02030068 (3) CITY DSONO
IVIIINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11567 COPPERSPRING CT GOSAL HEATING&AIR CONDITIONING 02030068
IWNF.R'S NAME: APPLICATION SUB DATE
TURUMELLA, BABU 2679 CHERRY BLOSSOM WAY 03/14/2002
HONE: (510) 441-2318 SANITARY NO. CONTROL NO.
,Fa YO Zo ARCHITEC(ENGINEER: BUILDING PERMIT INFO
ce ;{r5 BLDG ELECT PLUMB MECH
LJ __J L_J
LICENSED CONTRACTORS DECLARATION
✓+Z I hereby afmt that 1 am licensed under previsions ions ofCha ter 9(commencing Job Description
wim Section]000)of Oivisian3o(the Bu.net and Pmfesziom Code.and ray licenu ADD 4 TON A/C UNIT
nfull ttandcff t. �I/�6
i.c.a 9 1
co me
u O t; ARCHITECT'S DE RATION
gI arta,and my plans,hall be uud ui,r miu,records
j g o o
Licensed Professional
o Oat I Ind exempt
DECLARATION
1 hereby affirm that 1 am exempt from the Contractor Ca License Law for the
F Z 0 following reason(Section 703 ensu Business and improve.
demolish,
e Professions Code:Any city or county $3900
I x o which requires n permit construe,nhen;t lot such
h Permits or repair n statement
ateme t
n3$ ^patot its issuance. dacquiresp applicant for Connetor,mice signedtmmem. -_ ____
(co he IcctsNp oaten the pro spats of IM ComlazmrsL License (Chapter9 p (, Fttp� pp,,�� Valuation
---------
(commending 'ms C11 ]nn) f D 'd.0 3 of the Business atdP r : Code) `�'
or tbrt be tS exempt memfroln and the basin for alleged ciemptlor Any violation `
-of Section 7031.5 by any applicant for n permit subject,the rpplicenno a civil penalty-
of not mme than me hundred dollars(3500). 2 044PN� !R FLOOR F ME' " ' Occupancy Type
❑Las owner of the property,or my employees with wages as their sole compensation.
will do the%m1,and the stmctue isnotintended or offered for sale(Sec.]tli4,' - - - - - -- - - -
Bnilness and Profession,Code:Tate Contractor,Lirm s,Law does not apply It,an 3 03 - ROUGH MIRCNAWCCKaions"
owner of property Who builds or improves thereon.and who does such work himself
or through his own employees.pt�,gdeg that such improvements an not intended or _--- 3 04 — ROUGH ELECTRICAL
-oftemd forl"alF if however7dic b'Iding turinipowmim,is old web tone ( .-- _...-. ......-_.
Icon,the ower.wlder will have the burden o year 505 FINAL ELECTRICAL_�� • . . �:
iamp a pr sang that he did not build or
mprove far pugnuofsme). 507 - FINAL PLUMBING
with- e- - ntra
—5p8 = FINAL-MECHANICAL; -- _ _. _.
❑I,ns owner of the pmpcnY.am exsiness)eontractssioxCadc:)x Tin
�.{;� -"-' --"
- -
canLicense
et the prod.jm(See 9USL Business and Professions ills or The Contractor's
an, �wmCInotapplytoanownerotp wonscnubiicense pursuxtto,ths 514 - FINAL PUBLIC .WORKS'
i. and wh°cnmrams for sucM1 projects w;th.r<omranar(s)licensed pumuant_m.the. _. _-
. ComracmYs Licenu Lvw. _-.
�. p c:' ,B'&P C for this mason
❑tem exempt Sc ,
ORK
WER'S COMPENSATION DECLARATION
/ 'I here by aErmunder-ped alryofofthe.following declarations. FIRMALE®
•fl ❑ 1 have and will maintain a CeniGcate of Consent to selbinsnre for Worker's
Compensation, as prov;led for by Section 3700 of Ne labra Code, ror the MAR 1 9 2002
performance of the work fm Permit which this peit is issued.
❑1 ho%n and will maintain Worker's CtimPenmtibn lraamrk,as r<quirtd by Section
is st'folic lobo Cad (o th perf immu'e f Jt cork f heli th gal is BUILDING
s'suW My\Vok C pc t♦�I� CJ`Nl/! �)p-y
$*FYI•.0-aT'L ' " 32f-II - . .
- r C[RTIFlCATION OF E%EMPiI FAUM WORKERS T Y,�� l is._r_ !;:J�r 1} s C,l i .T t rat i �'A s. -; " " '
' '..' ,,,_COMPENSATION INSURANCE ' *t "
Cphk section nesed not be completed if the permit is for e h ndtcd dollars --
151o0)nrlcss.)
Loci that n in Person
Performancef theh f which u ctPermit sued I - - -
Coui not c npl°y Lows,
K n m any manner so as to become subject to the Wnrkeis -
Compensaticnfa. of California.Date
Applicant, - -
NOTICE TO APPL e Wink B,cher,making thisC n i of of Extra
pt you should
Z bean subjenmtM1C N'nrkeri Compcnsat p ns°f th Lab Code,you'must
CC forthwith comply with such provisions or his permit shall be deemed Invoked.
CONSTRUCTION LENDIN di gent
1 hereby affnn that to conxwSee lend n'a ages y f the per(urmanec'Q.
Q of the k fo h ch th permn's ssucd(Sec 309] Civ C)
yLender s Name.. ..: . ... . ... .... .. . _..t...,. _ —._ ......__.-.
Lender sAedmss, --- -'-""' - -- ---
cenlve In t I comply read ons appliccity
and ion cmand stain'but theunce,a ds tate law,
is "
W:[r cnrwt:1 vgtee to comply with all dry and county.°rdimnees and state laws relating
�.0 brob le-do mimesis m,dy far exuthoiimuposenutivcs of Ns city menmr upon
the aboee) t cdsapent'f .pcdo purpose,.
Fads (We) g- tossm imleminify oilk ph yinthey tybfCpn mod aid ,a
.rat
liabilities, dg n,fcosts d ponos which may in wt'w y c gains said '7
U z City inconsequence of th gra g (Nis pc t '• ^�
p L LVDER N AND WILL COMPLY WTIH ALL NON-POINT' v
w C� E 1 I " �y Issued by: ate
signal t eof Apprcantrcontm2mr'. .: ... Date. �" Re-roofs /
t' - HAZARDOUS MATERIALS DISCLOSURE "
'^ WIIN appli"apt -roe budding apt t i or drink, cars Type of.Roof-__ ,_..
as dermdby theClaid oMunicipal Cod Chaps 913 and the Hellh ad Safety "yp
Code S ton 25532(el - y s
❑Y r Y '.ON -Apt lid 1 P • Imr i g. \{ )l _ Cls,. s
_All roofs shall be.inspected poor to Any Woofing materia] being Installed.
mitplum apc t name n firedoccupant- -uuaAequipment devicesgremor If a roof is installed without first obtaining an inspection;I agree'to'remove
ha nfo m nt,e oma,by he Bay AreaAirManagement
""" all new materials for inspection. Applicant.understands and will comply with
❑Ys ❑N - ,
all non-point source regulations
' I he mad the bmrdous mat, els rept, ens ander Chaps 6 95 of the
Chlifom a Health&Safety Coda Sect ons 25505,25533 and 25534 I uneentand that
'f techri[ding vloses not currently have a tenant that it is my responsibility to notify the
oe up ofrN mquimmc s h1 t t p- to issmnc f Certificate of
i. 0<u anf I I ..
� ��v1' Signature of Applicant Date
u,°^==dagent to All roof coverings to be Class `B'or better
u
— .. I - OFFICE-.__ _. .. ...._—.. ._.. .-. -
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