02060155 (2) CI BUIL of C DIIVC,ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
21639 EDWARD WY A PERFECT CLIMATE 02060155
OWNER'S NAME: APPLICATION SUB DATE
ANJU SAHAY 10570 S DEANZA BLVD 06/24/2002
PHONE: SANITARY NO, CONTROL NO.
(408) 861-9545
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
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a 5 y i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z-G 1 hereby affirm
that 1 am licensed under provisions of Chapter 9(commencing
P v,Fw with Sectign]000)ofD;vision 3 of me Buy,,..d Prvfcsswas Cale.and my license REPLACE FURNACE/ ADD A/C
Y I J is in II ice a adfci ../ S
z'<a Livens Lic.p
x O i V pZe a — Com cm
w c a. y as ARCHITECT'5 DE ATION
z�00 1 underoand my plans shall be used as public records
y i O O Licensed Profbsuonnl
OWNER-BUILDER DECLARATION
t� 1 hereby effort that 1 am exempt from the Contractor's License Law for the
t z< following reason.(Section 7031.5,Business and Professions Code:Any city orcounty $4975
Y x G which requires a permit m construct,alter,improve,demolish,or repair any structure,
a3_-.pro , l s al rcy ie th PPlicam for such permtt mfl 'g datanement _" _
thd,h mlcertsedpbc a ud lip pro line of the Convector LicenseLa (Chapher9 S F[ FIQor-AEra.^ p Valuation
(co n gonfi Se ni ]011 of Division 3 of the Rusine@ and Profgssns Crude) �,(�w+; 3'519.0'1L VU'�•i+`s•p kd-`It^:' t
or rhes he tv nempt therefrom and the bas s for the allegcf elemLarn.Any violet on {
-of Section 70315 by any apPhrant fact permit subjects the applicant m a rkil penalty N[� U1��eeL s
'lefmm mre lars15501).othen five hundred dol301APN R�UGri PLUMBIN Occupancy Type
❑Las owner of the property,or my employees with wages as their sale compensation,
1�III It
-will'do'the work.and the structure isnot-intended'or offered for sale(See ]Oia,' -- -
Buluiciv:and ProfallmasCode:IbeCnmracrprsLicense Low does antapply man 304 - ROUGH EL TIO ctions' ..�',...
owner of pmpeny Who builds or improves thereon,and who does such work himself
or through his own employee^,provided mat such improvement,an not intended
' or -of
offered I If ti wcver,the biiId g id' ,h ney `or ._ FINAL ELECTRICAL _
completion,thw'lderwalhavedibumeaofprw,ngthathedidnotbuilder 507 - FINAL PLUMBING
a
tap f p p of sole')
.—._........
_ 508 - FINAL MECHANICAL
OL -al they pent a duxi ly-o tract g -,M1httused conhacnors to - - -- - - - . . ------ - --.
_ comwct the vejen(Sec T3 W But er : nJ Profess ons ills 1 The Conte rrom.
License Law doth not apply'--a owo-w of property who builds m improves thereon. '•I '
_and cc Liccns fu such,p j ns w m a ronwcorts)licomed.pharmart no toe_ ._..-
' co v n r License Law.
0 a.csa.pl order Sec. D' B&PCfonhs Mason �®
Ower 'Date L
WORKER'S COMPENSATION DECLARATION AUG 0
1 hereby Rrm d pe l ry n
lty f Pe e al Inc following daclat ons: 9 2002
11I h J' '11'ma t C rYhea f Chosen,to self insure for Worker's
Conalansation. anprovided for by Section 3701 0f the Labor Cafc for the BUILDING,
performance of the work for which this pennon rs issued.
❑1 have and`will maintain Worker's Compansalion Insurance,az required by Section
37W of he Labor Cale,for the pirformenc,of me wick for which this perms,is
issued.My Workers Compensation Insurance carrier and Policy number are
C 1 -� XE cy No
't I' CERTIPICA OEXEMPI'1 OM WORKERSr 4,+ •. 1 :[�:pVf. 'Is. al ., -'.1 RT ^,f Taj,"v;
COM1IPENSATION 1 ANCE a
`(This union need not be completed if the permit is for one hundred dollars t -
i% Ice nifyman nm,p r fth kfwhichm tot
aEall not employ any person in any mancer so as to become subject to the Workers -
Cmnpenmuon I.aw.a.1 Coiticurf Dune '
Amlicaar _ r
O iN ' APPLICAYT If.alle,hoodding th . yhould
--- — _ _.
Z became
%oj t Workers Compensation p s of the[..bar Code you mumforthwith
o ply with h provisions or m Permit shall bed rev eO - ; .....__.
'CONSTRUCTION LENDING AGENCY
I harelo, r Out hear isconn r e leading agecy
for the Performance ..
W; Lame wfororts h'h,h M I'.issued(Sec.31 W] CI -
y.c 'Lenders Name _ ._ _ ..
D Z nder's Addrcssn . ..
U
1 O I certify that I have read this application and state that,he above information is
conic.I ogre,lo,comply with all city and county ordinances and sed¢laws relating
O.V t0 building connruction;and hereby authorize representatives of this city m enter upon
�..W the above-Lemum d pmpeny for in.pceion phrpows.
4
liabilities,jmlgmenie,costs and expenv
A. (we)ogrce to save,indemnify and keep hannl<ss the City
of CuMriino against.� ce which may in any way venue against said
VIZ City in coequ
nsence of me granting of this prmit
e . - "
APPLICANT ^1 DEBS NDS'ANDwILL COMPLY WITH ALL NON- LST " Issued by: b
S011.Ri RI LATIU.' �(' Date
gnawre of, piconVCo t mo -'1 ,Dam,
HAZA U$MATERIALS DISCLOSURE
Re40pPS
'•'' wiBIt,apploemnormm.abuildingwelpsom baconhandle horsudUtommenal ....Typeof.Roof_-__.._._..
cad, dbythCpenpM PIC) Chapter 9.1 and the on
Health dSfty _
Coca5gcY 2553 U) S.x•�.h aT i�': i FI f .I"'-1• _
_All roofs shall.be.Inspected prior to any roofing,material being Installed.
Wd us air t f r b 'IJ building occupant usequip� to d icewhich If a roof is installed without first obtaining an inspection, I Agree IO remove
emit hazardous cunt m rantu as aefnng by the Busse equi Quality Management g p
°i51.'oY all new materials for inspection. Applicant understands and will comply with
all non-point source regulations:
LC�ifomi
h read the h d mterial. requirements under Chapter 695 of the '
Halth&Softy CWe Sections25533 and 2553a.l underhandtomilding due,not cumnly have a chum.that it s'my reSperse' litY,o nb,ifYtheConcerto o e rcqui en¢which must he tan rior Lir nmanrof a Ccviticote of
/aSignat_ureofApplicant Datera,. h i:`d° '" ( All roof coverings to be Class "B" or better
._ ._ .... .. . OFFICE -
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