02050006 (2) cl BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N'0.
7409 FALLENLEAF LA DAHL PLUMBING CO, JOHN F 02050006
OW 1 APPLICA ION Sr,.DATE
T MICHAEL A AND JANET 329 ALMA ST O5j02/ 002
I�PHONE (650) 321-5500 SANITARY NO. CONTROL NO.
QO O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m U— BLDG ELECT PLUMB MECH
F z LICENSED CONTRACTOR'S DECLARATION Job Description
1Z=0 I hereby affirm that l am licensed under provisions of Chapter 9(commencing REPLACE FURNACE
with Section 7")of Division 3 of the Business and Professions Code.and my heenee
is in full force and effect.
a ce a Lieenx Class Lip.n
f O Date Contractor
?u O r'rARCHITECT'S DECLARATION
�.5 I understand my plans shall be used as public records
3 p O Licensed Professional
OWNER-BUILDER DECLARATION
usi I hereby affirm thin I 1 exempt from the Contractor's License p law for thefollow $2080
C?Q whichingreassanuiresa Semion]o3Loom,S. aims andve,demolish,
C"or Any city county
O which requires a getout m cores th, alter,improve,demPlls 1 or repair any structure
i 3� .pro Bol a c um q rc dre Dpl cult for CouracmiuP ice Law(suamctn a
that hael mW pursuintwthe processorsof doe the
Bustr License La ons Coal
a,
Valuation
Iso g 'NSection a ]/1001 fbe Sofesit 'nes and Prpf ons Code) t„t; 4 j S4• •s- ,/{TS! ) ={,1.rn
ur rho hes limbi my app li and be ba.'. fur the site, caempnna Any v Pena on '
of Section than v any hundred
oll for a permit subjects the applicant to a civil penalty
of not mote man Eve wmrce ernara(ssoo). 30pPN Occupancy Type
o1.as owner othe p,npeny,ormyemployees with wages its their sale compensation. 303 — ROUGH MECHANICAL
will ne the work,and eCFto¢mm Ism,bac*,, i or a credLaw for sale(Secapps mor - - 3 0 4 - ROUGH EU3^PT 61 tions'
Business and Patery,W ions ilds o The Cotnuaoro.and w law dict not apply m m r^giaH6Na1 r - '
owner of progeny who bases or improves thereon.and who does such Bork himself 505 - FINAL E LE CTR I CAL
or Nrnngn his own employees.provided that men imprPvfmwra are not intended or
offered farsble.If.however,the building--'m t is sold wiihinbnd -' --” "'507---- - -_. . _._ `•
e burden udf FINAL PLUMBING
Completion,the owner-builder will have she of proving that he did not build or "
improve forpnrpPxPraale.). 508 — FINAL MECHANICAL
rot Ne progeny am exclusively contracting with licence Coria m - "
icewn the project(Sec.]o4•f,Business andPM Professions Code:)The ConBuaor's
Liccrue Lew docs not apply m an owner of pmpeny who Wilds or improves,M1ercon,
and-who,contracts for,such projects with a.umtucmr(s)licensed pursuant to the
Contractors License Law.
f� `_ ❑I am ciam/pB�urode ec }y�. •"I I ,B&PCfar this recon .t�� /� p epi.); .- .`•. -..._. _..._._. _ ..__ __._. .. ...__ -
�i.ner. ` !B, RKEER¢'SCCOMPFJ7�ATIONSD CLARATION �I A041 A�aau®®
1 hereby affirm under penalty of perjury,one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self-insure for Worker's MAY 0 2 2002
.. y Compemanon, as provided for by Section 3700 of the Labor Code, for Ne
Performance of the work for which this Permit is issued.. 1 1 (��
[I1 have and will maintain Worker's Compensation Insurance,as required by Section BUILDING
_ 3700 of the labor Code,for the performance of the work for which this permit is
.. iisucd.My Worker's Compensation Insurance carrier and Policy number are
Carte �:.� r.'.•PPI No. .. jj .
t CERTIFlC(TION OF EXEMPTION FROM WORKERS'] i°+ ' C.it_ t flf. „5.1 i'„y,`
. .,:,...�t. -COMPENSATION INSURANCE -
'� (Th ' ton need nan b,completed if the psrom is for one hundred dollars tl r• s
1s(SIM)or lm.) ,
' lenity th t in the-,pct f,M1ework hit which this permit toed l -
,,hall am c Ploy an - any m n ss fpg r�pg subject m the Work rs r:. t•t 1."l t
P pen. to�al'f .� �Gl
pl cant _.._ .. . .. . . . .. .. ...._ .___. . .
IGE TU APPLR;ANT If ❑ mior
lk ,'his Cnf t fExemption, 'should "-' --
Z. hes toes bjeclipticW k C pens uo povisonsofN L W Code yobmus'
fonhwnn comply with such provisions or sh s permit Nell be deemedvalued.
.. ..... . . .......... _. .. _.-.__ .... ..
. . .. . .I ._.. _. -
�" > CONSTRUCTION LENDING AGENCY
a } ''1 hereby affirm this there is a issued(Sao
097.C agency for Nc performance t -.
`. ofmework far which this pctmn iz issued(Sm.J09],Civ.CJ
-Pander's theme.:.. _ -_ ... _i _ . .. .-.
cri Address' _ s . ._. . . .. --_. _ .... .
Lend ., •t.
V' I agree Nat 1 have fwd Nis application and Bore Nm the above information abort is ' /)
0 E. to Wildrept.I agree m compland y with all out and counry�ordinances and sato to en er open
(, to aWse-mentioned
of this city toemerupon
}.ry the above-mcmionctl proPcny for inspection purposes. `
es judgments.
costs and expenses and kap h may in any
way a turn,a ai igains
Vl liabilities,sequence foss andrg of which may in any way acme against said
V.� APPLIcnnsTUNIeRSTANDSof the "ANr,hii permit. Vv
APPLICANT UNI iRSTANDS'AND WILL COMPLY WITH ALL N111
_ uecE -' S�2 2 Issued by: 1Date
ignamre ofappbeanuCPat acwr Date/ Re-roofs
HAZARDOUS MATERIALS D11 LOSUR
W 11 tlu applicant foul had l g occupant Hort handl harsh s B n I _Type Of Roof
as d
chard
by Ne C pen Mun c Code Ch p e 9.12 d N Health d Safety - yp
Code Section 2.5532(7 t v 1 ' 's ,( a 1 s f 9 J 1 -T ,( :{ '•, .s .
oYes T t All roofs shall be'inspected prior to any roofing material being installed.
Will the applicant future W fined of e m use mAiequipment devices which If a roof is installed without first obtaining an inspection, I agree;to remove
emirbet? - B is a; f dbyth 'B Bay ILA Quality M Management
°int all new materials for inspection Applicant understands and will comply with
❑Yes ho r,. non-point- -
I ha read the hazardous m
s ater el. m
geircents and Chapter 6.95 of thsource regulations
e all "f
CaliforniaH"a1N& ,S
Safety Codeermons 25505,25533 and 255341 understand that
if tGe W ilding docs ria currently have a terms.that i,is my rcsponsib,hy to notify Ne'
occupant of the requirements which must W mer prim to issuance of a Cenifica¢of
''- cwo:__ • . r J Signature Applicant
l n/� .. Yj S z z B. -pp _. _ .- .. Date
Owncrorm,h...—agen, Date All roof coverings to be Class "B"orb'etter
-' _::.. -.a.e •. ....,,. ..: _ . _ .: -. OFFICE --