01070079 (2) CITY
ovSIONO
BUILDING iSiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
902 BLAZINGWOOD AV AIR MAX HEATING & A/C 01070079
OWNER'S NAME: APPLICATION SUB DATE
HENNEUSE PAUL R JR AND C P 518 S ALMADEN AVE 07/18/2001
PHONE: SANITARY NO. CONTROLNO.
(408) 971-6292
D ARCHITECT/ENGINEER: BUILDING PERMIT INFO
tOu BLDG ELECT PLUMB MECH
ad LJ L:J f__7 1.-.1
F LICENSED CONTRACTOR'S DECLARATION
Z O H Z I hereby affirm that I am licensed under of Chapter 9(commencing Job Description
O z_Q y a provision per g
wiioullf n]I Me oilizi°nJanne Business ala 2Pr°rez.mn.cane.and my license INSTALL A/C
axy� is in fu 11 toren arWe a. 7S`3J �
z O License Class Lic.a
se
A CHITECT'S DECLARATION
I understand my plans shall be used as public records
6 p Licensed Professiomal
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for,he
z< tbuawing rental.(secarx,7031.5.Basiness and Pmfaszmns Cade:Any city m raumy $4000
E O_ which requires a permit to construct,alcor,improve,demolish,or repair any structure
n3 _plate to its issuance.also requires ifte applicant for such persnt to file a signal srnmem.
tat henci witsed hSection
ct n700 prouonsof,hc he rncmfs,andPrLaw
onsCar 9 �g �� r p, a, Valuation
(comatec g withhtin "!000) rDivision 3of rthe Irj&dassomPm.AnyviCode) 4:4>�,T336•.�'2iT(���?;U6eti1,j.-yTLt_}:`
or that he is exempt t,arcrrom am or,basis for the alleged exeidern 1.Key t"u'lln )
atseelanaoJl s ny aay nppuram Tar,prmtit xid,irns me nrnfram m n rlvll nennlly
ornotmore thin live hundred dalian(SSW). 303 N -iH MECHANIALe`.• Occupancy Type
❑1,as owner of dm pmpvny,or my employees with wages a their sole comnconar,ion
Will do the work;and the sbucture is not intended or offeredforsale(sec.]BW,
'Budneas and Froressun-Code:The Commcturs License Law does not apply m an 505 - FINAL Egq giRdlltt tions"" "( l u
owner of roi Who builds m armto cs,herecn,and who does such work himself
nM1 gh h a employ provided that n p , t mnded _ 508 _- FINAL- MECHANICAL
Rered ffirnalIf.howeveCthe Wildinjor improvementissold ilhia We year of
complction,me ler W Idewill have the burden of proving that he did not Wild or S, .1.'
improve for purpose e f ).
p l as owner of,he property,
_ _ npr pertYexclusively
I 'v l- contracting , sed contractors m
construct the n(Sec 7W4. and Professions Code.)The Conts
law does pc to owner o property whoimpowes,,herbon,
and
d-wh contracts. such. pursuant toNe.
G❑1 pt rder'S< tt��-�AttURIP�nsllR OYY b/s2_61G1+�2
�00®2att ,L n,cL . B&PCfor daAreasoni _, `_
'
- -
Owner .. .{ ... Dam �y gk, .
'WORKER'S COMPENSATION DECLARATION 8u�.7��DIItlG
�
1 hereby affimt under,penalty of perjury one of the on declarations: '
❑ 1 have and will"mainmin 1 Cbnificute of Comem'm self came for Worker's
Compenm,ion axprovidedfor by Section J]W of the Labor Coda, for-the
'perfommncc of the work Tor which this Dermis is issued.
291 b ❑will mnint n W k k Comp i 1 nee;as myo red by Section
3700 of the Labor Code to,We laoterrommee of he work for which N s paint,is!
issued.My Wtaker'x Com nsmion I sumntt ca_rricr and Policy mamba are:
.. b: .�]
Cemer ° i .PofcY No.: da9- ,les Ni hf-'/ r•r '� -�'+ 4;i'tr{_�! ( . .y:.f il:a;:,fi. .
i`;it(CERTIFICATION OF EXEMPTION PROM WORKERS �.1. t e�'1•.t r,['., „1- .".f .a J ;'},:�'�„ I
COMPF-NSATION'INSUkA NCE`'' '�_"
s,
(This sx�tion need no,W completed if,he permit is for one hundred dollars
(SIM)or less.!,
1 erffY or I'll the pert tt ftl - kf h hths purti, .su'❑ 1,
Cmr i e ploy any p .int'mann t. m beea ne wn/ba,m Ne Warkeri
t o.
Compou ion Laws ofC I'fo' iaf Dam- -
Appliefirt.
NOTICE TO APPLICANT If,after making this C of ae ofExemption,you should
'� fonhm<hubl a ,M1eR k C pc .at p .. sohh LaM Cade Y u t I
p o plyb,Ih h pini orth p 1 shelf be dremed nuvdad. I
� " CONSTRUCTION LENDING AGENCY "' -- -_ . I�•--� -- -
;� I ,I hereby affirm th,th,e, a con vua I d'g abincy fat ,h perforrimn5e - a ,n
W > of Ne work for svh¢h this Pearm, s s d(S c 7(19] C'v.C)' '
-Lendcrs Namc- "-'.- '..--. ` _
G;O -... .__ ..... ._._..-- -..... -. ._ ...._ .. .... ... ... .. .... _..__ ..
z 'lin❑ .Adifires r r
Lz. Q un 1 n ft'th t I h read th PPI' t mad we thath W fat ,ions `
m, 1 maconpl ilh all l' J r9tubly.endurances ad.,t ]a,,nelanin"
rJ J tuMlnll,om,asnm mJ hsaehyamha prw mi'es fth.,en,wevu upon
k}. W hen o a n v yt ,im ai port
ra'h (We)x,rue to J m'fy andkeep h the C,Y ofC pct n:ig'in't
liabilities.
U Z C, scquen n,rn, de ,mi h Y in Y against �`
Y 9 nD of RST 4 t g of this t !/
!APPLICANT UNDERSTANDS A\D WILL COMPLY WITH ALL NON PONT
SOURCEREGu�TOp naiWle
lavedmam f 1I'
Issued by
:
Date
gn u fgr.r, D,be
HAZARDOUS MATERIALS DISCLOSURE Re-roofs
Will ne pprcaaor furnace W kleg«u,.,sh
as tlType of Roof
Ctqi. pSafety
Section 2553 ( 1
❑Y: + 11L3rN .','. t1 t'E'
All.roofs.shall be.inspected.prior to any roofing material being installed.___._.._
Will the applicanto future Wilding occpaed meNuiplatima m devices which.1 If a roof is installed without first obtaining an inspection, I agree to remove
emit htorandom,air reenconammis as defned by me Bay Area Air Q al,y Manage m
"t"°' ' all_new materials for inspection.- Applicant understands,and will comply with
❑Yez t FTN° . - . ..
all new
source reg�a[ions. „pp
1 have mad,Sa hazardous matonals myo 25533 d de Chapter 6.9trof the
if the
building
Health Safety Cede.acetousant.3.h,itis and355Ji.Iunderstand mnif Na,
' ,..iftolinin iffhe requirees not ments
whit must te,me,prior
smy-isuance ioila tonmify the
capon,of,he rcyuirememi which must be met prior to issuance of a Cenificae of
-, Signature of Applicant _ Date
-': a ranothar g d.bcm a, All roof coverings to be Class"B" or better
...OFFICE _ - . _ ,__ -.. . .. ... .. ... .