02040117BUILDING DIVISION. PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1125 YORKSHIRE DR AIR DESIGN HEATING & COO ING 02040117
OWNER'S NAME: APPLICATION SUB DATE
MURDOCK ROSAMOND E 480-A SAN RAMON VALLEY B VO4/22/2002
PHONE: (925)837-4328 SANITARY NO. CONTROL NO.
1
aQ zo
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
m m C
_.... .._ . _...
rti._.
F' TV)
BLDG ELECT PLUMB MECH
t<i
W.�
,-"
Of thework for which msprml ueJ (See. 3097 Cv C.ly �,,.
Unit Name
LJ t—j
' z iS
LICENSED CONTRACTOR'S DECLARATION
Job Description
i- c
E
:tty
1 herrn affirm that I am licensed under f Chapter 9lmmmencin
r a provisions o p g
wiinfal on]000)ofDivision 3ofineBu sanaPwressionscod.aamyB«nk
REPLACE FURNACE & ADD A/C
:,2J<
is full far c wm[,Tg2,
Linnse L�pss CC. LL L' �giZ6
O u U
j virporn
u t,
/Pz S DE�S r�
\% ARCHITECTS
L 1
T
'-V 1 undecaand my plans shall be used as public rc<oNs
as public
!M0 O
igioned
t
IWe1 agree Io save, indemnify and keep harmless me 01y of Cme
Licensed Professional
V3
- U.Z
DECLARATION
Oat
w -
I a. GUILDER
1 hereby M. that 11. exempt from the Contractor's c taw for the
V1 `/
I
C ? M
Business and : Any
following mason. (Section ] oli Calc Any city or county
Issued by: Date
or ,x p
construct, improve, de
whichrtrequirespermit c t t❑ r, p demolish. p anystructure
$5000
or
a
Poor w it usu a also eq- J applicant f M1 permit to file signed smtemem
_ __ .. ___.
S�
Yr' c i 7 C�jCpa'y
3 � �]. 5.�.�.I,N
Valuation
3
that he slansedprsuant tom previsions of the C uawrs License La (Chapter9
from n' with Section 7000) fD"si 3 f,h B sacs adY fevovsCode
Will the iiihearn r I b kir_g fam some or hurndihaiiandmi,..coal
or mm he is exempt lhdmffom end me basis Rome alleged exemption. Any violation
r' i e I b "L b' S..0 V [a�
as def ed by the Cu,mins, Municipal Cod Chapter913 and the Health and Safely.
Cod. Section
t,
jt ,
i11`k iso e'(�t.i ft7�r 1; s
of Section 7031.5 by any applicant For a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (s5fai
W`o '4'' l:i
" `"' Occupancy Type
. Willtheapplicant or future building part use equipment or devices which
30 Y4PN'�Uftl PLUMB IN
emit hazardous air contaminants as defned by the Hay Arco Air Qua l ty Management
Diemcr._
❑ 1, as owner of the proper% or my employees with wages as their sole compensation,
0ys
—'source regulations "
all noo-poi Int
will do the work -.and the strucmrc is Out itnrnded-or"ofered for sale (Sec. 7014,
B.i has and Professions Cade: The Cmionsw's License Law does ,at apply 10 an
304 - ROUGH EANqupRt¢LnWtions''
owner of progeny Who builds or improves thereon, and who docs such work himself
Or through his own employees, provided that such, improvements am not intended, or.
FINAL ELECTRICAL
offal d'f `sale:If, ti he bagildioPrP w is sold with n one year of
------
completion. the owner -bit lder will have me hu de of proving that he did nm build or
507 - FINAL PLUMBING
improve for purpose of sale.),
508 - FINAL MECHANICAL
Signature of Applicant Date
property. mn commning
- ❑ I, as owner Of the - with licensed contractors to
- __....._-......
- t
All roof coverings to be Class "B" or better
Business and Professions oris
cTheonswn the project (Sm.
.. .,,
-
ids or improves
License Law does not apply roan owner ves the
to an owner o progeny who solids improves thereon,
th s
_and.who caricas for. such pmjeccs.wilh.e contractors) licensed pursuant or ale.
"- -
''-
ConOa<wrs License taw.,
w"
FI '@+\LG®
❑ I am exempt under Sec. �v ,B&PC for mi....on
Opp
_ -
OwnerDam
WORKER' S COMPENSATION DECLARATION
�l (� ntOoy%
I1 r Il La L b
APR
I hereby affirm under penally of perjury one of the following declarations:
❑ 1 havd and' will'maintain a Cenificam of Consent to self -imine for Worker's
Compensation, as Provided for by Section 37W of the Labor Coda.�for the
BUILDING
performance of the work Bewitch This permit is issued.
—
❑ I have vnd will maintain Woiker i Compensation Insumntt, as requirta by Senior
_
3700 of the Labor'Cbda, far the jieAonnvnce of the work for whits this permit is
issued My W ke s Cd'npci sauon hsuru d Puli y be
TIFICATION OF F.KF.MI'fION FROM WORKERRS -
a �I �ka I {x,!'i :e\: r- A )..iP'11'. ai? e
tCLR
- a u `'
.t
'.
"" COMPENSATION INSURANCE
' s ' \ ' '' 1
cl if the pert is for one hundred dollars
(This Semon rived not tie complemmi
($10i less.) _
I c a fY that o the pc form cc of thic work to h ch this wmit is issued, 1
' 1' '
shall not employ any person in any manner m as w become subject to the Workers
Compensation Laws of Celifomia. Dem;
become, subject to me worker s Compensation provisions ml he Labor Code, you must
O
Doi comply with such provisions re this permit shall be seemed revoked.
_.. - _...... .... .... ---- ...
_.... .._ . _...
rti._.
F' TV)
.... .....
h i`" '" CONSTRUCTION LENDING AGENCY ', ,'
1 he b 17nn that the e c ngmctid' <nc for rfomwnce
a-:.
W.�
,-"
Of thework for which msprml ueJ (See. 3097 Cv C.ly �,,.
Unit Name
a.❑
a•Z
Lender's Addmss .-.
U'0I
w:H
candify that 1 have read alis application and state that she above information is
t7,:U
ember. 1 agree to comply with all city and county sernwi res and scam laws enter
hereby of milcity mercer upon
to upon
} Ica]
entionedmmund
the above forinsfamioaeraponenuiivee
pmpcnd Torinspersionpurposes., ,_
Ilia aba(WeI
E.: tY
igioned
t
IWe1 agree Io save, indemnify and keep harmless me 01y of Cme
V3
- U.Z
!nil
against
City inico sequence costs and expenses welch may in any way accrue vgnimt said
City in consequence of clic greening of this "'
pcmul.
AP'LICANT UNDERS WILCCONPLY WITH
TUND,I
V1 `/
I
_
\NDSAy13 ALL NON-POID'f"
ICL -•
S�
Issued by: Date
•.�'
Ll�E `ro2
-
Signa re of ApplicanVcommctor' ,- •- ... - .. • - Date'..
Re -roofs
" t, •� '" HAZARDOUS MATERIALS DISCLOSURE � "
Will the iiihearn r I b kir_g fam some or hurndihaiiandmi,..coal
Type of Roof. .�
_
as def ed by the Cu,mins, Municipal Cod Chapter913 and the Health and Safely.
Cod. Section
t,
jt ,
i11`k iso e'(�t.i ft7�r 1; s
W`o '4'' l:i
,
roofs shall be inspected prior to any_roofing,mater al being installed.
. Willtheapplicant or future building part use equipment or devices which
--All
If a roof is installedwithout first obtaining an inspection, I-agree:tdremove
emit hazardous air contaminants as defned by the Hay Arco Air Qua l ty Management
Diemcr._
all new materials for inspection. Applicant understands and will comply with
0ys
—'source regulations "
all noo-poi Int
I h ve read m<har4Mous ma¢r calx rcgmrcments under Chapter 95 or the
Cnlifoenia Health & Safety Code. Sections 25505; 25533 and 8534. I understand that
-ifalc building dues not cmocify have amnant,that it i.vmy responsibility to nmifythe
o,....1 of clic iequimme which a sc mel prior m issuance of a Cenificateof
Occ
' _-'
Signature of Applicant Date
�. .-
uihonzcd aBeni_ ace
All roof coverings to be Class "B" or better
OFFICE'—