01060156 (2) CIB t of c UPERo NO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO,
1148 STAFFORD DR A PERFECT CLIMATE 01060156
OWNER'S NAME: APPLICATION SUB DATE
JEUNG ALBERT M AND VALERIE M 1 10570 S DEANZA BLVD 06/27/2001
PHONE: SANITARY NO. CONTROL NO.
` (408) 861-9545
o se z ARCHITECTIENGINEER: BUILDING P17RMIT INFO
O- BLDG ELECT PLUMB MUCH
Fa,<u, L-1 I= [--AL-1
LICENSED CONTRACTOR'S DECLARATION
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- I hcreb man Inco I tan licensed ander f can ter 9(inmttmncin Job Description
D Z-p Y u provisions u P 8
F_Fu wire-axion]BBB)ofDivBion3ofineBmi«essanJPm(cssionsCodeandmyliccnse REPLACE FURNACE & ADD A/C
a 11 in full fOKt and000qqqC
.za . License crosx Lie.a 23 UP/DOWNSTAIRS FURNCE CHANGE OUT
comracror
ARCHITEC-SDECLARAIO lcry-4.1 A/C ADD ON UPSTAIRS .
C O 1 understand my Ilam dull be med as public records F' E
w�O O Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm mal 1 am exempt from the Cmuramr'a License Law for the
t• .,,,),count, J U L 2 5 2001
Z I fallowing mown.(Section]1131,5,Business and Professions Coda Any
�x which requires.a impair to cunstmct,alter,improve,dca ohi h.or repair any structure
to r ,.at to its iuunnce,alsuaa,a,the applicant(orsu.h Penum m life a signed snmanion.
-' chile 0.Ii"rwd pr"oun,t,d 1' '.- I ilh,Caarwl,a, Lov(CI'pn9 S Ft..Floor Qrea , Uatlon - -
(comoso b with Section 70y)) ID' . l fineB - tWP fix, 'Code) • .y' . "!o
• 1 �' UILDif����
or that he is exempt therefrom and the basis for the alleged exempt on.Any violation
of Section 9031.5 by any appficam for a permit subjects the applicant to u civil penalty �p�_tt,� _
of net mare man five hundred dollars(s5001. 361,0%/ y u/nU6 .. Occupancy Type
❑1,as owner of the pars ,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec.]6141, -
Business and Professions Code:The Comcanor's License Law does no,apply to on 3 04 - ROUGH EIS $LnAMtetions
osn`r of property Who builds or Improves thereon,and who dares such work himself
roughhisownemployeesPrvidedthat such improvements we not intended or 501 _- FINAL ELECTRICAL, ENERGY,
offered for safe.If,however,the building or improvement is sold within one year of 505 - FINAL ELECTRI CAL`' •"
completion,the owner-builder will have the burden of proving that he did not build or
improve for purpose of sale.).
❑Laxowall of rhe pmpeny,am Business contractingwiN licensed Cantrauts ro Yt'
cOnxwm he project lapel](ova.Business and etty whonx build
-u The Conthe m.,
and who
Law does nm apply ban owner of a cony who halide se pursua them..,
the .
- n : . and woo is License
for such projects with a conrmnodsl licensed pursuant to the - _ . .. ... .. .. .... . ..!. - ... ... ..._ ...-. _._...... .
Contractor's License Ww.
❑Ium exempt under Sec. " - B&PCfor this rcuam x'
Owner Dam
WORKER'S COMPENSATION DECLARATION
• I hereby affm under penalty of perjury one of the following Jeel2onions:
❑ I have and will maintain a Ceni6cam of Comm ai self-asum for Worker's
_ Compen ation, as Provided for by Section 37M of the Labor Cade, for he
performance of the work for which mis permit is issued,
❑1 have and will maimain Wnrvr's Cnmpegatf m Insurance,as required by aecrion
37W of the Labor Code,for the performance of the work'for which oris Permit is
issued.My Workers Compensation Insurance carrier and Policy number aa:
Cariicrt�-T�iN� •'Policy No.: I SJU�1 - s. t - .•''t
CERTIFICATION OF EXEMPTION FROM WQRKERS9 i
COMPENSATION INSURANCE
(Th's.section need am be completed d rhe permit is far ma,hundred dollars
R 100)'It less.) ,
1'c i IY th.t in the performance of the work for which rh Permit is i%surd,1 -
ehall hal employ any farina In any resumer so as to heoumc xabje,l ,, he Worker'
Compensation Laws of California.Date,
Applicant
NOTICE TO APPLICANT:If,after narking this Cenilicam of Exemption.you should
become suu
bjeco the Workers Cnmm
Pearion provisions of the Labor Code,you must
0 fonhwito eaaply with such provisions or this Permit sur 11 be deemed resake d.
V]� CONSTRUCTION LENDING AGENCY
" ' `_� " .� ere
1 hby ailirm that mere is a cwootaxtion lending agency for the perfnmance
t
�;Qb(mefor which this peninii izsueJ lame.309],Civ.C.) _ _
..Lender'sr',Name' •. .-. _ .. ._ . . ., _ ..
p" Wndcr's Address - )\ i
� z
V o 1 unify that 1 havc read this application and lame that the above information is
I. E. correct.1 agree m comply with all dry and eaamy worim ince,and sate laws mitsm,
C V to building construction.and hereby mdonu mpmsentatires of this city to enter upon
r) rhe h i t J p.,,city
........(Wo) F tis indemnity and keep h mlvess.the City of Cpertno aganst
N i 'r j s, r and expenses which Y n any yet Satin. said
Cityq corm y. (\ nn p L
APPLICANT
`.—
- q�
UNDERSTANDS AND WILL COMPLY W'ITHAl:1 D �r'DINr' Issuedb Da[e ff++
SOU$(1rtR - y.
Si a(ApDlicaMComrnorDiftuf
� Re-roofs
re MATERIALS DISCLOSURE ,_ '.
soder war tihhe ee'Cu,emnoMuntip]Coe.Chaptstorenrhanmehaalthan Safety
Type of Roof __ _..... . __ . .. _..
p .and me Health end as&p' . . ,
Chapter
C&fe:Sec tion_5532(u)"
i
y K tamps ., aP°
LI Yes All roofs shall be inspected prior-to any-roofing material.being installed.
Will the applicant or future building occupant ase aptipnmm or dexims which If a roof is installed:without first obtaining an inspection, 1 agree'to remove
emit haum
rdous air coaminugeme
nr as defied by the Bay Area Air Quality'Management
at
all new materials,for inspection. Applicant understands and will comply with
❑r« NNo '_" all non-point source regulations: . ,•I,., t
1 have mad the huimbous materials mquimmcnss under Chapter 6.95 of the
C.10muia Health h Safety Cade,Sect ions 2550.1.35533 and 2554,1 undersmud that
if the building docs am iarmmfy hie am......bar it is an,rtsponsmilby to notify the
occupant of rhe regniremems which mmr be met prior,.issmnce of a Certificate of
Oc:upancy.'
Signature of Applicant . . Date
< aamanxe ager, All roof coverings to be Class s'B" or better '
OFFICE