02030021 CITY of curEeTlNO ,CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT -
PERMIT NO
BUILDINGADDRESS 1 02030021.
22680 ALCALDE RD
APPLICATION SUB DATE
OWNER'S
M 03�06�2002
11 ARIANIST NOVITIATE
PHONE' .. SANITARY NO; CONTROL NO
WOO ARCHITECGENGINEER: BUILDING PERMIT INFO
+ BLDG ELECT PLUMB MECH
I D U
S y i LICENSED CONTRACTOR'S DECLARATION lob DeSCTIption
i Z=O I hereby affirm that I am licensed under provisions of Chapter 9lmmmencmg
6 with Section 70ODOf Div,s,on 3 ofihe Business and Promotions Code.and my license NEW POOL COVER ELECT GHC OUTLETS (2)
=.Y mfmlfomeane cl` 2 5/7C) POOL COVER BOT.
a ,ceme Class' ✓ P 4c a l
i S o ARCv TE 5 DECLARATION ].a h S
I an slam Y plans .11 uL• v ubl,e 2eora.
f -
icensed Proles a �DBA•p���
'OWN am eU1LDCR DECLARATION rt y III
,i o a 1 hereby affirm,not I am ercempl from the COmranor's License Law for the
following rencer:(Section 70315.Biomass and Prafessmna Code Any any or county
?,O .which regwre,a permit an consumer,alter,,mpmve.dam il"Ir or repair any same ure . . - .__.... -
0..3� prior toitxssuonce.also,equires the applicant for.such permit to file a signed statement 1"¢&NL1. 3 -
methe,slicensedputsuantotheprov,s,ons oftheContractor'sLimrcLaw(Chaple 5 S . Ft Floor Area-,, ,fry', aluation
rcmnmemmng wnn Secban,7000)ofDutaon 3 of the Business and Professions Code) {q q15.,,
or drat he in exempt mereh°,nand the basis for the alleged exemption Any violation 3"
1I 1 ¢pk'
of Section 903 l 5 by any applicant fora Pe^nn%objects the applicant a ova penalty - .r {,y,y,f mb$J 1 v'LuiNQccupancy Type
of not more than five hundred dollars(8500) ]�I'1sl 1V U
0 1,as owner of the pmpeny,or my employees with wages as their sole compensation, 1 01 _ P�ITTATTI T,PTr1TT
-win do mrwork.-and the stortum,s not mxrded or offered for sale(See 7oaa, Required Inspections'
Business and'Promos,m,s Code The Contractor's License Law does not apply to an 10 2 - P IERS 4 P
owner ofpropenr Who builds.1 improve,mema°,'no who does such nckhimself 103. .-__UFER
_or through his awn employees provided that such mr,umcmen¢are not mmnded or -. ._ .._..... - -- _ __ _ ---------
,compl rte.the If,however,rw balding or burden f pro a old wend one year of
completion,the owner-budder will have the fiuken of proving that be did nor bald or 104 - REBAR -
,mproro for pa,p°teofgale) 105 - ANCHOR BOLTS "
pro -"""" eo 8w, 106 - SEWER & WATER
•,,- ,` 1. sawn or the. open�,am exdmovel vxan th licensed mn¢anorsm "�� °�" ;
e nsuvci the protect(Sec 7040;Bmmexs and Profm rear,Code).The Commcmr's i. .,
-= UNDERFLOOR PLUMBING
L w does rim apply 1°an owner of prop,ny who builds anmproves memon. 2 0 2 -
id-who ocontracts for such protects w,ih a comma.,(.)licensed punuanI to the _. _- _ _ AL
and.wnoe 203 = UNDERFLOOR' MECHANIC
111 am exec L,ttnse Laer, -
apt mnepr s« ' Ve'ffi PCror,nis rasp" 204 - UNDERFLOOR FRAME'':'
^' Owre, WORKER'S COMPENSATION 05 - UNDERFLOOR INSULATION Doij
NSAT10N DECLARATION n�, If
- 301 - ROUGH PLUMBING
I hereAyafrm under Mrtaltyofp(olml aiie of doe full-
rileoolloomal 302 - TUB & OR SHOWER
1�❑ 1 have oad will mnmlar.a Cemficam of German to self-more for Workers 3 03 _ ROUGH MECHANICAL
A Compensation, as-provided tar by Section 37W of the Labor Code, for the
pedordenucebnhe work for which this permit is issuea,,ts, 304 ROUGH ELECTRICAL
61 nade'and will maintain Wodker'v'Camper onion hieuraum'ae required by Section
305 - FRAME
which this perm;,is -
:',' ,ssuedM Worker's Compensation Insurance i .,
0o r,M1 labor cod r ,M q:,rm rain work rr 3 0 6 HOEDOWNS
My pe ur < carrier tie Policy number are ._
r P l yN ,� 2D$•�� .. 30,7-. INSULATION? ,.., -
c`� ICAib�OFEXEMPTIONPROM.WORKERS', " 308 SHE'
11
COMPENSATION INSURANCE ,
3-0-91,;-,-, EXTERIOR-LATH i.
fTms'secti, need not bec0mpleted ifbe Permit is for are hundred dollars
310 - INTERIOR LATH
I5100)arless) SCRATCH
_ .. .:..:.• rte, _ _
'lro ihasmttie peRormaxe,N the woik for which fits ,;a issnad,i - -3'1'1"- COAT' ';
Cora non Laws of Cabornme.P. cr so as m become sub ea m,1he Workers' s,
snmrnat employ _j, 313 - ROOF NAIL
comply ELECTRICAL .ENER Y
z Z ICnsmAPP APPLICANT: peak` - . . _. . 501 - FINAL -
a YPe Y
Applicant
- A G -
H Some or Labor Code,you must -you
ansonne Lamed ravayaa mmsl 502 - FINAL PLUMBING .ENERGY
O foanw,m' snaureepe:i revoked .503-- FINAL MECHANICAL--ENERGY-
i.
' Ihc,eb affirm iONSTRvCTIONs EN ffsc � - - - - - -
NOTICE ANT:If,after making this en,
.n j Y, d(Sec.3097 AGENCY •, .. „11,
offid ork for wash tins iit',mo1 O rotes,
beconm s Worker's Com
E., w cons i CageneytonnepeIfominae 504 FINAL BUILDING ENERGY...,
t this ran _
rp '�'�' 'CONSTRUCTION LENDING
iii i
a g":G?. ... -'_:,. ...'::.. . _ 505 _-- - FINAL. ELECTRICAL._.._ --
aALender's Nam-. 1-' :''- s... ...._ -
' Under'sAdds_ss" 506 - GAS TEST i
0 507 - FINAL PLUMBING <
U , 1 scruffy that I have mad this application and state that the above information s
w'F correct i agree to comply with all city and county ordination and gate laws relating 508 - FINAL MECHANICAL
C V to budding concur,coon,and herebyauthonxe represenabdes of Nis city to enter upon
W The above-menu°nea,progeny for inspect ion purposes, 509 — FINAL GRADE
_a (We)agree[exact,iademmfyandkeel harmless the City of Cu'penino against
.. m liabilities,judgments msLS aura espenseg wb cis may,n any war as me against geld 510 - F I NA P I NG
t) rya co m ea sequence of dhe taming of sins pe ,m' "'
OURCE RE UERSTA SAND WIL 'C MPHA; `y-POINTt IS-sued ,IN I�!C- KS Date
uorm p 'ATIONS L JJ II 1 , 1�
p (y� /
_ Sg
Will lye P!:c HA&RDOU5 MATERIA1SDISCLOsURE �a1C: ' Re'COOPS
�.' area handle ha:5td6dsmate`nm ,. Type of Roof .--
pbcant future rebuild 8 hanln - - .-.
O Yes" 9.12.and the Heath and Sa&ry '• ,
m defncd b the 532a Mumu....Cade,Chapter 1 r'J ,,.
code.gentian 25532(a}' .' "-t R;,' _-... y '' �9 CZ' i I"'°(',�• v Y Y•d pr,'( `, s
r;Ci °" '�'' <'�-'`is= All roofs shall be inspected prior to_any_roofing material being installed..
W,II the appl cam o f t n is g pa eq p nt o'devices which If a roof is installed,without first obtammg an inspection, I agree to remove
t hazard t t def d by the Bay A A Q l ry Manag tit
cor Dr t d1 - all new materials for inspection. Applicant understands and will comply with
❑Yg on' all no -point source regulations. ,
ha e'rcad me haaraoas m er I regmmments under Chapel 695 of the
-,ftn bmldm does n ,a mend hav responsibility to n of trim
mS oSo c ledunl.that - 1 understand ._ . . _ _ . .. .... .... .... .._ _ . . -
c Yfa qem i...eof -
occ pant or the rcqu,reymems"pith, o t be'met pnor3 and 2
California Hcahh&S rn
tier rotor e t n Y '.sunrise
alley,. ,.�d gen� ....:L:.�y_-- - _ g_ _ PP. All roof coverings to be Clas
,., s"B"or 6
a
3'rS , Si nature of A Meant _ Date _
_ o" ,. F: .. �.r �am,., otter
7 1i OFFICE