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CITY
I BUILDING DPERTON
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT NO.
10970 MARIA ROSA WY
ALLIED AIRE SERVICE INC
01100116
OWNER'S NAME:
APPLICATION SUB DATE
WILSON WILLIAM M AND LINDA L
661 SINCLAIR FRONTAGE
D10/22/2001
PHONE:
(408)934-8844
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
LICENSER CONTRACTOR'S DECLARATION
Job Description
provisions ofms chapter Code9lrommecense.it
3.1' the
with Section ]000) of Division 3 or Ne Busirmss and Prokssions Code, and my license
Ilion 701h.1' Divisihat I on
REPLACE FURNACE (80K BTU)
L1. icense pie d< 0 sic.a 3 S
Date Y� Cnno-acun
ARCHITECT'S DECLARATION
[understand my plans shall be used os public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's Licenu Law for the
fallowing reran. (Sectino 70315, Badness and Protection Gde: Any city or county
$ 1541
which q pe tit t construct, her. 'mprove demolish or repair any suucom
_pda t t Iw req' the pplicant for such pcmtn to file a signed annexation.
ttm hytl,lt&tf$dpursmnttotheprovistonsoftheContractorsLicenseLaw(Chapter9
(comttvuwmg Sectio 7110f1) o! D'viston J of Ne Buss and Professions Code)
r i �:Y
Valuation
•,'N
or that M1e is exempt there(rnm end the bora for the allegd exentptbh. Any vmlahon
l [ t ] f,S.3 _�4l �ts_.'lvz'T-• Vi.\ st let / P
1
-"f Seniom]OJ LS by any opplicam far o permit subj«m the applicam to a civil penalty
mf not raorc themfrve hundred dollars ($$W).
7�ta�,��st�fit.
3 0 ?PN � ICl V'H PLUMB I
•"T `<' Occupancy Type
°1, as owner ofthe property, or my employee with wages as their sole compensation,
will do the work, and the structure is not interdd"or offered for sale (Sec. 7044,'
'9uihaess and'Professions Cale: The Contractor's License Law does not apply to an
3 04 - ROUGH ES�QfPg2lIIlt�$ tions'
owner of pmpeny Who builds or improves thereon, and who loan such work himself
505 - FINAL ELECTRICAL
or through his own employees provided that such improvementsrc t intended or
. _
-5-00 -
"-bffered for cele If, however, the bu Id'ng improvement is within one you of
.._
7 - FINAL PLUMBING (' '•"
completion,the owner -builder will have the hardenofpmvingNathedid not build or
mprove for purpose of sale.).
508 - FINAL MECHANICAL
am to
,contras owner of the p(Sec,
i .t L t' + . .YJ" 1'. r--
7 Bussexclusivelynd Prating ns Cricen The Connors
aonawn the project (Sec. ]044, Business and Cale:) The Contractor's
LI � pr A p
'
property who th
License Law does not apply m an owns of property who builds or improves thereon,
r Y ti /y LE ®
and.who contracts for. such prolene. with a comracmr(s) licenmd pursuant m.the_
... ... -.. _.. .. _...._
.. _ ... ..�.. __.. ._. .......-
Commvmr's License Law.,...�s_
" t" t
❑Iamexempt underSee: .9&P C to, his
•.. ,;
UI.I 6 2001
Owner ' 't Dote
- t WORKER'S COMPENSATION DECLARATION
I hereby affirm nnLer,penalty of ury oneofthe followingdeelaritions:
BUILDING
❑ 1 have and will 'rrminmin": Ccnifcam or consent to ulr.insum for Workers
Cona,matimi as provided far by Section 3700 of the Labor Code, for the
performance of the work for which this pcnm. is i,aud. „ x
O I have and will maintain Worker's Compensation Insurance, as required by Scction
3]00 of the Labor Code, for the perfnrmoncc of the work for which thin permit, is
issued,My Worker', Cpc s t do Insurance cancer }and PPoiicy nprobeer
tame 4'� 5
t� ir1'{
fit
I N OF EKEMPI'ION FROM�WORKERS'
I- IICERTIMCA'0'
COMPENSpATIINSURANCE° Y
ON
-.-a_e
-�•: .. eJ'f the snit is
bihu (Thrsisen on nccJ ntot ticcornlei far one hundred dollar
"t p' 1"I ';� • t. ):t -;.V' ) ;'u'
I4100)or less.?
Imnify, that in the perormarceofthe work for which this permit is iuued,I
._._..�__... _._-_-_... _. ._ - ^,I ;.1`';�trrr1Yl •, 'v ... .. ~... •- ..•. .-. +•,-
shall'nd employ'any 'person'in any man.cr so u to become subject to Ne Workeri
..
compcnsati.. Laws of California: Date' ""
.'Applifant o 1...... ,..,., .... ... ...... _.�. ,..
..._.
NOTICF. TO APPLICANT: If. after making this Certificate of Exemption, you should
- �.t
n on
beyome subjduoth<Workeh Compenshtian psov sbf the Labor Cade, you mutt,
forthwith comply'wiN such provisions or Its Itcrtnit shall Si domed revoked.
''"'"`I' CONSTRUCTION LENDING AGENCY.'
' - 1'tiertbY affirm th chert if iconst r o lending ego cy forN, per/..once
'of the work for which this permit is mtiod(Sc6. 3097 Cis, C)
I, '.,.
Lender's Name'". _' •"''".' •.
.. ___ .._
Lerder*i All
is
.1 certify Nat I have mad Nis application and statin that Ne above maws
reiati
center, 1 g tocomply th 11 and county ordinances d state 1 hang
tob'IJ gin .t cion dh byre th represett fth. t upon
out
the M c t d e pee, f p ti
upe
(We) ge t a mdemmpe dVeep hp" 1 i'th C'ty '!C -pert oeya
i aid
liabilities.judgments. con d expenses which y in vny ry e egamst said
CitYtoconsequence of the a g.o Nis p<rmtt. .' .
cAPPLICANTUWER$TAN ". YD VILL CONVEYN'ITH ALL hrO POI
n „: "
Issued b Date
y
.
SOURCE RECULATIUNS. v /O�
//11/x.
Sfgnnum of ApphcallUC"Illoc oq• """�"' ""':"" �� .,'(Dam"L'-
Re -roofs
,•( .HAZAI MATERIALS DISCLOSURE
"'�' WJI N pplicant or fm m biildin8 ampant aide os harMle.ai rdous material
_ -
Type of Roof -. - . - - - - cc
YP
aztlfnd bythCupertino Mntcpat Cade Chapter913 and theHealth and Salty
,'.;, Cf -r•F,i I
'"e
Cd s er.!z52(a)
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ti f"
i�y.i, S la, ?T'•, '..c•.?_r{r a 3ai `'.
R c
All roofs shall,be,inspected prior.to any roofing material being installed. . _.. _.
Will m applicant t r t building rc< pat equ p t tlaen which
If a roof is installed without first obtaining an inspectton,'I' agree to remove
cmn he u c rata t defined by theB y Aria 'Air Quality Management
Distinct?ii:L
all new materials for inspection. Applicant understands and will. comply with
El Ye, . t°� ,. Ir..
r
'I hase'icatl,ihc hazvdous mSmnals rcquirememi+undeiChepter'fi.9$'d(the
all non -point source regulations. ,, , -'
,Ca
,if ailing th Sof cur Cody,ase 35505,-2itis and 2A3mbilayounderstandtthe'
dieb os ramify thin
doescurrently base
if Ne. M1n, d
f, requot
met prosmyrcapormicf.c
"ocEopaht oft ' iyquire is which"muni la, met Piior,to issuance of a Cc Ificate of
°°"` " jp " •
Signature of Applicant Date
a o�.
All roof coverings to be Class "B" or better
owner oraa�nnd ages
L.:, "— OFFICE