ. C.)
Lenders Name
'
Lender's Address
I cenify that 1 have read tis application and auto that the above information is
come,. I agree to comply with all city and county on inuues and sou laws elating to
building consnction, and hereby authorim mi esema iw of this city to enter upon the
above-mentioned proper for inspection purposes.
(We) agree to ave, indcmni fy and keep humorless the City of Cupeslim against
Iiabilitics.judgments,cusu and upenses which may in any way accrue against said City
in consequence of the granting of this remit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date '
SOUR EGULATIONS,
Re -roofs
Type of Roof
goature, of Applic vector etc
A7ARDOUS MATERIALS DISCLOSURE
c
Will the applicant or future ildin6 meupam smrc orhandle hazardous manorial
az dented by the Cupenino Mu iry1 Cod Chafer 9.12. and the Heal@ and Safety
emle, sec den vsu(a)?
All roofs shall be inspected to any roofing material being Installed.
❑Yc¢ Nn
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant Or future building occupant use equipment ordcviets which
hurardous air contaminants cfined by the Bay Area Air Quality Management
all new materials for inspection.
Davin?
❑Yet a
Ihave mad requirements undor Chaapter 6.95 oftM Califon
nix HcalIhavSafetyNCea rtlueraNdnusam2a5e5d0alb
Nv iftM building
does not eunendy haw a erecta that it is my responsibility to noul'y the occupant of Ne
rewire h ¢Ix mnprimloiauamm.ticenifieseo N^„ ey.
Signature of Applicantk Date
All roof coverings to be Class "B" or better C l
vena ser autnrircJ aF Dae