02020053CITY
DPVSIONo
IPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10627 B ISIDLEY' DR
ICOM MECHANICAL INC
PERMIT NO.
020200c;;
WNER'S NAME:
—
APPLICATION SUB DATE
'66APPLE
477 BURKE STREET
02Z14/2002
HONE:
SANITARY NO. CONTROL NO.
(408)792-2292
0 ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
G
BLDG ELECT PLUMB MECH
is
"I rJ L-1 LJ
i LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm Thal I am licensed under provisions of Chapter 9 (commencing
Job Description
P
with Section ]0001 of Uivisionl Mlhe Business dProfeuionsCWr.n dmylicense
in full 700)id Di,h� � ZL
License
REPLACE A/C UNITS (4 TON)
.
� �p.yk Co rm ar
h Jf RCHITECT'5
DECLAR
1 unJerslnp{ y plans shall be used as public rtande
s �Jn.ni3
I.nMnf-J�Ibtcsal
OWNER -BUILDER DECLARATION
1 hereby affirm on 1 exempt from the Convenor's law for the
1,
a which ngreaesa (Section ]031.9, ionxCWr: Any tiny orciliary
e: Any c
comedo, alma, improve, demolish, ore pair any mm�um
t. altess r. improve.
ve. de
a. poorat iso a pemlin tmmena,
iamedP...,quhea
$15000
-ho o Ncepplfnan fm sucnpermh mlleaeLaw(real uapter9.
- -Nit lid is.littn¢d punuim so die Williamsns of the Contrazlots License Lew (Chapter
Oil liths
(rommencing wiN Se<tion]0003 of Division laf Ne Business.nd Professions CWc)
5 Ft:r FIOOr:ALea .t
t- ! yam s \ t
i. Iv v,.
Valuation
or Nos be i3 nem 1 Neferrom ane Ne bexix for Ne ane W e:em aoi. M
P g P Y violation
• 1.
3 2'
mit subjec¢Ne epplicam mecivil l<mhr-
-ofmare
'of.., mart Nen five hundred dollars ($500d.
than vanydreddllfrs($50
APN Number Occupancy Type
❑ 1, m owner ork.- progeny, or employees »ages as their sole
301 - ROUGH PLUMBIN
will ur is net intended , (See:uiion.
endo Lad foes am 1$@: ]B•U,
the work. -and n,he suracode:
"" - -'-
sinti Tire
Cede: The Contractor's License Law dos now apply m an
v Lie a
owner err
owner of.hd'Prry Who
Who la, is at a was x n k nimm8
- is
304 - ROUGH E
his ow provided
or used his own employees. P idea o i M1 improvementsarc t meed or
;drceRarar.me Irma» m imldiii P'-ementis 'le -within..._
eyes ar
_ _ _
-- CAL .,,ENERGY--
completion, the comer -builder will have the burden of proving that he did not build or
improvernrpmryamarxme.>. g
_�','•" -
502 FINAL PLUMBINGENERGY
-
y g contractor, o'
503_.__-_FINAL.MECHANICAL.- ENERGY - -- -
consumerNvfen(SeanwnBaine, ad Prom„om.cnde:) TheContracto,,
,_1
505 - FINAL ELECTRICAL.,,.,
License Law does not apply to an owner of property who builds or improves lherson,
-and who, contracts mrsuch.Projects with -a convamods).licen,ed. purauam.lo. Ne.......
507 - FINAL PLUMB I NG -
_.. ._ _..... _-___....
Convenor's License Law. ., .....
❑Inon ,esem nynd«SW.P,%B&Pckathistanann
508 - FINAL MECHANICAL..
Owner a �p,o-Date
WORKER'S COMPENSATION DECLARATION
I hereby aff rtn under,Pcnalty of pedury,one of she following dcclaraions:
-
O I have and will'inaimtnin Is Cenifcate of Content so self-insum for Worker's
Compensation, as provided for by Section 3700 of tire Labor Code, for Ne
_ Performance of the work fm permit is this peis issued.
tea. a
�aaa tl w+
❑ 1 have and will inainiaiii Worker's Coinkrolaudn Inimarice. as eequired by Section
-lobo
3700 f d Code far the kaficamenice of tha, work far which N,'permit is
'
. uW W k Conniption t minium -e Policy. ,�
1r� f�k/ [t /)
MAYA-6 (•O.O�,
u�yybye�/
Caiji� V'
_
i. s!�;] r as "Cl-I.-J”Fxy
rl CERTIFt %�kA�le ON ORKERILa
s
-- COMPENSATION INSURANCE' a `
.-
. .. - . .......
is; -'i. I(Th
n
...... .w... -.._ ktl,.n
���• DI1��-
ml�i� ccd not he compinee ifnM1e permit iz for one nundrtd dollars
h.
,.. .:t; 1
cent y lbal in the Performance ofthe work for which this rmit Islioused
'scall
not employ any rvirson in any manner io as to become bj �io the Workeisl'
..-• i is',
Copen. Ilan A lAWof California Ualt .. •.. ,. •..,..
m
N O APPLICANT. aft Ong Cesi r am npi on you should-
come su r h
bon perms ons of the
the CWc; you mum
nrchwiths
tit Workers Colons
s '
aLabor
artily
fonhwinh fomPly with such previsions or phis permit shall be deemed rtvoked.
1 or
. _ ...
_. .. _..
1 ""•' `'CONSTRUCTION LENDING AGENCY - '"
_ ..... _ .. ...... . .... _. ........ ....
-
I
I he by- Thum that Ne van lending agency for Ne performance
ci6ed
of the work for whifh Nkypermn is issues (See. 3097 Civ. C )
s (
Lender's Name"-• „_. .. c.»__.•c ._..:_.
1lnder's Aeeiexs
- --
,I certify that 1 havelined this application and slam that the above information is
correct. I, agree to vidnPly,with all city and county ordinances and stain laws miming
no building conxmxction, and hereby i uil repmsemmtives of this city to enter upon
she above-mentioned progeny for inspection nationals.
"
(W) agree to tart, indemnify and keep hamllcis the Cny of Cupciiino'"against
liabilities.judgments.
cosu and expenses which may any way are against said
City c etram fNeg morning of dr, r •..
'A PP ICANTUNDERSTANDS AN WILT OMPLY WITH wLLNON IT•
SO RC Ef L
I O�
Issued
TI �2��}
by: ate
ignal irclof Appl cars d2o, ., 'O ;' 'Dime,�,�,
ARDOUSi
HA]IxRDOUS MATERIALS DISCLOSURE
.
Re -roofs
W ll the heart i m building g ham t handle i vial
weer Wl
T e of Roof..
YP
HeaNn
[heCPann M u
municipal cod Chapter 9 1 z e N Health and Safety
C'de S n 253321u)
I,, i eliNNo ITs X11
.
I 9 d ( iiy C '• i � .;� -
� Z tt tv
..❑Y
�,; cpy4
'ac
3I_s K��tT dlii
. •_ --------
All roofs `fiat] be inspected prior to any roofing, material being installed..
,., W 11 the aper t f t building P aAi t dl hent--
t
Dinh E usmrcnnmmmamsaseefineebytheBayAieaAirQualnyManagement
.- .. .. .. . _... ..... _
If a roof is installed without first obtaining anlinspecllon, I'agreeto remove
Districts'
r ❑Y _
all new materials for inspection Applicant understands and will comply with
aIC non -point source iegulahons
.1 nisvi, read the h11% in'd0usmaterials' coq irtmemk6nde Ch pier 695 of the
California Huldi & Safety Code. Sections 25505 25533 and 25536 1 uedersmnd that
dthchuilding docamn cuncnly have. tenant, itis
"
than my rtsponsibilily tonmify Nel
softy c
�u em! a i r uirearso is which most be n prior in isivance'of a Cer ifuse. ofOcc
' _ -- - - - --- .-_ - -- - ----- -- - - - - - -
'
Signature
__ of Applicant Date
All roof coverings to be Class "B" or'better
�r ale
...--.t .._............. { __ ... OFFICE--..