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CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
20366 TOWN CENTER LN
J & J AIR CONDITIONING
01100071
OWNER'S NAME:
APPLICATION SUB DATE
HUNTER PROPERTIES
1280 N 10TH ST
10/10/2001
PHONE:
SANITARY NO. CONTROL NO.
(408)920-0662
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MFAH
uuuZZZG
C� C:--] I -J L7
Z LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm thin 1 oro licensed under provisions of Chapter 9 (commencing
wwithgection]Ltl0)afDivisionJuhheBueinessnngmles'onsCode-an� Ranine
REPLACE A/C UNITS
io full forceand effrc 2� Jf D
Ub
Lisen CI Lic.is
Date .` Cantmamr
Fn
ARCHITECT DELLA A
5 1 uboentaM mY plans sM1.11 be used as public records
Olicensed Professional
OWNER -BUILDER DECLARATION
I hcrcby aRrm that 1 nm exempt from the C"mructor's License Law fusion
< following mi mn. (Section 7031.5, Business and Professions Code: Any city or county
improve, demolish,
$14500
D which mquims a permit to conswa, alma or repair any structure
ch pnku, fle.,igdm
$ ,priwm ibau quites theelicint forsumtm smnent•
isaece, alsortpp
__ _. _._. .._..._ _ __ __ _____ __.__-____ _ _- ___ _
- tliatM'ii,IiceircidpuisuinimtheprovixiomoftheC.nuxmrsLianulaw(Chepta9
(commencing with Section ]OIX)) orf Division J of the Bufineu aM Profe(s' m Code)
.S➢ -F� F C [C ar•p ,--r ` Valuation
; Q ss .T 3 D a .�V r.., i.1.T ! k). �
or that he is eximpt therefrom'and the basis for the alleged uemptiod. Any violation
6��'4 0 i
of Section 701t5 by any applicant for. permit subjects the applicant to a civil penalty
'"r not more than five hundred dmlars(sew).
r Occupancy Type
301APN (JUGH PLUMBINO
❑Las owner oRM pmpcny, or my employtts with wages ss their sok compsmado .
-.will do the work. and the structure is not intended or offered for We (See. 76 .
Business arM Professions Code: The Contractors License law does trot apply m an
YWl Ctions
s or improves ereon, and who does such work himself
peny Wildth
r of pmbo W
ofthrough, his own employ�.wnvidedtnasuch inaPow,mant,are nor intended or-
304 - ROUGH ELIff&"
50.1 - .FINAL ELECTRICAL
;"Hand for sale. If, however, the Wilding or improvement is sold within mm year of
ompletion. the owner -Wilder will have the Widen orpiuving that he did an, build.,
.
502 - FINAL PLUMBING ENERGY
improve ter purp,w fcola.).
503 — FINAL MECHANICAL _ENERGY_
oi:a"wneroithe"ope,y.�eadai y..ctmgwithrcnxde.tamt.'
505 — FINAL ELECTRICAL G°
Lm—ct the project (Sec 7W, Business and Professions Cade:) The Contractor's
icense Law does misapply to an "caner., property who Winds m improves thereon,5
0 7 - FINAL PLUMBING
cunhreat licensed purat. the.
and who conmutsfor shell forcer, with a vcmm
_
508 - FINAL MECHANICAL:
Contractorau«nseLms it t„
❑ Lem exempt under Sec,' Bk PC for this mason
:^I' •k `•'. l,' G91
Own l u. •
;.in
- WORKER'S COMPENSATION DECLARATION
I hcrcby affirm under pephy.f perjury one of the rollowing declarations:
kP 1 have and will maintain a Certificate of Cmelou'ia self -inane for Worker's
FINALED
Compensation, as p ... ided for by Section 37W of the Labor Code. for the
rerfer.pntt.f the work for which this lxmm is ill.,
❑ I hove and win--m.mtain worse, s c.mpenaa6.n in.gr;nte, a� repaired lar sec6.^
0 C T 2 3 2001
3700 ., the labbor/emd e, for due, putlormaaca of thin/n a o rk for wpbien ora pa;It„is
und ec\D
zp�
CamsVM9 '[.StT_s.�Jil-? ,Poorl'cy No. /`�7 r-' z.
'7 3�/z[� •o O it
I F,E%EMPr10NFAO .WORILptS'I,
'
10"02;
:_t T� ,.l •x'_BUIL'DING
Ii ....:,. COMPS
'ilf the patron is for one huiMred dollars
TIT i orCBt � need rad h completed
_........ .-_........... ._ .. - _.... __.
- I certify, Rotor the Pafi eia of the work fro which thin recent is Issued. 1
shelf not employ any person inlay manner m as m become subject to the Workers'
,
Camp ensmion Lown of CLifomin. Dee
j
Applicant
I NOTICETOAPPLICANT: IL after making this Certificate of Exemption, y.us
I '
brcome subject td the Workers Cmu'rw tion provisions of the Labor Code, you must
forthwith comply with such pmvisione or this permit shall h deemed revoked.
CONS7RUCIIONLENDINGAGENCV t
I hereby M. tram thcie iso couswnioti lending agency for the perfmmanm
,
t
Lf the rood for which this permit is issued (S«. 3097, civ. CJ ]
.. _ f ... .. _ _.
Le d r Name'
� hence Address'
1 certify that I have reed this application and state that the aWve information is
'
cannot: l agsa to comply with if city said county, ordinances and state laws relating
i to Wilding c.nemeu.n. hereby aulorize'apremnuuves of this city to enter upon
g! the above-mentioned y for in tion purposes.,,
1v (Wc)eirec to v indent` d harmless the City of CLpertln. against
n liabilities judgment , cab end us nth may in any way accrue opsins said
City in mesond- o the em ,n .ftlye it. -
APPL'AMU'a STANS Dy7 LCOMPLYWITH AI.0 NON-PoINT
Issued by: Dale
y'
S f . REGI TIONS
u .air ra .actor: -. - -1, ”' ;• . Dau '.
RDOUS ATERIALS DISCLOSURE
'.a
Re -roofs .
`(
licr r. Ring pantsmeornaml heaardii.meterial
wnme Igto
_Type of Roof _ - -_`•^
urge Code Chapt 913.tnand thnBeall and Safety
asdaSedbyshetion
y t by,
i. (.' { ( ti- a,
t ,read
'
❑ Yes . ON. ti.y'
shall be inspected.prior.to any.toofing.material being, installed._. _
' Will the applicant or future Wilding orearent use equipment or device:which
__.All.roofs
If a roof is mi[s]led Without first obtaining an inspection'; 'I'agfee'to"remove
emit hvallous air conteninemb as def red by the Be, Ates Air Quaiity Management
Districre
all new materials for inspection.. Applicant understands and will comply with
❑Yeas QNo t j
all non -point source regulations'..
s
',I he!'rtad'th a one ma 'requirements under chanes 6.95 of the
_ �•,
t
Califomia '12th&. fie i s 5, 35533 and 8536:1 understand the
if the Wil Ing docs t mmesa : the it is my responsibility to notify the
fire menmei prier to issm fin of .a Certificate of
3�.tist
Signature of Applicant Date
All roof coverings to be Class "B" or better
O.W, dl!V,,f Data
an r
OFFICE