02060038 (2) OF
CITY
ILD NG DIVIISSIIONNO CONTRACTOR INFORMATION:
PERMITING ADDRESS: PERMIT NO.
WY: VALLEY HEATING & COOLING 02060038
R'S NAME: - - APPLICATION SUB DATE
ULINE SWANSON 1171 N 4 TH ST 06/06/2002
r -PHONE:, SANITARY NO. CONTROL NO.
(408) 294-6290
❑P±o za ARCHITECTIENGINEER: BUILDING PERMIT INFO
8 w 2 BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR's DECLARATION
os=z I,.° knrtbrirrmthtlanlive. nd< v9 : pofChapter9fcammcnctng`, Job Description
Or f-u9 swim p n7o00jorD tpn3afN�vnes dProfcssionsCmlas/nd�mylccnu FURNACE REPLACEMENT '
¢mS� -aer ace and elTcl� loos S7o 1 t', '• ..
Ice Lssc,.--- _. _`: LUc tl . .. ... i. t
U .•Contraction
3 afn CHITEC fY.��CLARA ION 1
< 1 understand hall be MI u public recoNs
WW1
oust.i p O Licensed Professional -
RBUILDER DECLARATION
d hereby affirm bar on exempt location Cmurrim's License Law for the
F z" following reason.(Sec ifIB3 L5,Busincs and Professions Code:Any city or county' -
4 i which requires a permit to construct.ailen improve,demolish,or repair any swcturt $2300
ea 3°_-prior to its issuance,also requires the applicant for such pemtiuo file a signed statement
a. that he is,I scented pursuant to the provisions of me Contractor v License Law(Chapter 9
(commrxing is 0 Sctim,7000)or Division 3 of Ne Half.. ad Pmhusoos Code) ! 'r�.v,..l`i35S�2Flt. i `,." „ T+-�'. Valuation
3j V ,R.'�.p a.
or that he is eaempr therefrom and the basis for the alleged exemption.Any violation "•"
-ol Senion]pJ LS by any upplicnnj forapermit.ubjeotc sM1<upplicam toacivil penalty. NN�����D,hI,�� �
of no more Nan rive hundred dollars(s50l 204APNMlgkFLOOR F E ` I Occupancy Type
0 I,as owner of the property.or my employees with wages as their sole compensation.
;will do the aods,rd-Ne structure is not intended or offered for rate(Sec.704,1,' ”- - - 30i RGUGH
Businessand Professions Code:The Contractor's License Law does not apply to an 303 - ROUGH t�SMCtions' ' •.-
owner o'proPeny Who builds or improves thereon,and who does such work himself
or through his awn employees.provided that such improvements are not intended or _ -304_---, ROUGH_.ELECTRICAL__.__
Reside,
ored for lf.In e di - "'p s s sold w than one year of "-'-- -
compleiion the owner-builder villhave the burden ofproving that hedid no,build or 505 - FINAL ELECTRICAL"
improve for pnrpott or tale.). 507 - FINAL PLUMBING
T - - - _._
1,as TN v e ty alt lcontracting with d t emrs'a 508 - FINAL MECHANICAL
'
construct p l<n(S 11YW Business and Pf ssaons Cad 1 h Ctnctor't wn t
License does at aWiy to an onsmarefinufferry who Wilds or improves thereon, 514 — FINAL PUBLIC WORKS
c c, :and who coronad,for such projects with a cmtmctm(a)-Iicensed,pursuam,o me - - '
!Cont t rsl save lv - .. .__.._._.. _ _. _..___.... -. ..
❑Iasumpa am.,S - ' B&PCT Nisrc d ,. t•',{;v:
tn1 . .
Qwort,lSt fp 'WORKERS COMPENSATION DECLARATION II—�r��Ia r,ALE® - -
I'�a
I hereby affirm underpcnalty ofpep ryone of Ne following declarations
❑ 1 havc'mal will maintain a ceniPcaie'of Consent Yo self-insure for Worker's
�7 ation, JUN
2 qq L,v002
Compensoa proviprovided! Labor vidfar by section 37W of the Code;for the *JUIN ,S
a.
_ - perfovwnce of the'work far which this peorm o issued..
❑Ihave nd'wII'nuinta Worker's Compeni the
we
we < cq reJbyS'tion BUILDING
J7s10 of th Izbo'Cede forthe performs e f the rk farh Nmi
h pert is
.k ed MYW rkr ,'t InP
- JoI<Y rte rc
-i iin
ts-CEIONOFEXEMPTION FROM WORKRRs�
COMPENSATION IUSURANCE t
Ml iiiiiIhin need not be cnmPlcoc of the permit is for one hundred dollars (rr _ ,, ):ilI. ,1 b,
(SIM)or less.)
- .. -. .t '
l e n fy,te n c"pert e f th -k f h eh Na. ct i s rsorker I I
Cocro titian y any pc cry mune m become cabled to the Workers ''l`.I. „ •1.I
�, California, - ..
--Applicant,
PPI antro Lawx of D m;
.._..__ .....___ .... .......___ ... _.._._.__. ..__._ _..._.._.._ _... .. ... _....._.
If,
NOTICE TGAPPLICAUTr's Compensation
omnakigN Cin fisof of Enabrllas yo you
,
becumttfi subject y the Worker's comms or this provisions Ne Libor b,oka ou must
O fdnhwiN comply withiuch Provisions or this permit shall b<damcd revoked.
F try •' ':.R-!'CONSTRUCTION LENDING AGENCY .'.' .. ...__-.... . . ......_ ... .k l. .i .- .. .... ...
1 hereby Kira tat thenons mct an Icndmg age cy for the performance
z"sued(S 3097,C v.C)
:
.; ,.... ._
a
= Z linen Adds t t
.,, Ic nty,N tlh c ad N. ppl tion dtmlhmN bo info",tionrs i
[.., correct I'"pretp mply N ll ty a J c my o d ce. and tat rtlatmg
O_U be a Rlm�cnai*gpn, rid heori upect a po.sentai vase ofN scirytrcnter upon ,
Y:Iry -Ne'aboveagreriedpmp:indemnify and
and kephcrrpds.', -
(r L' (We)a6 ao a rid fy dk rmut: NeCp fC pen no agaroses y
✓� lions t p s which y ;toy Y gninm said
U Z City 1 q6 desofN g and g'frAi pen ' !^
APPLIGWTUUD AND WILL C 0fsIPLY WITH ALY NON POINT", Date
souRCeRFaui if s L Issued by:
Signature oYA I'anpeJ Mac Wl cod CT pt 912 D to ( Re-roofs /
PP
H R OUS MATERIALS DISCLOSU
w u m ppl : t t b'Idng pa t assinn c hazaalwss ro t 'al _Type of Roof .
at deC d b theC and h Health and s f ty - yp _
Cdd Section 2513 tat s a • d .
❑Y 1 I N' r t.a R r
- - 1. AII_roofs shall be mspected pnor,.to any roofing,material,being Installed._„
1 WIIN .ppl cat -Rre buld' e occupant use equipment de which -
'emtn dsairconmwmdardelnedbytheBayAeen'ArQuota,Management Ifaroofismstalledssvlthoutfirstobtaininganinspection,-Ilagree-te'remove
Die' t all new materials for inspection.,Applicant,understands and-will comply with,. .,.-
.i. 4 11 1 . .'1 ` y. .. .....
❑Yes l N all non--point SOnrCe C0 LLIah011s - t
P g
a 1 have f dike Safety
Cod . i pals req 25533 a under 4,Chapter 6.95V stand the California bu l ril.1c&off
cur Code,Sections 25585 35533 and 25534 understand that
-,Ilhebnllofofrep, cuncnJyhave aonunr.that it ismYresponsibilirymnotifythe
-dcedparn of Ne rcquirem a which must W mei prior to issuance of n C iC, te of r.
., w' OccuPancY.'v,- . ..
S
Z ignature of Applicant Dale
owns ro limon d, ,- ,.e All roof coverings to be Class "B" of better ,.
._ ..-OFFICE