02120064 CITY of cuvFSIONNo CONTRACTOR INFORMATION•,
BUILDING DIVISION PERMIT �;.
BUILDING ADDRESS, A & H HEATING PERMITNO.
20652 CLEO AV 02120064
OWNER'S NAME: 770 CHESTNUT ST APPLICATION SUB DATE
BURROW -_ 12/16/2002
IONS. 408) 279-0722 SANITARY NO. CONTROL NO.
ARCI IIITLT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L�
�00
LICENSED If.,ACONTRACI'der DECLARATION
u F I heresy 0)ottn lbs 1 am licensed under previsions of snarler 9(mmmensi is Job Description
Nz� with Scninn]IXXp of Division}uf the Busln fynJ Professions GWc.unJ myliccnm is
<N inI'dif anaeIfe .J� FURNACE FINALE®
OZ-o Dae / Z''( —6;V Conlraflq{� r gk
� ARCHITECTS ARA I DEC 1 9 2002
< 1 understand my plans shall N used i s public records
Ed
OyU
LLOS Licensed Pmmaxional
OWNER exempt
DECLARATION BUILDING
ce w<y 1 Wrchy affirm That 1 L .sump,from the Contractor's :Any c Law for lbe
m d 0 ofollowing rcamn.(.Section 703 L5.Business and Professions Code:Any city or county
,--E! which tedi im,a permit 1,,construe,.alter,improve,demolish,or repair any structure
,w prior O its issuance.also requires the applicant forsueh permit o file a signed Statement
< that he is licensedpursuantothc rovisionsofNCContncmr'sLicenseLaw(Cha(Chapter S Ft. Floor Area
cute P d 9 $28'ffl4Ltion
u, (coOur he is exempt
xempth therefrom
fromon Iand the
hour
3of ISO al Business exempt Professions Code?of
i 3$ that be is exempt Wcrtfrom and Ne bazis for We alleged esrmptinn.Any violation of
Section 7031.5 by any applicant for a permit subjects We applicant to a civil penally of �. O
not more than five hundred dollars(E500). Occupancy P Y Type
01,as owner M the property.or my employees with wages m their sole compensation,
will do the work,and the strucmm is no,intended of offered for sale(Sec.]o4q,Business -
and Professions Code:The Contractors License Law does not apply m an owner of 303 — ROUGH IUns
prolpertown roywho ycei.provided
ided thmslhc¢prove who does such work himself or eedthrough his 304 — ROUGH ELECTRICAL
however,be building or
such rat is sold
arenot intended
mpleti n,Orsale owner..
hutlder theaveteorimprovementissoldwithinone year of completion,themoseo
Winter will have me nameri of proving that he did not Wim or improve for pnrpssu Of 505 — FINAL ELECTRICAL
sale.). 507 — FINAL PLUMBING
I,as owner of the property,am culusierly contracting with licensed contractors to 508 - FINAL MECHANICAL
construct the pmject(Sec.7814.Business and Professions Code:)The Contractor's Lt
cense Law does not appy to an owner of property who Wilds or improves Nemon,and
who contracts for such projects with a contracmr(s)licensed pursuant o the Contractor's
Licmva Law.
❑I am exempt under Sec. ,B&P C for reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby of ore under penalty Of perjury one of the following dedidations:
do❑ I have and will maintain a Certificate of Consentto self insure for Worker'x Crimper.
cation,as provided for by Section 37M of the LBWr Code,for the performance of the
work for which Nis permit is insure.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3710 of the Labor Code,for the performance of the work for which this permit is issued.
My Wirt.•:. Compc'nsalinn Insvnncc came,and PoIcy nu t Wr a2:
Cantel.r�b cuL EO.£i PWicy RO
��CA1 CERTIFICA EOP EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
(This section need nut be completed if the permn is for rine hundred dollar.(511X1)
or less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject m the Workers Compensation
Laws of Cahfomi r Dale
Applicant
NOTICE TO APPLICANT.If.are,making this Centric..of Exemption,you should
beeomc subject m the Worker's Compensation provisions of the Iahnr Code.you must
0 forthwith comply with such previsions or this permit shall be deemed revoked.
Z M CONSTRUCTION LENDING AGENCY
F Ihereby affirm Or,them is.mnswction lending agency torte perlinmancc Of
ai the work for which this permit is issued(Sec.3097,Civ.C.)
UJ QLender's Name
z0. Lemdere Address
O Q I eerily Wall have read this application and state that the above information is
0 F breed.I agree In comply with all city and county ordinances of and slam laws relating e
OU buildingbvmentioned construction.and he2hyaulhonprposesenmlives of thixcity toenter upon the l/t/`/f`/-•_/
r 4[7
above mentioned it)sartyve for emnifyan keep es.
d
(We)agrees.save,indemnify and keep harmless the City of accrue
against
HN in
of ms.
cristsand expenses Pemiich may in any way acerae agamsmid City
V z A cPLrICANTc of UNDERSTANDS
ng of A permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC�EGULATIONS
�P� r�' 4L�1�z�7 Re-roofs
g woe ofnpphean✓Contracax tram
HAZARDOUS MATERIALS DISCLOSURE, Type of Roof
Will the applieam or future building occupant atom or handle hamedims maternal
as defined by the Cupcnino Municipal Code,Chapter 9.12.and the Health and Safety
.dftLGdc.Section 25532(x)l pros No
All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building Occupant use equipment If a roof is installed without first obtaining an inspection, I agree to remove
PP g p qui l lir devices which g p
emirhafimous air contaminants azdefined M1ythe Bay Area Air Quality Management all new materials for inspection.
District'
❑Yes 4,7177
I have mud We hamNnus mamrlals requirements under Charlcrfi 95 of the Califor-
maIlcalth as SdctyCode.Sections 25.NI5.25533 and 25534.1 undeoswJ Nal if the building
docstcurrentlyh auor.Nit is my esgmsi hil ily m roti ly the oereport of the
rcgniEomcnts haw m
st be me r nonceor�mfeate of Occurancy. Signature of Applicant Date
Owner/\mauthori.magen, A / All roof coverings to be Class "B" or better