01030094 (2) CITY
I BUINoONO
BUILDING VIiSIiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10340 BUBB RD 01030094
OWNER'S NAME: APPLI ATION,,ssUB DATE
SAN FRANCISCO FEDERAL S&L ASS 03/19/2001
PHONE: SANITARY NO. CONTROL NO.
OceptO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ra u FF-- BLDG ELECT PLUMBZ.
EC
6 tl
h i LICENSED CONTRACTOR'S DECLARATION Job Descrip 'on
OO Z-� 1 hereby affirm that I um licensed under provisions of Charter 9(commencing
t..,o,t_w with Section 7000ofDivision3oftheBusiness-no Profrlsims,Code,andmylicenx REPLACE A/C UNIT.
car6 m y, is in fun force and effect.
z
no o License Class
Lip.a
Dae Contractor
F a O ARCHITECT'S DECLARATION
1 undersand my plans shall he used as public records
r
wi p O Licensed Professmnal
ape.ftOWNER-BUILDER DECLARATION
I hereby alErm stand I a'm eaempa form the Conracmr's License Taw for the
F•Z< following patron.(Section 70315,Business and Professions Code:Any city or county $80000
which rcyuires a pm ^retrrn
ermit c ,alter,improve,demolish,or repair any strucmrc
at a .prior to its issuance.also regmr<s dic applicant for such permit to a e n signed a ctiment
-� nou hq al.hisirropatp pnl,ad theproa rh C t m:l L (Chapmr9 p p } f .t. 5 k. . ! Valllall1111
0.o ene' gw1bS t 7WO) rD' :' 3 fah Bats dP f. ions Cash) Vs';^,s.."e 3,5 �Ub 11(�or�t,el �.
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
} 'C k' t" k-�'
of Section 7031.5 by any applicant fora permit subjecm the applicantran a civil Faraday
,°form..than five hundred dollars(s50o1. 203APN OtRFLOOR ME HANICALOccupancyType
❑1,as owner of the porpes as cny,or my employees with wagtheir sale compensation, -
will do the�work,-and the strucmrc isnot intended of offered for sale(See:7011,
-Business and Pm essWns Cod,The C°nrraemr s License Law d«s not apply to an 503 - FINAL MEQ mBS�ec�k%Ii,RGY
owner r of property Who builds of improves thereon,and who does such work himself
or through his own employees.provided that such improvements are not intended or 508 - FINAL MECHANICAL
of.ied for sale.II <v<c ahc building or ."- _
or imporvemens is soldwirhin oone Year of - - rills T,.-;
droplet a ba ld ll has the burden f proving th t h did t build or I s _
rep p Tavm of sole.rt
'a ow LN P pony musinceparij contractors to
construct wct rh fousect(Site ]n44 Business d Profession,Cod )The Contractor's
License La d . misapply To nes f p p ny what builds p thereon. a;
and.who omva tsfon ch P leets w th co tacmr(s)I ed.p nt m the _ _._..._.
Cover License La _11_11 _ 1 .__ _ ._ _ .-
❑1 pt oder Sec - s'• B&P C f his reason --- _ _- _
Owner- "WORKEWSCOMPENSATIOM1IDEC RATIONI ..
'�'• •" IM1ercby affirm under penalty of perjury-no:o`ithe following dcclamtiuns:-
❑ 1 have and wlllcmainain'a'Cendaccam or Contention self-imure for Worker's
Compensation, as provided for by Section 37W of the Labor Code, farthe
performance of the work for which this permit is issued.,
❑I have and willmainiain work<ns Cmnpeniasion Insuiahce,as required by Section
37W of But Latour Code,for the perffiro r¢e of the work for which his peFmia is
Csmell My Workeh Compensation Insurance artier mal Policy trumpeters
am I a 4I t t\''Policy No.-
.CERTIFICATION
o CERTIFICATION OF EXEMPTION FROM WORKERS
I' COMPENSATION INSURANCE
- ,.. p Ferris is for ooe hundred dollars ---- —_-_- _-` __ _---_
orllisseecion nbcd iluibe'cam land if the
IS 100)
. . irvp ... .....d .:..�.
liall'h en'y ah, Ba perfoma ttoI.f the kfo which this pe .n vueAT .. _ .. _ .. __ , t.YL'• s._ -` _ .. ._-_.-. _ -__-
P Y y pers0 f Y . ro'beco ne aubject to theWo k rs
Co pensmion Laws of California:Daml
' "
.'Applicant , ... 1.:1, .. . .. .....11.1. 1 ... ,
O 1NOTwICtEnTOAPLaft arealslarallIn,,Certificate
of Eemushould
me. to the
Workers Co pcmationp ons ofthe laMuCoaah,youmanZZ India
lnmplr wire seen pnwlslnns or ams pefmh snml x deemed revoked. I .
to -a
F., CON therms 'pml LENDINGAGENCY ' " - - ----
a.7 - 1 h 6Y Rim alis them nst t on J ng ag<ncY f the perfomtnnce
y:c -Lender s Name- 09]"Civ.C)
nhn e r n'en m tt ren is tan<a fsel i
-
ZU zI<rM s Addrc.. ,. , .- _ - r
Vr� 1 conify that lhave mad this pylic[ and state that lM1e above information
, • _ - int
�• E. correct I agree to comply with all city and countyordinances ape state laws relaung
i O:U
to budding construction.and M1ereby'3umarric represcmmi4ee of phis city to ender upon
the all re<n6oned pmpcny for Inspection imiff-es._
E. P. (W) g t sa J mnify and keep handless the city of Cuperiino against
Vl Bounties,judgments.costs and e persons which may in any way appose agaiar said
U City o yueru'e ofth g-mnsafthi perms
APP-CANT UNDHRSYAI AND COMPLY WITH AL NON-POLY'[
.RCE REGULAT10Ns Zi lssuedby: e
m o ors - cant/ am mr " Dore'.; Re-roofs
ZARDOUS MATERIALS DISCLOSURE
-
"do.p licam o f t rc building a win ink rr Rinm hazvdaus ro.,mrw Type of Roof
mtl f JbyN C pen noMunicipal Cod Chapt 9.12 a data Haled road safety - -
Cm Section sss3 gad13 Ye". '.r at1ONt I, t .P,'1( f. r tY k:. (' . ,tf rl a.),1
a All roofs shall be inspected prior to any.rbofing material being installed.
• Zankf it l a ro future bulJmg pant a< .AI,equipment ae ices �If a roof is-installed without first obtaining an inspectiori;'I'agree'to'remove_
emit h b +1; a A1r Q lay h1anagm era
Di s a coram n t d t rtes b the B Afe all new materials for Inspection. Applicant understands and will comply with
r r
Y ❑N _ _s
,' ' -all non-point source regulations ,, - - "-
-- -1111.._.-.:.. ..
'I ha a r ea hpo d ua'materials - the
C if mie HcaIM&511111 Cr,de Sections 25505,25533 and 25534„1understand f that
;i thibwldsng aces not cumcnd tit is my responsibility,to hoaifY the -- - -'-- --
r. 1n nr2yf Jin r< which. n be met o is.manc of a Ceni(cam or --- - -_ __ ;_
r
� Signature of Applicant Date
° rearst onieait - DolP:. All roof coverings to be Class "B" or better
'.
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.. OFFICE .. ._ .. ._ .. _.
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