01020088 (2)CITY ler
DF IxONNo 'PERMIT- -',CONTRACTOR
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INFORMATION
BUILDINGADDRESs
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PERMI'I'NO., -
IR HVAC-SERVI
ESF ' 01020088
OWNER'S NAME:, I It- -
y,
APPLICA'nON SUB DATE
TERMINAL- WAY
022/15/.2003
PHONE: -
SANITARYNO. CONTROL NO,
ARCHITECEENGINEER:
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- gIJILUING PERMIT INFO
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BLDG ELECT. PLUMB MECH
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- I ICI CONTRACTOR 5 DECLARATION
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lob De SCrlptlon 1'
hereby9001 but mI ' a d d p fat )(on g
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wOSIt 3manegt 1lrt res: Code.enol license
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Lanso Cless 1 e N
FURNACE o
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j lanecmand sty pL ::hull he useA n ub code
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jLicensed Prnfeuional
OWNER -BUILDER DECLARATION
o 1 hereby of inn I],at I am exempt from the Cuntmclnr'x License Late for the
L Ii llm,ny reumn. (S_ tion 7031.5, 11 finless end Per ...nus Code: Any city or county
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which requires n permit w omnsnum, ober, Inmpmve, Jemnlish, ter repair uny stmewrc'
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prime In its issuance, also requires the applicaht for such permit o file a signed statement
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ValnailOn
that he d parmantt the provisions oltn C I Y rsi Jecase Law, (Chapter 9
'IFSection
pre b 9000) fDivision'3 f0 B JI f!, : Code)
nrlhthes nlmrefrmnnd the basis for alleadeem lot. An
P b p Y v'olm on
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tb]cte lLc aPPl cote mac vd pe tatty
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(him 11,
n.l1, e hundred dollars. -1
APN Number -
'Occupancy Type _ .
El 1, fthe p p tY mY y p f ,
-_, ssam
ill N k ed
.mot tit led offered I .a, (S 9044,
F,upt de
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r'.m . C>v Tn c -. L L d h t
Required Inspections - -
owner. property Ill. orimprovesthereon, whoe ssuchworkh mxelf
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lu searr. l
r Id Itie awn such are urn amended or
provided that codemmere
301 —' ROUGH PLUMBING
fm however
uttered rmname. B: however, he nmim'mng m imnnrovfinem is sole whidn are rear, of
is
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me mwner-builder will have the harden of proving that he did not hold or
- — ROUGH MECHANICAL
' 303- :,�
-imcompletion,
prove for parptrse cu"alm).,
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''ROUGH ELECTRICAL
❑1 of he prpny n i:vly concern, thf m:ede m,lar,In
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nthe project (So 7(94Hennesand Pr:s...Cd,)The Cottmet)ra
505 — FINAL ELECTRICAL
iiten,
s 1 does not apply I o an owner f p pe ty ho builds r P lees thercun
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.and who connacc hu .such protects with a commctur(s) licensed pursunot m the
',507 FI NAL PLUMBING ^
,Cmmmelers license mLAW.
olaexemptunderti B&Pcfor this no an.
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508' FINAL MECHANICAL
'owner ' 'Dsee
WORKER'S COMPENSATION DECLARATION -'
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11 r sty ft de pc ally fi ) y e fmh f II gd Idmf n
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�1 ❑ I have and' II annould a C m f I of Can,., to ,Ippe,mo for Wok :
Compensation, a. Imrded for by Section 3700 f the lab 'Cele for th
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performancrol th k for ench this perant is issued.
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❑1leave ' 1 11 pre't' Worker', C p 'f I _ ymi dby Seton
39fX1 r te 1 st cue t o pe f r te k 1 which mk permit is
ssu d My r Insun r, lI
ynu�mber�a•/re'� (�
C'nr Pal' No
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LRTIPICAf10N of EXEMPTIO FkOM ORK RS
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• COMPENSATIONINSURANCC
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(n t n need t n mplete 1 if d p at is rmr mum ha,dren sonars
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($1W)orfir, - [
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- I certify that in the perormunce of the work for which this permit is issue[, I
shall not cmpiny any pcmon in any manner to as In hereon, sabjeel to the Workers'
Compensntimn Laws of Califmrum.Date
Applicant
NOTICE 'GO APPLICANT: If. after mak'mg this CcrdOcatc nl' Esempmimn, you should
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became subjecnotheWorker. Compnestien pro,kions bf the l:ahmr Code, you nus,,`
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I Ifiv id, comply with ouch pmvfximns m this permit shall be deemal covered.
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CONS TRUCTIONLENDING AGENCY'
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-1 hereby aB tet o c iiIn en t lend ng uprue, for the performance
or the work forwhrell this pant:... ed (Sol. 3097C's C)
Lender's Name- Jr
a
I'l7ebifyth l I ri lth - ppre t d.rleta b t urret is
correct. a e,
city sad nIY d' du. l..e rebs b-
llydhe
a,,m i
tobuilJnK [nn,arue'oo mdho 'by auec;,ijh& sn nm srs fIh'selY wetter pot'
thy
the above -menti.. Proper mspeeties.(Wc)agre
n milt' ammlcssthelyof Cupeninongains(
pliuhill
c c ny many 'y against said
City 1 -of min, thi��APPI ANT 1 )E D IPLY WITH ALL NONPOINT
CF..R
- Issued by.' liat0-
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ig pin ac metro - - Date'
`:-Re-Yoofs
GALA ATERIALS DISCLOSURE
`
Will pp am future buldin,oc,lu,stal:t h' 11 J modal
Type Of Roof
asdefined bythe CupuritoMun'dpal'Code Chapter 9.12, and the l oulthnm Salcey
Code, Section 25532(x)?
0 yes El N
All roofs shall be inspected to any roofing being install.ed.
W ll in pr 3 I r n Id p' t use wary t e c : her
emilh M[u. refund bytheBayAreaA
_ prior material -
If a roof installed without first obtainin an
ection,'I a ree to-remove•-
g P g
aonlat'mmts.sQomuyMnnagruenl
Dirlri[tsr -
-ins
all new materials for inspection. Applicant comply with
oyes .. 0No
understands and will
all non -point source regulations.
Lhave read tire he p,piram, inCh pt 695 of the
Culif `Healthowle, Spell 5 5 and 2 34.1 understand the,
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ifOtabu'Idin stns mllyhave to atL lipay]F'mhlitytonmtify the
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cupanl n r regal nes whichu p or In trunprof 4 CCrtifwle m"
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ccupa f •
Signature of Applicant_ ., Date
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'All roof"coverings to be Class ` B�"<or better, -'
.Gnrterm ,aim, agent.. kTae'
OFFICE