00060019 (2) CITY
my SIONO
NCONTRACTOR INFORMATION:
PERMIT fT lf.
BUILDINGAM4 URKUENVIEW LR ATLAS HEATING - PERMIT N(00060019 •'
OWNER'S _ APPLICATI@6 "WfjV2000'
IONE: (408)739-0516 SANITARY NO, CONTROL'NO.
n z Z ARCHITECT/ENGINEER:, BUILDING PERMIT INFO
BLDG ELECt PLUMBMECH
LICENSED CONTRACTORS DECLARATION AC job Description I
OZ p
' i05s Ifhereby ciff fDthat
:l licensedtinder
nit brp Jis ,ns Chapterors e9panylw,a nnsg
sl 1 lf faradeffect.
Wf- Lic Class Li,
XO Dal Contract...O e
- ,
ARCHITECT'S DECLARATION
I understand my plmns shall be used ns puhlio records r
r
�`O O Licensed Professional
OWNER-HUI;D, ARAT-
ION
6 I h ny ff th[1 bocri,t
nomtIheContractor',
License' L fix the
believing (Section91P15 Be,mess
IP fiCd Any county
which 4 permit construct,ahe improve,Jer ,1:h pbY.t aurc
'
�t3m hathentsssnsed parlsort to the
lheappfwnl for such perm)to fie a signed statement
mm he is reefnxee pnfmfan[tome providnn,of the Cotenraves License Law(Chandra 9 S Ft. Floor Area V�18>SiDh7
(cunm
nemeingisidSection 91101 Division 3 of f he Huslncssand Procession.Code) Q' ,
or that he is exempt moral rom and the hosts for the alleged oupophor.Any violation
of Section 703 15 by any applicant for a permit subjects the app]loan[to u civil Penalty
offail morethan Ford handled dollars lr ABL'S6Tjtt 6, 00- __ ,Occupancy Type .
❑I,as owner of the progeny,or my emplo\b.�pa
wages as their sole compensation,
will do the work:and[he.svunurc is nor offered for sale(See.701
Business and Professions Cada,The Conkense Law rices no[apply m an 303 — ROUGWgMM iAbt�- &l1K
orr of progeny WM1n builds nr improveand who Docs such work himself
through his own mnployee,,pr..videl but ,prow re b,are not intended nr 304 — ROUGH ELECTRICAL
opened for sale,It,,;hnwuvee the building .cut is sold within one year of
fnio alVCn fnf me nHnennaJJer will havodravingalmhedidnmhaild n' .505 — FINAL ELECTRICAL
pnrp1sof,ale). 508- FINAL MECHANICAL
❑1,as owner of the pmPeny,am exclusively contracting with Ilcemcl droner [o -
- utsVuc[Ibe project(Sec.90144.Business and Professions Code:)The Commctor's '
• Licence Law,does not apply to an owner of property who builds or improves tM1umnn, - w
and who contracts for such projects with a upurcep r(s)lincoseel pursuant to the s
Contractor's License Law. -
❑1,in exempt nother Sec. B&P C for this rcnson
Owner Date
WORKERS COMPENSATION DECLARATION
I herchy nffnn antler Penalty of perjury one of the following decllcon.....
] 1 have and will maintain a Certificate of Content to self-inure for Workers
Qnrovesation, as provided for by Section 3900 of the Labor Code, for [be _ n.performance,of the work cur which this permit is issued.
Ie and will maintain Workdc Connpnnsmion lumbonhe,as required by Section
3900 of the Labor Code,for the para roan.of the walk for which this permit is n
issued:My Worrkkerr's(CC nn m Inwruncc carrier and Policy number are:
Can�ier: GI'•/n/ //b►j Percy No.: 7� -
CERTIFICAT ION OP EXEMP HON FROM WORKERS'
COMPENSATION INSURANCE -
(This section recd not be completed ifthepem,it Is Income hundred dollars -
($too)nrIexa.)
I certify that in the performance,of the work for which this permit is issued.I .
cot employ tray person many fnannnr n,a to become solder,to the Workcrk
nmmayor,io s of Cnlimmia.Date -
Appllcam
s,N01 ICET I'PLI MI:If,after makingt fa ndseme of Fiengnmr,you should
became subjectmOe Workers Compibral n s ofthe Labor Coda you cons[ '
O forthwith comply with such provisions or Nis p ti[shall be deemed revoked . -
•r '
CONS hattheRUCTION LENDING AGENCY' -
a Ihk Far waffiral hich[ha[[hemixd aimed(Sri. lending agencydor the pnrfmmanco -
,of the work Far which thin permit is Issued(Sec.3099,Ci,CJ
LQ Lender's Node k
7 z Lender's Address
V C 1 certify that 1 have read this opplicvtioo and team iha the above indabliamn is
W Fr correct.1 agree to comply with all city and county ordinunces and slate laws"cluing
Q C.1 I.banking consubtralonund hereby uuthnriie be,evenlativea of this allym vibration
fy [� the above-mentioned property for iespecint Pumesce, ,
F Ot .(We)agree to save:indemnify and keep harmless the City of Cupenineagund
Z3 liabilities,judgments,costs and expenses which may,n any way accrue against said
U Z Cityinamsequcneeofdm rantingofthispermit: c/
•APPLICA L! - _SAND WILL COMPLY 11'ITHLLN N,"kNT Issued t Date -r.0
z A/A',7�!RDOtiUS
"sDate Re-roofs
MATERIALS DISCLOSUREsolam tar future building vocapmn store or handle harameax material •Type of Roofas defined by tno Municipal Code,Chapter 9,12,and the Health unit SrfdyCalcSection , "
❑Yea ❑No All roofs shall be inspected prior to any roofing material being installed.
lvul me applicant or future handling occupant use equipment or dealers wmgl, If a roof is installed without first obtaining an inspection, I agree to remove '
nob hamnlous air aotuannnamx ns eaMCJ by dam Bay Area air Quality Monngcfnont
)is
all new materials for inspection. Applicant understands and will comply with
❑Yes ❑No all'non-point source regulations. -
1 have real the hmurlous fnn¢riulx requirements under Chapter fi95 of the -
California Health&Safety Code, No
25505,25533 and 25534.1 undersand that
I f lhehuildln does nm currenI y havea�kttar,'har it is my responslhil]ty o,notify file "
ecup.at requirements which 11 fall be and prior to issppon of u Certificate of '
Q G Signature of Applicant Date
is or amhmfirnd ager, ✓ Date All roof coverings to be Class`B" or better,
OFFICE