02010117 CIBUI OF G DPERONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10538 SAN LEANDRO AV A PERFECT CLIMATE 02010117
OWNER'S NAME: APPLICATIONS H DATE
PIEDMONT ALLEN R ET AL 10570 S DEANZA BLVD 01/29/2002
I PHONE: (408) 861-9545 SANITARY NO. CONTROL NO,
O-0 ARCHITECrIENGINEER: BUILDING PERMIT INFO
kC O❑ BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
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ob Description
1 herebyaffirm that I am licensed ander pvision..fCha,_`9(commencingzPi_ with Section]uW)orD;visioJarm<Buu�ssend Pmleasions Code, nd my licensee REPLACE FURNACE .
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UQIIdfss,, HITECTS DECLARATIO f
n my plans shall be to las public records
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25 a O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
z a following motion,(Section 7031.5,Business and Prare:tions Code:Any city or county. $9900
E x O which requires n permit m corolla,alter,improve.demolish,file
repair any structure
a. m.
poor to beA aI rcqurt theapplicant( such permit License .(Cha(Chapter
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issuance,
NetheeRe. dpc ttNpt ivii ftheC treemelandNLew(ra,Cod ) '�rr ( �) I Valuation
(c ig iN Se urn]000) 'f Uiv.' Jfthe Bminea and Pr Jesoons Coder 5_\tis9'�'�3. vnO�V,��iY�YHe.'1'?il Js yt�ft
or Na he R exempt and the basis for the alleged ekempubin .Any violation -' 1
-of Section 7031.5 by any applicant for o permit subjects Inc applicant a.civil penaity- ,
of nor marc Nan Fiv<hundred dollars($50k). 3 01APN I�W6H PLUMB IN I tr' '• Occupancy Type
❑Las ow.er.fda property,or my employes with wages as their.mli omo,onsaaon, 3 - R IJMECHANI AL
-will do-the work.and Ne'swano
um Ii' t'n ctuded-or offered far rah,(Sec-71144t- '"---------- -- - .___ ._._. - -.. - _.-------
t
'Bus ness and Potfamions Code:no Contractor's License Law does not apply t 304 - ROUGH EII& 'Rd[t0&ctions "I-
ow
r of property who builds or improves thereon,and woo does such work himself 505 - FINAL ELECTRICAL
or iM1 his own imployies,provided that u himprovements "m intended or
miffierid'or sale:'If.n ve.me wuemg pmemer,hisold withinone year or
_.._ . ..._ FINAL"PLUMBING
_-_...._. __.._., _.._. ..__.
completion. bu � eN horde fp provingthat h did not Wild or
tinpfor l )
-5--.0_ 8.._. _ FIN_.A...L. -_M_-EC_HA.NI.C. AL
01 of property, exclusively sYe r gith licensedcontractorsto
construct Nproject oaa Businessand Professions Cock:)The Contractor
License La doe not apply t n owner of praprty who Wilds p ver Nhcmon.
-.,.
_and. ho commas for mch.pro)ect..wN contractarts)licensed.p uant.m.thc
Contractors LicenseL
❑1 pt deunder "t B,&PCI this. eon
'WORKER'S COMPENSATION DECLARATION
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' •. '.. 1 hereby affirm under penally,of perjury one rLNe following dcdantions: ..
l ❑ 1 It will maintain a Certificate of Consent to mlf-insure for Worker's
Compensation,-as provided for by Section 37W of the Labor Cade:for the
pe,fmnomv.orthe work for which Nis permit is issyed.,
❑1 have and will maintain Worker's Compenvdon Idsumnic,vI required!by,SictiIan
J]W of the Labor Code;for the performance of me work for which this permit
isined.MyWorkers C tape aur haturarm,carrier aPol Y b areenA ) o
am ri Pole - �"J v p; ]t
f CERTIFI ATIONO E%E. ION FROM WORK 'Cl. s y s ) a 3 a 1
_. COMPENSATION INSURANCE s
(Thissection n errors be rnmpleted it the permit is for one hundred dollars "' ` " """ , -f
IS I W)or lett.), i
1 cerdify that in theperformance of the workf which his porm, s JI
hall'not employ any porton in a,y ma nc as 0;be un a mblccr to he Wnrkcrs
ComperivationLows Of California.Date
Apiplis -
'NOTICETOAPPLICANT If free makingdai,Certificate fE. rept - y 'should s '
Z becorne subject to the workers Compensatioripr mol of[fie Labor Code.you hair
Q 2 --form th comply with such pry s ons o thispe t shall be,J e ned revoked
. _ ___ . .- . -_ _ -. . .__ .. _._ -.- _. ._ _ ._...._, .._.... ....._._..
F.y "'I _ "s CONSTRUCTIONLENDIN'GAGE,NCY
I h by ff that th n t a n Ina ngg gen Y f the perform nee
permit is a;Q Led Hf hM1IM1. P ......., _.. ..._ ._._ . -.
7;Z L,6,t AJd ss•,_ , • . . ,. 1 .III„'...I:
V C) 1 ttrtiry that I have mad this application and state that the above information is
eorrena agree tgcm illy wire all,city and<o,mty unhoances and state laws.chin,
Q.V tobad ingconst6:tion,anhemby'auMx
orirepmsenmuwpo
tivoftnisciiyenterun
} W th bo t ned pm,,rry f umpe t W r,.s.
(•" 0. (We rec to a< indemnify and keep harml the City or Capers.stmnat I
D`
liabilities dg r s t: d, pensc h h y n uny ay c against said
V'�Z City 9 c fm r'ng of lh pe t' t
APPLICA T NPI A. D AND WILLCOb1PLYWITHALI NC -POIN I$$ued b r Date
s RC ,'S ti y'
ignature'r, A lie nm ., :./,. :;Dan. Re-COOT$ /
HAZA QU MATL ID
Will pplISCLOSURE
ba t of fu I<IailatnIt cu t t b handle mad material _.Type Of.Roof
ces defirsedby the Cupertin M 1C Chap c912 and he Heath ry
dS f
CM< S❑cY 2553_(1 'T ` rs. [d.r ;'-,
' ' '` ,All roofs shall beinspectedprior to any roofing material being installed,
' Will the applicant or future building Occupants equipequipirmor devices hich'. If a roof is installed without first obtaining an inspection-I•agree'to remove
c t haurd arc ream t. dei J by th B Y Am A Qu 1 tY NI wg - m'
District, all new materials for inspection. Applicant understands and well comply with
” all non-point source regulations „
I have real the harallous marenals rcgmretsKna unser Chapmr fi.9la of the
Ca arni5 H &Safety Code,Sections 25505,25533 and 25536,1 understand Nar
"do
is
di N "snotcurcntly haveaten 316 thinhis my rcspom41liry the
r quit e�tsr quit core whidn prior to issuanceprior to issuanceem _ Signature of Applicant _ Date _
w ett t ,gtt,.gent All roof coverings to be Class B or better -
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- OFFICE