02020116c�
_ OFFICE-
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CI OF TINO
CONTRACTOR INFORMATION:
BUILDING DIIVL'ISI ONPERMIT
BUILDNG ADDRESS:
PERMIT NO.
22204 VIA CAMINO CT
AAA FURNACE & AIR CONDITIONING 02020116
OWNER'S NAME:
APPLICATION SUB DATE
SCHWARTZ ROBERTA B AND MARTID
1712 STONE AVE 02/28/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)293-4717
ARCHITECLENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MF.CH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby affirm that i am licensed under provisions of Chapter 9 (enmmencing
with Section 7") of Division 3ofthcBusonessandProfession, Coda,endmylicense
CHANGE FURNACE 12000OBTU &
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iamronrnmean
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ADD A/C 600002TU
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License C a s
Dae _ fLL COmmnor
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ARCHITECT'S OECLAR N
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I understand my Plans shall M1e used as Public records
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Licensed Poofnsional
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OWNER BUILDER DECLARATION
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I hereby of Tin that 1 am exempt from the Contractor's License Law for the
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following mason. (Section 7031.5, Business and Professions Code: Any city or county
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which requires a Permit to conamet. alter, Impror<, demolish, or repo. any suumae
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-prat t c, also q N forC nammem,
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o lonm,Li,,r
Nath 1 icdpurs Moth provisions thftheBuIm 1 LewChapter 9on,Code)
'th Section,o7001) fDivision lat Tia Professions
, �Sq.-,Ft, anation
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latle)
Icon be rnan ealigelled . Any violation
of that he is exempt they mail the boas for the cts the ek
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licam 11
- of Senior 703 1.5 by any opPlicam far a permit subjects the applicant m a civil penalty
ppli
umber
Occupancy Type
;of not more than five hundred dollarsS500).A
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❑ 1. as Owner °f Ne property, or my employees win wa,r, as their sulc comPcnfation.
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3 03 — ROUGH Mg-C14AR tICREptionsb
'will d° the work: and the structom is not intended or offered for sale (See 70s4.
' Busness'and Profession. Code: Tire Contractors License Law does not apply In an
owner of 5 property Who builds or improves thermn, and who docs such work himself
th...foIf bnoono intn>� o�
m,m,�eiourn, ms
.__.... --- 3.04 .-. ROUGH . ELECTRICAL ------- --
or If, noplinyear.rp nwieidshatisuch
sold tnortr
505 - FINAL ELECTRICAL '
Ne owner.mdwer Win have he rumen ser that he did not build or
Tip a ion, Proving
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mproveforputpr".1'sale.).
507 — FINAL PLUMBING
contractors to508-
❑Luowner ofthe propcny,am eaclusivelycoProfeinionsCoe:)
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- FINAL MECHANICAL '
Th
nnatmet the eat (Sec. 7044. Rusmess and Prorea,n,n. Cone:) The enmtmnora
project
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law does not apply to an owner of Property who builds improves thereon.
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arta who conkers for.projecr.s wiN n commnor(s) licensed pursuant Tess Ne.
and 1
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Comrutors License Low.
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Case exempt under Sec. .R1&PCfor this rtawn
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Owner Door
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WORKER'S COMPENSATION DECLARATION
-' 1 hereby affirm under Penalty of perjury one of the following declarations
❑ 1 have andmi, will maintain Certificate of a se for worker's
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Labor
hoc by Section 3]00 of the Labor COdc, for the
Compensation, provided f 37M O
v
For
performance of 0e wort for which his permit is issued.
he
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O 1 have and will maintain Worker's Compensation Insurance, as required by Section
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37(gl of the Labor Code, for the rernormmce N the work for which this Permit is
issued. My Worker's Compcoution Insurance carrier and Policy number are:
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Cerrnet� f�T i'I IF,-bi
XEM
P. `....` 1 i) t.. :.
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.CERT I IONOFEKEMPTIS OM QRKERS'('
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' COMPENSATION INSURANCE: ". ' °
(This section need not be completed if the permit is for one hundred dollars
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($I00) or InuJ
I certify, that in the performance of the work for which this Permit is issued, 1
shall not employ any person in any manner so as to become .subject io the Workers'
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Cmmpcy.mdnn Laws of California. Date
Applicant. .. ... ... :. ..
.- .. ..,_ .. _.. ... _ .. ..
NOTICE TO APPLICANT:If. after making this Ce orhour of Eaemptioo, you should
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btemon subject m the Worker's Compensmion provisions of the Labor Code, you mutt
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forthwith Comply with such provisions or this Permit shall be dimmed revoked.
yCONSTRUCTION
LENDING AGENCY
1 t erebyM. that there is a constmctinn lending agency for the performance
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of the work for which this permit is issued (Sec. 3097, Civ. C.)
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Lender's Name.. .. __....... „ .
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L<nBer'a'Address
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1 moony that I have read Nlz application and stain him the ifin is
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ammy ordinances sena sate laws offing
I agree tr comply wiN all d state
't ho
enter
upon'.O to building mnsmction, and hertby amhoriee reprcscmetives of this cirymeninr upon
d authoJ
Y Ls7
, he above-micurnmed property for inspection purposes..
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(We) agree no save, indemnify and keep harm i the City of Cupenino against
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liabilities. judgments, costs and expenses which may in any way accae against said
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City in consequence of the granting Of this permit. -
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APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N -POINT
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Issuedb : Date
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SOVIB7E'REG )TONS.
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Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the pplicam Or future building oncepant store or handle harandersmt •A
Type of Roof .... •. - .. .. .. ..
u claimed by me Cupeni Mun'ciral Cod Chapter 9 12 d the Health end Safety
Guru, Section 25532(0) it �.
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All roofs.sh_all be mspec[ed poor to, any. roofing, material being. installed...
will theappl'eant Or fount building occupant usecquipmern ordevices which
If a roof is installed without first obtaining an inspection, I agree to remove
cm t harardous ser camammantz u defined by Ne Boy Arm Air Quill ty Management
District? "'
all new materials for inspection. Applicant understands and will comply with
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all non -point source regulations.
�./ 164 read the'hazalloux rnatarials,rcquiremains under Chapter 6.95 of the
Catfnmia Health&Safety Code, Sections 25505.25533 and 25534. 1 understand that
Tribe building does not currently have he ant. Nmit is my responsibility t°°otify the
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oeculpsno of the requirements, hick in be met prior m issuance of a Cenifcme of
osa mays
Signature of Applicant Date
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All roof coverings to be Class "B" or better
Own..
or wtnod ed agent V.
_ OFFICE-
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