01060119V Q,, 'I cans that 1 nave read Nis application and sorra that the shove information i.
(i.F corset: I,agree, to complyiwith all city and county ordinances and state laws relating
�crJ to building con.tticu JM1 by auth presconatives oftps cityt tar upon
the athrove-marrioned property, for inspectionpurposes,
F'-ty
(Wa) oPme t indemnify and keep Wrml-theCii, ofCoco .Inaimt
_N lidb fi j dg t t a pence which y in any 1 gain', said
U: CtY nconsequcn.e ftha ginning ofth .paint ,
APPLICANTUND8RSTAYDS'AND WILL COMPLY WITH ALL'NON-POINT
- - - SOURCE REGULATIONS:'"'
Silromeof ApplinWC.M.1mr. - -" •' ', Datc"
„L ',:,it, '• HAZARDOUS MATERIALS DISCLOSURE
- Will the applicant or foam building'«c.part store or handle hawdous material
as dcfitied by the Co,a,mmo Municipal Code, Chapter 9.13, and me Health and safety
Code Section 2553:11
!CI Yes' A I4I.iiN,°,t n
;Will the applicant or future Wilding «cupant.. equipment or devices which
emit brizak m, an commotion, as defined by the Bay Arca Air Qoallry Monapernoo
DiWirY.' . . .
No
,1 have read therhazsrdous materials requirements under Chapter fi 95 of [be
",he
,h Wd"does not cumntiv hve tit fdanu is my responsibility 1. a.. YI
«c -Pont
bit
h qua etc hhmu the tp'rml fp Cenil'cme of
O mer or authorized agent Data
C"p.0l
Issued by: ///-,- .. _ _ Date
r.
Re -roofs
Type of Roof.
All roofs shall be inspected prior to,any. roofing material being. installed. _
If a roof is installed without first obtaining an inspection;'1 agree to remove
_all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.,
Signature of Applicant _ Date
All roof coverings to be Class "B" or better
OFFICE.
x
I
Gl1Y VM CVYC;KIIINV
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
C
BUILDING ADDRESS I
PERMIT NO.
11013 SWEET OAK ST
RESIDENTIAL HEATING AND
/C IN01060119
OWNER'S NAME:
APPLICATION SUB DATE
KAY TOLOMEO
65 CRISTICH LN
06/20/2001
PHONE:
SANITARY NO. CONTROL NO.
k
4083774073
« Z
O
ARCHITECDENGINEER:
BUILDING PERMIT INFO
w
BLDG ELECT PLUMB MECH
ai
CJ I- t L_J CI
Z S H Z
LICENSED CONTRACTOR'S DECLARATION
Description -
O Z_
F„2�
I hereby firm that 1 am licensed under f Chapter 9 (commencingJob
y a provisions u p
with Section mad,foielsion3onneaoaineazand PmreazionaCode. and mynrente
INSTALL FURNACE/CONDENSER.
<:2<
is in lull (lace soil effect.
a a
`D u.
License Clazs Lic, g
a's L a rn
°' O
Date Contractor
ARCHITECT'S DECLARATION
FI N
S
1 understand my plain shall b< used as as publicrecordsALE
D
�r
va O
Licensed Professional
a. oPy
=
OWNER -BUILDER DECLARATION
O Q001
JUN Id
t�i
F ? <
I heathy reason. (Scr aha[ 11. eBusin form the Cosociv, od Lina tow for the
i Cave: Any city or roomy
followingaisonstr Business andmp
L
$500
E s O
to ve. de repair any structure
aper, improve, demolish,
Permit demolish.
which requires permit oe con
fi
,pr i issuance. t'he clpe tiu fl g dxaae nem
q th.os
_ _..
�L pbbI�l�epOr,�ye'h .,•
j.g)\': 32LS •1'U V6 {(;.'•i.''sy
Valllatioll
f
N thmrramn ithS II. mine Pau lin: Id C t mr. l' L'... Cour9
t
n ]IMP) (Divi. l fah a,dmo edf. k. ns Code)
g,mh.Sct
or
or hers bi thercfmin a the basis for Ne alleged exempnt to Any
- rOl1 ,(1„j;
I
1
Sec 31.5 rd l pennon
of not mo than tiv any hundred rs (S50 mit subjccu me applicant m a civil penalty
:or not mom man fine n°oared aamrs scoo).
301 APN� PLUMBIN
�)..., v, .t• OccupancyT e
YP
01, as owner of the p.,ny. or my employees with wages as thar sole compensm ion,
3 04 - ROUGH EL I VII( actions'
-will do the work, -and the Srmcture isnot intended or offered for sale ISec: ]Obt',-
Buain,, and Pmm,n..e Cale: The Contractor, License Law does not apply [o an
owner of property Who builds or improves thereon, and who does such work himself
505 - FINAL ELECTRICAL_
or through M1ls own employees. provided that corn improvements are hnotim intended or
' ofrer&1 rorgr. ut however. He nbildm .......' t is sore ',tanto one f
geWola°"`m`" "r°
-_ _.. _ _ .._ ... _ — . _ . ..
507 — FINAL PLUMBING '
completion, the ownerbuilder will have the burden of proving that he did not build or
I
improveforpomaaeer,faale.).
508 — FINAL MECHANICAL
-
— . b ----- ----_ �_- . _._ ._ ..
ar j: as owner of the P(Seeny, Ima with licensede to
— — — --- — — — — — -- — ---- — — — —.... -
-.
r
C.ncmts
Business and s
construct theow no (Sec. ]ted, Business and Professions Cale:) The
'
'. .-
does
License Law does not apply m an owner of improves
who builds or improves thereon.
thereon.
1- '_
apropertycontr
end whu.contrects forsuch.pmj«ts wire -o commcmrlsl licensed pursuam.t° the
J -- ----- -
Contractors License Law.
❑ I am exempt under Scc.''f :B'&PQfonhis ...,on
-
OwnDatc .. ,. ... L.
,t:'
WORKER'S COMPENSATION DECLARATION
'
- IM1caby ellitm under prosily of perjtiry'one oftne, following declarations:
0 1 have and will' maimtain"5Cenificaie 'or Consent to .velllu ubt for Worker's
-_
Compensation, as. Provided for -by Section 37W of -,ha Labor Code, for he
_
performance of thb work 1. (or which this permit is issued..
01 nave and will maintain Wairker'x Cumpen.mnon Insurance, as required by Sermon
- -
37oo of the labor Cale, for me, performance of the work for -which Nis permit is
-
isue
sd, My Wo ales C.ortansation Insurance carrier and Policy numner an:
5a.
Carrier: v' a .... i^:: Policy No.:
a s. -
i t 1;N i-.... I t.'.; •.{.e.�.: i.L..
CERTIFICATION OF, EXEMPTION FROM,WQRKERS''
-' I
:'+ s.. a
_COMPENSATIONINSURANCE „_,
IThu xetion need not be cbmpletcd trim permit is for one hundred dollars
($10(d or less.)
'ro
,', Isentry :tha in th Mrf anne,bf oto M1 h'[h -pc l su.
j, t ,' s ;I�11 •'
kers
shall not employ any person in troy mat us m berome ubjec� m Inc Workers
''
'
o pc . y Laws f Cal f a. Dam
Corr
APPI
NOTICE TO APPLICANT. W fico makingmis Cenifimte of Eseen,amr, you should
t”
subject m the Wmkcrs aimpcnsaimn pmvioors')fthe Labor Code, you must
Q Obecoine
forthwith comply with such provisions or this permit sun it be deemed revoked.
s ' CONSTRUCTION LENDING AGENCY
af
IT
agy'pt;^o
I hby that th ant t lending y farts perfontnce
or
_•uhinwhich rets potic slued (Sec JU9'/, Co.
tek
V Q,, 'I cans that 1 nave read Nis application and sorra that the shove information i.
(i.F corset: I,agree, to complyiwith all city and county ordinances and state laws relating
�crJ to building con.tticu JM1 by auth presconatives oftps cityt tar upon
the athrove-marrioned property, for inspectionpurposes,
F'-ty
(Wa) oPme t indemnify and keep Wrml-theCii, ofCoco .Inaimt
_N lidb fi j dg t t a pence which y in any 1 gain', said
U: CtY nconsequcn.e ftha ginning ofth .paint ,
APPLICANTUND8RSTAYDS'AND WILL COMPLY WITH ALL'NON-POINT
- - - SOURCE REGULATIONS:'"'
Silromeof ApplinWC.M.1mr. - -" •' ', Datc"
„L ',:,it, '• HAZARDOUS MATERIALS DISCLOSURE
- Will the applicant or foam building'«c.part store or handle hawdous material
as dcfitied by the Co,a,mmo Municipal Code, Chapter 9.13, and me Health and safety
Code Section 2553:11
!CI Yes' A I4I.iiN,°,t n
;Will the applicant or future Wilding «cupant.. equipment or devices which
emit brizak m, an commotion, as defined by the Bay Arca Air Qoallry Monapernoo
DiWirY.' . . .
No
,1 have read therhazsrdous materials requirements under Chapter fi 95 of [be
",he
,h Wd"does not cumntiv hve tit fdanu is my responsibility 1. a.. YI
«c -Pont
bit
h qua etc hhmu the tp'rml fp Cenil'cme of
O mer or authorized agent Data
C"p.0l
Issued by: ///-,- .. _ _ Date
r.
Re -roofs
Type of Roof.
All roofs shall be inspected prior to,any. roofing material being. installed. _
If a roof is installed without first obtaining an inspection;'1 agree to remove
_all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.,
Signature of Applicant _ Date
All roof coverings to be Class "B" or better
OFFICE.
x
I