02060177 CITYUILDI c DIIVIISSIONPERMIT CONTRACTOR INFORMATION:
t BUILDINGADDRESS'. PERMIT NO.
10464 DEMPSTER AV ATLAS HEATING 02060177
OWNER'S NAME: APPLICATION SUB DATE
PAYER RUDOLPH AND JEANNE L 155 SAN LAZARO AVE 06/26/2002
PHONE:
(408) 739-0516 SANITARY NO. CONTROL NO.
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z 5 N_ LICENSED CONTRACTOR'S DECLARATION Job Description
O Z-O 1 hereby affirm that 1 am licensed under provisions of Chaplin 9(commencing
pr-nFy
with Scenon9000)of y ' 3'o^ftheBusiness add sion Cal and my license REPLACE FURNACE
z m E is in full force and <ce�V
S eco i U
sect . Lic.p /V1 1L �a lSN/UV
a�3 LL H Dam Conmamor 8��,J�"
ARCHITECT'S DECLARATION
O
r 1 undero n l my plans shall bc used as public records D C� O Lz fy o00
O L L
pop Licensed Pmfenanwl
_u OWNER-BUILDER
1 hereby.!Sero thin 1 am exempt from she Contractor's License Law for she �'�D'p'/�
!'z n following tenon.(Section 703 LS.Business and Profession Code:Any city or county 5 0 0
Hp which requires a permit to cult,the,alar,improve,demolish,ore.air any nuemind
t its . •ossa rc4 N apps sent forInch permit I s g ❑ uumwt
(hath 'slicensed,Section
pr sin.Of the C t mY L' La (Chapmr9 �z��s y0pr� p v rx Valuation
(coin g 'N Se ton]b(d) (Divi o Sof theBsipessand Pofe ons Code) 1 '"� 32�(]04t'09 Sd1r-a' T'dw N
ate Nat he s exempt 0erefmm and the basis for the aIle ed exam sion.An �' 3 �' "
g p y violation
of Section 903 IS by any applicant for a Permit subjects the applicant o a civil Penalty s
Of not mere than five hundred dollars($5a). 3 0 3APN�i MECHANI(,Ali'' `-' Occupancy Type
❑1,as owner of the property,or my cmployces with wages as their sole compensmion, _ ROUGH EIECTRT 'AT,
will do she work.and the structure is not intended or Offered'for'sale(Sec:]DLP,
Business and Professions Code The Contract.,a License Law does not apply to an " 505 - FINAL ELI]KmRI CAketions"'^ (- -
owner of property Who builds or improves thereon,and who does such work himself
orthrough h. mployeev provided that such oprovemnals arc not intendedor 508 FINAL MECHANICAL
"tiffened f left h wevcr the build ng or improvement m sold within-ane of _ "'---'- - - -._... ... . .:_... ._ ..... _...._......_.. ..
completion,the owner builder will have the burden of that he did not build or -
for of sale.),
Proving
I
improve puryou o
. Elj ' .____.... -
al Inc p(Sec.rc, am Basin la t fe i with e:)The Contractor
s
n t" t to projectno(Sec ]Does Buz owner
o and Professions Cade)The Cnnlmnor s
License law does not apply m.,owner of pmpcny who builds or seimproves t to th.
and vector's icens_(Law., prolects.wit tIa commaarts)licensed pursuant to the_
Contractor's License Law.
❑lam aempt under SCC. � I ' ,B&P C far hls,Cason
9wnc, Date ..
' WORKER'S COMPENSATION DECLARATION
1 hemby eflirm under pcvilry of perjury one of the following dedarmions:
t -0 1 have vul will maintain a Ceni(cae of Consent to self-insure for Worker's
b 4 _ Compe...lun, as provided for by Section 3700 of the Lattice Code, for the
_ - -
performance of the work for which This permit is issued.
O 1 have and will'anumain Worker Compensation'Insurance,ax rcquircd by Section
3700 of the latbo,Code f thepe form of die work f which this Permit'
issuM.M (
rkk�' ( 1 m tender
and be
�PoI yam
Cam - s w mPol it
y N
CERTIF CATION OF E%EMPTION FROM WORKERSz d i es L V? � �,.y12 •�s 1.1 A.�1{ �<,., t
COMPENSATION INSURANCE'zV
e
.action neednot he completed if the permit is for one handed dollars - •. .. _ - .--
($100)
0)or oeleca.l -
s Iccmfl that i n e p 1 an f the work 0n come u ct t
shall not nim L any Person ur any manner so as w become subject m the Workcrsl •' t
Cmhpcnsmicn Lawn of Colifomia'Dann
Applicant
s NOTICETO APPLICANT ❑t m
If ak g si f me of E pt y should
0
Z neeOrocso
co the N k C rap to o p sat the Labor Code,y,u must r forthwith oh ply w ith such provisions ooh Permit shall deemed revoked,
Mthat here,,ac
CONSTRUCTION LENDING AGENCY'
t I ,kfor M.(tie there is o"sued(Set. lending,gen<y fol the perfomtance +
id the k tt hlch th- permit .._ r5 31>9),Civ.C.)
Lend .Name „ . - 111 ._... , .... ._.
Lend Address
-
Icnfythat lhave 'd this application and state that the bnve information i
[st t1 correct.l agree to comPlY will,all e p and county ordinances end state laws rel ting
� V tobuilding construction,and M1 by antlacrize reprciuivcs fth%citso, ter u,na
} ¢7 the be e mentioned p ve.ny for"n peal n purposes.
-F. L (W)agrce s. ., mac mfyonJ kecphm a,,in the Chyorinue quimllann
V] liabilities,judgments,cos expenses which a,,in any why acerae ogain.w said
U Z' City in connauto sx o c graining of thi+penniC' �.
\° 'V Si'ANDS.AND N'ILT,COMPLY,11'I \LI OV-P h'T'
titre .. u df '2 - Issued by: Dale
f A plican. 11:"D for .. Date
tIAZARDOUS MATERIALS DISCLOSURE'' Re-,OOPS
' .
Will a applicant or future building w�c'vpaotstore orhandlehaa.annismamriul. . -..Type of.Roof
_.__.....
as cf M y'heC Pamn Municipal Cod Chapter 91 and the Health and Safety I ._..__ ... ...,. >...,.• ,.,,.,.... _ _., ..
C SeY 25991.) - � ,s.x .�; I. : . .-
( i tat" f 1/ ( +x
t. \ I S ;l. L
_All roofs shall be inspected prior to any.roofing material.being installed.-
W
dth it coli t r t building c p I e equ p ant a ares which If a roof is installed without first obtaining an inspection; I agree to'remove -
emth Jo t t sddined by th ByArea�s Qu IIY Managemem
°i" 'oY _ �- all new materials for inspection. Applicant understands and will comply with
.01 all non-point source regulations..
1 h ail the h r J triak"turcurvers order Chapter 6.95 ol'the
California Hcaat Ytions 5505 5533and25534,I nderstandlin
' if the hall in til nc yh.1 lenonl.lha loamy rcsponab'nym ifY
ac m of the m which mum tie met Pri r m t, nc f e Cen' eau of - - --
C--
up
Ja.
U 1�� Signature of Applicant Date
Owns aero adage t - - Date All roof coverings to be Class"B" or better
. . - -OFFICE-