02090176 cl BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10140 N BLANEY AV VALLEY HEATING & COOLING 020901176
DWiyERE1'$�kpt JIMMY J AND PATRICIA 1171 N 4 TH ST APPLIc09 / 002
NE: b�
N/262
P�HIO. (408) 294-6290 SANITARY NO. CONTROL NO.
n.O za ARCHITECDENGINEER: j BUILDING PERMIT INFO
z ` BLDG ELECT PLUMB MECH
y<� o u u r :I
LICENSED CONTRACTOR'S DECLARATION
5„ ffirm Job Description
pi-� Thereby O).f that B.sinundprod PronsofuCedChapte9lcomyficemg REPLACE DUCT & FURNACE
I„yFu with Scetio ] )of Divixion3of the Bu�and Professions Cod and my licenu
a Y J ism full r° a C,.
ai e re a Licenu is
- GT L:c.M
KOiO rc - Comraa��r tC�11AG dA
F u LLO}-i, ' ARCHITECF'S'OCCJGARATION G'".
i 3 1 unJerstanJ my plans shall W used L�Ipp blic records
C'a o at Licensed Professional OCT 0 4 2002
nOWNER-BUILDER DECLARATION
u� io
h I hereby arlimt that I um eacmpt from the Contractor's License Law for the
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following reason.(Seninn]031.5.Business and Professions Code:Any city or county
$1800
which rcy e permit t c i t alter improve,demolish,o repair y structure BUILDING
iit�. Pn t It.issuance,al q m applicant for such permit to flsigned.tatement - g 1�, _....._ .. ._. .... ._ .._.__._- -.__,
th lh�' Ic nk dpws.mn-theyi°v Bions of m<Connano L L (Chapter9 „„h 3x181 f9 V4'Ory'ea 2 ., Valuation
(c m 9h,wah S u° ]000).of Division 3 of the Busm t, d Professions Codc). ; •1/ y�_,,,, 11 :e a',1... .-'fV.l i
or moi he'is exempt mcrefmm and the basis for the alleged exemption.Any violation '•
-of Section 9036.5 by any applicant for a permit subjects the applicant in civil Penalty
ofmot mom man five hundred coal.ars S500). 301 APNAbUt49I PLUMBING +'"-"`"" Occupancy Type
01,as owner or the property or m'yemployees with wages as weir sole compensation. 303 ROUGH MECHANIC li
_.sit[do the wort:and me simian.is-nm'lmeaded'oroffered-far salr(So,.]lata:' - - 304 - ROUGH ELEE�� ' jq��-t c',n:.
cBusihess and Professions Code:The Contmam's License Law does not apply to an A kl&Q ectlons"'•• :F
ofpmpenyWho buuaaorimproves memon.and who d«s such work himself 505 - FINAL ELECTRICAL
or thmugh his awn employees.pmmded that such improvements are not intended or
oR:red far sale:If.however,the Funding ---'improvement is soldwithinone ini of _ ---' _.._....____..._._.__._.._...__.._..---_.__.
gonmen of pro w x 507 - FINAli--PLUMBING----s:••-.s. "• 'e•aP .t ',;.
compaction,the°weed s ildcr will love the burden of Proving that he did not Wild or
improve for purpose or sale.). 508 - FINAL MECHANICAL
- - - p.Laa ownerpf-the pmc--i---._ra.a.i_,with-licensed-----ncontractors to
construct the project(Sm.70at,Businessand Professions Coe:)The Contractor's-'s
I ;'' • 't i'. ---
4LLG
License law does not apply man owner of property who W ills m improves Ihercoo, """ - ”
_and who.contmeu.for such.penums.wim a.comractortsl.liansM pursuant to the. .-
Contractors License Law,eY"-.: __.....__....
❑lam exempt undcr'Sce. ,B&PCfor this reason ,• ,.
'.'.c.., u. i... .. .. ,
Oncr: t:b. IDaie"n, � ,,... ..�: : ,.,,
WORKER S COMPENSATION DECLARATION
` IherebY ffirmdo pen❑y of pet ry. n at the following d 1 tions.
Cl I h 'd "II' ,x nta a'Ccmfi t of'C en
st If
m ' . re for Wmkcr's
C w. i . provided r r by Section 3700 of he WWr-Code. for the
- _ - wrromtanefdrm�w��k B,rwmen mspermd is iss�ea. ,
❑I haveand will mihnain W'k •.'Cd pen t ri'msurad required by Smtion
n0q I.n Lab C I r there f, r te r h'n m permit,t
issued My Workers C tope t Insurance er P y. W
` -+'TFIG ION OF,E%EMPfION FROM WORKERS., i 'n '. . .{..4..
COMPENSATIONINSURANCE' - - "'
IfY1 ` (Th suninn neeJ nm Wcomplc¢d fine permit is for one hundtM dollars i a7 '�`I " ..."til 1 i 1,'f1:— --_-
(5100)or lcvs,)1 '
shafn In pert rmance' f m rk fo h ch th perm i s'is -ed I ...__ ---------.... ,,.
slizill not employ any person in any manner u a!m become subject to the Workers .(:;ill 1 ` - "~,.,_�...._W_.�_..,•y
Comwnsaiion lawk of Ca ifirmia.Dae'
-.NOTIAlipllani. P" - - ..__-._ .- ._-_-.. _. - ----------
NOTICE
_.._- _ - - _.._ _ __._ _.
NOTICETO APPLICANT If, fcr makingm'.Cri ficamfE p,o you should ,. r1 --- -- -
Z become shbjecraothe Wmkers Compcnsamn pmrisionsof the l_iWrCMe.you muia
ZO fdith'with comply with such Provisions or this permit shall be deemed my°kcxk
F„ m CONSTRUCTION LENDING AGENCY -" 1' ' : 4' I'•^
.99-- 1 h rctiy aRim that m a con tmcr o lendin6 erg y fonhe performance
•of m ork for rich m s permu Is issu d ISec'309]'Civ.C) � '
.;D.Z 'L'ed .Add s >- •.• . ... .._ .._ ._. .- ... . .._ -'-_I- _._ _.. _ . ... .-_ ..--_.
W... 1¢mfy Ina 1 ha e rc d th.oppl c t on d.mm that the W information is
F cornea.I agree w So p1Y, ,h II iry and< ty Ninan< d t m laws
retain,
_moi tJ �to building corewaidn.anJ hereby authonze reprcsemativesbf this city me mer upon
',�.,-Cs7 the above-mumioncJ propcny for inspcnion purposes.,,,
-; ;L, L (W I grc<io a d nfy andk pharml theCty fC peri rob against
L-; rq liab t ) dg ems <n t d e pcnse h M1 y try y gains said
U Z Cit c - -• "• '
APPLICANT U.NDER�TA.D$+YD WILL COMPLYW'ITFi INT Issued
Issuedb
sou 1cE R uL-+ aV Y Date
a fApp¢pnUCot t " Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
u to ppi t n f t re handling part to handle hamNo x madefind . Type of Roof
as de dbym GPnaoM pl,Cad CM1pt 911 dmeH lth d5 rty .f . '.l i t
Cade s ctq ]5532101 t ! t {
1 ❑Ye - t1 fl t^ �nf t l-B(ire* ) ra'4, �
.,
.. All roofs shall be mspecfed prior to any roofing,material being,installed
I
Will the
Oplmo future Wilding patoequipment q es which If a roof is installed without first obtaining an inspection-'I'•agree'[o remove
c Ih mrdcontaminantsdefined by Bay Ateq Q or devices Management
Di t' ' t _I. ,all new materials for inspection,,Applicant,understands and will comply with
' FJI i ❑Ye "r 11 all non-point source iegulahon5
1 have Health
& Crate. maanal.s mgmremens u der Chapter erns obme
Cehe Wil Health&Safety CMB,Sections 21505,that it
end 25530.1 understand that
if theWildingof gdpesnotcurea w haveatc W me,Prior,
is,Y2spohsiofa mnd'x'Yof, ___--,-
' occupam of the Fegoitements which mon Sema or to issuance of a Certificate of
oee wady: ,. P `
..._Signature of Applicant_ Date
ti c maummnexsdag m � , Date, All roof coverings to be Class "B" or better "•
�.y
OFFICE