00110034 CI BUILDF G DPERoNNO CONTRACTOR INFORMATION:
PERMIT '
BUILDING ADDRESS: PERMIT NO
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OWNER'S NAMl:.
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C�C ARCHITECTIENGINHER: t InzA �4]. )i:a 01 BUILDING PERMIT INFO
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Z Y LICENSIiD CON'TRACTOR'S DECLARATION Job Description
O
Z'4 C 1 heathy oilra that I am lexnsed uMer provision,of Chapter 9(commencing
p:tt�i with Section 7011111 of Division3m menusmessand Professions Code.anJmy hcenw
YY tam lull force
c'„�uncwr 'I IYZIL^J�✓M SUNROOM ADDITION '
W 3 W y ARCHIIECT'S DECLARATI _
5 I and erstdnd my plans shall he used as public recoil, rf r
W O Lmeord 1'ndm,ional J
OWNER-BUILDER DECLARATION
I hereby a0irm that I am exempt from me Commcair's License Law fur the
following reason.(Section 71)315,Busmes and Note,aan,Cash:Any city m county
{F O which requires 4 permit to conawcL alter,improve,demobsh,or repmr any samemts, — r
,6t Cji, proato its issuance,nlw acquires lhcupphcant lbrsmh pemunofle asiyned statement
that k,,bmnud purism m the proviso its of the Ciarnmem/s License Law(Chaper 9 AV S [ loor a Valuation
umm
tcencmgwith Section 70(911 of Division 3 of the Business and Professions Coders q C.r✓
or that he is exempt themfmm and the basis for the alleged exemption.Any violation f ZV L OQ L)
of Section 703 1.1 by any apaeam for.permit aubRCin theapplicunrto a civil penalty Occ rM�
,if an,...than five hundred unit...(s5BB). APN Number I e
❑Ln,ow net Of the pnipeny,onny employee,with x age,asme,ante cnmp,mat n, ry�yar��yy
will do the work,and the structure is ant harrideti or offered for rile(Sec.7014. 3265601 B. •RC uired Inspections
Bmmc„.md Pndm.wn.Corer The Commcmr'a I.iamc Law,does oat apply or no LI P
r of property Who ball,m unproven meretm,and who does such work himself
mowthr ash his own employees,......tied Nat inch improvements nth not ImendeJ nr
eted for sale If,h iweret.the molding or i ninowcnem is sold within one year of 101. — FOUNDATION .
cnmpleuon,the owner-bolder will have the burden of proving that he did not build or
mmo,a for parpo,e..t sale 1' 102 - PIERS
❑I,its timer of the property,am exclusively contracting with licensed contractors m 11),3 - UFE R
Lconstruct the pngeci(See 71111,Bmineu and Pmic—ans CodOLThe(7momntni a
n'tooe Law doO,not apply m an owner of property who had,m nmpmvea theman. 7 04 P,E BA P, .
and who woomen Inr welt projects with a ruminants, licensed pursuant to the
Cmitmnnf,License Law. 105 - ANCHOR BOLTS
El nth exempt undo Sec B&P C for this rennin
J06 — SEWER R WATER Date Owner WORKER'S COMPENSATION DECLARATION 202 - UNDERFLOOR PLUMBING' '
I
hereby larm under by or oar 203 - UNDERFLOOR MEC'HAMICAI.
y penis pct 1 y one nl the following Jeclaraliunr
e and wdl mmmtan a Centfeam of C....,cat to seB.itrate hit Worker', PO4 - UNDERFLOOR FRAME
mpsumn...on, as provide) for by Section 3700 of the Labor Cade, for the
perfunn.mcenl the work farxhich this pemntto,rad. 205 - (JlJDEP.FI_OOR INSUI-ATION
Oi6avFand will maintain Worker's Compensation Insurance,as required by Section 3011 - ROUGH PLUMBING
3700 ni tine Luba Code,list the Ia-,( afce of the work far whuh the permn , +.�
issued Sly Workers,Co nwti i lnwruncc tumor and Policy aumbc me: 302 — TUB 8 OR SHOWER ✓°a
CarrierS p_ e+ r PnfeyNo_ 60((-e774 0 `:t03 - ROUGH MECHANICAL
CIiRTIit CA71ON OF E%EMI"I'IONTOAI WORKERS'
C' 31214 •- ROUGH EI_ECTRICAI_
OMPENSA'rION INSURANCE fl1as action need nth be uimplcled d the pant..,is rot n a.hundred dollars ,. 305 — FRAME
(sl()O,olea,) 306 ^ HOI_DOWNS
I centfy that in the performance of the work for which this pct inn is issued,I 307 - INSULATION
shall tie em nY.sawn in anY manner m e n 0(e whist,, m Ne N'orkets
Compen sun ,aasot rmµrymc ni /(/ �[ —(ate— 3t?I& - SWEE'fROCI:
Applmanl A(h
N(nlcEI rpucA 'o rmakmg this Cemfcat ofhcor i an should 309 - EXTERIOR LATH
Z 0 beeom wbSel to the Wutkce,Compensation pmvhim,of the Labor Code.You toast
forthwith comply with such provismn,or this mmo%hall be deemed revoked 310 TNTERIOR LATH
(~ CONSTRUCIION LENDING AGENCY 31. 1 — SCRATCH COAT
hcomy efforts that Omre is n cnn.amctiun lending agency Int the par
Wof the work for is bach this perm0 is issued(ses.3a97,Cis•.C.) 313 — ROOF NA I I
S Q Lcndcr's Name
D z Leaders Andres, 501. - FINAL ELECTRICAL ENERGY
U O 1m'mfy that I have mad tht,application=it state that the above information is 502 - FINIAL PLUMBING ENERGY
correct.1 agree to comply with all city and county ordinances and,tam law,mining
O v m building combustion.unit hereby unbosom epeacntativesof this city toenieru"an 503 - FILIAL MECHANICAL ENERGY
CW meavi(W o)magi..nal.a.rtytorm)andkepatpoma 504 - FINAL BUILDING ENERGY
L (W o agree onal .save,ny let ins action p hannleas the Cny of C'npenm..ug.una 1 1
f/a City i co judgment.cwt and expenses which they in any way accrue against send y. 50��, _, ECTR I CAL / ) D
V City LImiNTUND UNDERSTANDS NDSA Dion WILL F� L Of
SOURCE REGULTIONSr DSAND WILL COMPLY WITH ALL NON POINT' Issued by: 90A •s f-`rei`f Dale
SOURCE REGULATIONS.. '107 — FINAL PLUMBING
Stgnawrt of Appbc!IAZARmcar hate Re-roofs
unzofair. MATERIALS DISCLOSURE °43H — FINAL h1ECHANI CAI_
Will the applicant..furore buillCo .Chapter seam or handle hb,alth a Safi nl Type of Roof
Code,Sel by the CUpenmo Afum<ip.J Cnde,Chapter 912.and ma licJth and Satiny
509 — F T 61AL GRADE
CnJe,0yox 25532131^ KN.
All roofs sh51I110 inspg'etg{ilpmor Ft{—qqyllfpT(ing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is iR1a4ed_wiFhTp.JIFfrst t ' it on i on, 1 agree to remove
Am eab hmacarsaircommnnnent usdefinedbytheIft ryAmaAur QualityM,inagenem t��i,
'n O - - all new materials for inspection, Applicant 1)n erstanc�s and will comply with
❑Yes -RSN.. Xigna lations.
1 have read the hvnNous material,requitemems under Chapter b 95 of the
Cullotta.Health&Sudety Code,Seainn,255 115,25533 and 25534.1 undclsmnJ(hut ///((('''iohebntof Isma,monect, hick a the thus it is ,,awr.nceoii. tanntify the ,�iftim bun di the ck nor corn which .to he met pink ni iswmnce bi a Co ratifte he D cy )AP / I�Lw f Applicant Dat
ownern,aorb� War V L� IDIm All roof coverings to be Class,.B„ or better
OFFICE
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