02060182 (2) OF
CI BUILDING DIIVISSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO,
6387 MYRTLEWOOD DR ALTON AIR CONDITIONING & H 02060182
OWNER'S NAME: APPLICATION SUB DATE
HENELL ROBERT C AND JANICE L 45300 INDUSTRIAL DR #4 06/26/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 490-5655
O zo ARCHITECT`ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
I—D GI I_ ' LJ
LICENSED CONTRACTOR'S DECLARATION
Z 5 y 1 hereby rnrr that I am ucensen under rcha Job Description
O i_O Y u provisions i pre 9(commencing
HF_tw wimseenan7twolafDrvismnJanheStrsmeaxand Pmresammemle. amyneerae REPLACE FURNACE & A/C.
yy2 in run rorce arta a —/ 5
.6 w a License clans Lic. O'
3 y Dara Contmnhr.
CHITECT'S D[CLArRA
e
F u O; I undersmnd my plan xhall M used as public rcc
w O O Licensed Professional
that I am exempt
m the Contractor
ul z- I hereby uSectthm 1 1, exempt from the Cctions Co License Law for the
t_za .1hichfollowing eeon lS.itn7ofL5. t,.1m,Business and Pe.derliCade:Any city or county $4710
Exp whi,M1 requires a permit ra mics the alter,imprma,demolish, fi repair any amemant
-pn to¢`nsedprs rcy ie.theapplu tf schpctors flnig dezametn --- - -
ih mm's licensed of our ml nth Provisions fm Contractors.License mr miCod9
or men' g ntmsec 7rnaq rant'.' J nn Bgide aami.Amm�scamel r'tM1' 136 �'' b'l �or early I I.11,Ir.,'. , Valuation
or that he ix contortM1ercfmm End the basis for the aIle cJ intro Linn.An Z„u s I
8 P iv l Pennon 1
of Senior 703L5 by any applicant for v permit subjects the applicant to a civil penalty
of a.,mate man rise reacted dnnars(s5W1. 303 APNI Ff MECHANICL' Occupancy Type
O1,as owner or the property,n,my employees wire wages as theirsolee ii,ensution,
will do'rise'work:and the'znaetum is not intended or offered for sale(See.7011. - - - —
'Business aid Professions Cade:The ContracroCs License Law does not apply to an 505 — FINAL ELE=Rdt3nections'
owner of property Who Wilds or impmve thormn,and who does such work himself
Or mmugh his own employee.,pm.;ded that such improvements are not intended or 508 — FINAL MECHANICAL
o&red frit sale.Il':hoar,the building ob; nveimprovement is sold within otiay-er
burden
" '--
impletion,the owner-buil.¢,will have the burden of proving that he did nut buil)ldor
improve for pugisxe merle.), '
_ ..as owner of theproperty. . ed .. _ ___ . ... _ ... _._....._.. .__ _.___...._._.._.__. .. _ ... _ ...
°1, am Business
a d Pranisi with licensed eh Cium tis t,
consumer the project(Sec.71}14.Busineaa and urnfe.aaiom ild,.r The ves therms. •'I
License Law docs at apply 1.anowner of a comy who bunds se Improves thin the for such.projm¢with a contractortq licensed pursuant m the
and who.conwcts -
] or's License Law.
0 1 am u
- O I am cmpt under Sm.' t" ,B&P C for this meson
Owner" Data
1 WORKER'S COMPENSATION DECLARATION=• Jul q q 1hereby affrnunder penalty ofperjuryone ofthe following decimations: O !. 2002
° 1 have ani will maintuin n Ceniii of C....a, ,,self-mmm for Worker's ��'J
CompensaionSam
on as provided for by Seon 37W of the Labor Came, fnr the o
Performance of the work for which this permit is issued. ` ,�■^=
BY(have anwill maintain Worker's Compensation Insurance,as requited by Section `�
3700 of the Lahr Care forthe perfumtance of the work for which this perm i is
issued,, N ker'`CSpe stion) .mruncc carrier and Policy number arc: -_-_._.............. -v_ ,a_ • _ ,
Cent t Policy No.. 3 r
C[RTIFlCATION OF EXEMPTION OFlt MWORKERS � .,I- a..l.. P.1� r
COMPENSATION INSURANCE'S'
(This unction need not lie completed if the Permit is for one hundred dollar
(5100)or less.)
1 cenify.mat in the in a.,me of the work for which this permit a issued,1 t
shall not employ any pawn In any mvnner sn vs m hcrnme sObject w the Workers' _
Compensation Laws of Calltnrnia.Potc
drearm
NOTICE subject
APPLhe Work es Compensation
this CCnlns Of of Labor lode.you ould
most
hecdmesubjectm the such
Compenmthis prrmitshaof the Labor Cale,you most
z 0 forthwith¢Imply with such provisions or this permit shall be Deemed revoked, -
n :" •CONSTRUCTION LENDING AGENCY.] 1 hereby affirm mal them is a construction lending agenry,for the pcorpor a im
a
critic work for which this permit is issued(Sec.3097.Civ.C.)
1 - Lcndcr.,Name- -. ... _.. .. ,. ..
a z Larder's A.Jrc.w
.V Q�0�„.EOr� 1certaflthe I have readthis applicationandmatethat Wve information is
correctI agree to comply Mirs all city and county ordinanceand%l to laws telving
mbac,nsmu IM1eby th representatives of this city to enter upon
nu,nionad
aro . tde pea np
F,; L es,judgments.
dgme t smet and
indemnify keep h may at the GIyof tumaaiagmno
aid
Vi liabilities,jur4g encs, chez nJ expenses which may in am way vwmc against said f
of this picrian.
V z API�IQA. �f�EPf T,$mc pe D WILT.COMPLY WITH ALL NUN-POIYf I
Sill FRr: uL 3 ). dike �_ 2 Issued by: Date
sign a of ppTnuContructur . ' Data Re-roofs
HAZARDOUS MATP.RIALS DISCLOSURE
Y`he a I;cant ojaum biddingnen ant amm or Iwadle hamNous mammal -Type of Roof -
6<dcf eJby th Cup rn M ni tip nl nt Chapter 9J? and theHealth and safety
Cod S ti 25¢J'-1I - ` ". ', q`r Lia I{i ` s,';Jl i."rV q;
. , ° e . . _All roofs shall,be inspected prior to any roofing material being Installed.
. "slltneaPPlica^tafuture building«chP.at h.eegnipme^t orae.maswmmh Ifa roof is installed without first obtaining an inspection, I agree ro remove
emit hriadrnn air com,commms a<den ed by the Bay.Azr&r Quality Management
Districtall new materials for inspection. Applicant understands and will comply with
°Yet all non-point source regulations. -
1wee mai the hanisloua materials requirements under Chapur 6.95 of the
Califomia Health&Safety Came,Sections?5505:'_5531 and?SSJJ.I underhand that
it the build'mg due.nut cunanlly hme a maam.mat it i,,,,y na,mi,ibin,to nuofyahc -
dccupunl of the na,mmmenr which ren t he met prier to issuance nr tr Certincam of
citron
Signature of Applicant Date
e or antnarned agent Data All roof coverings to be Class "B" or better
.OFFICE