01030055 CIBUUs DI N
RTNo
IL PERMIT CONTRACTOR INFORMATION:
• NUI LD INC A DURESS PIRMI'I'No.
19996 EEKMAN PL 01'030055
OWNER'S NAME?' APPLICATION SUB DALE
03/09/2001,
PHONE SANITARY NO. CONTROL NO.
OO ATCHITEC'UENGINEEIi: BUILDINO PEIIMITINFO
P, BLDG ELECTPLUMB MECH
VL
I 71 IJ
w Z LInInCENSED CONTRACTOR'S DF-C
z I h rh,nfnr� ns 1 an
,l nee ,ed anderprtwi.rlons orelapler P memo eneieg Job Description
�v�p11I.semiml mal enrvisioo3 or nnbin,e.,I IT I.....,aiee,and any liralse
.i�nemu jolter
� Lo 7
70lREROOF.
3atIAm e -S DECLARAI ION FIAT TO
RC .
I undeRlund my pon, mc1iswl n„thhr
rccurd,
sw
o`o Llleroal rrmecaollm
a
ONYNIin,rxe iflilt,,D17CLARNI
orib ON
I eas)aNelb,hal m noel Iron Idr Cnnlort,C x LiAny r Law for the
Zi fallnn'iel ire,nr (Se.l inn 70315,Bm11... sort.R'efniinnx Code:Any city ormunry
F� p which myulres a,it.. ..u,le ill..the ulmi:Impose,h pet bit t file
repmr any troller.
'. 'I Ili Elf I f I p _ r, is 6 (Cha urn
�3—
BIT her, E It E p Iona 1 I , r L La,'lu.pmv Sq. Ft Floor Area ,®Valuation
0m s 'M1S 7O0IJ) Phe ', fo f1hvB s'm, Ilnb:i senior �"�
Ila,he I, 31.,It lbe rl'r,. and rbc nu,ls for dio wllesod exemp inn.Any l oltlior
ofSmtinn J(1315simydredawnllina500). subluln thewPPlialnl lu a.ivil penally
If Ilnt Inure min Bva n,lndred dnnnry lasonr. APN Number Occ incl,�y.FLq0
01,iev ownerof me pmpc ly,or,,r.n@Inycex with wtlse,a"IN” cm Tel"atio",
will To It,'o'k, 1 1 I t or'fllorl for'. I (Sre.7044, L ��h
Ile dl'f: L 1, Ill,C oo I ' n.ela I Iply 1,1, 31 G.J4JI1�jegzi red lnSpCCt10H5
of 4 um
property Pio nnld, tpr4 c- a,dwho dre uch work '
orvlhmogh hi,own empinycu.pro,d,l that Sufi intprnvrnwnts h',sdlire not imindid nr
nffrrwl Inr.de.If,hosorer
r,the Building or bolfrmmmmn Is sold wiWln 011e yeir of
Inplevoln
. ,eow nes-mBldirwBuer,w1lienanlen nrlilamdm
pni ins ,I,.did ilii nr 305 -- FRAME
unpivvo for pnryur ofnvlu.). v
El 1. nwn.r„rine 307 — INSULATION
(Set. inenlrne,ior,Crecn�hcCrnelnrxte GO '— ROOF TEAR OFF
merse the oes little,Ree.7144.ow icrol poll property
Milt h Cudep'rni cs Ir is
.ocd hLnwdie, I.,,"I'liply Ioroawurrel'I rollly sono bo los onn.pnn'e,di Ill he
end act.nnnwe„Inr.nm,pn,lees sold,a ei,ttieln o hr.nsvl Pn nnnl In Ine 002 — ROOF F'LYAIOOIJ NAIL
Ll I nor,i.Licrnsf,List.
❑Illi rxel,lpt nnd.r see. ,BxPeIll rlit,r.wxoll 603 — ROOF BATTENS
Civil,t Date 604 — ROOF IRI—PROGRESS
WOIIKI It S COMP PNSAT ION DI CI AR 1TION
I hereby fl pebtily of,perjury on,itfthe loll ib,deektation,
❑
I have alod will o4irolain I Cerlilleale i Cor,elit ill sell-irosetefor W,Rrr's
Cooll,ro,atili, 3: Povided for by St,colon 3700 of tire I ll hor Crib, Io Iho
p.for w ee IT IIle work f, sob ch W's per n' ,Issncd.
❑1 hwve ind w111 m dill,dn Wnrkcr's Compcnxafmn Ineurnncq;is myuircd By Srmion
3700 of 11.e Labor Cndo,Ibr Iho PorGmnano,of the work for ilid.this tont,
,wed.My Workers G„npemadnn In illice carrier rid Policy brother are:
Carrier'. Tolley No..
LEN LFICANON OF EXEMPTION I ROM WORKERS'
COMPENSATION INSURANCE
Pf......lion nein bol be I( plcmd if the per lot Is for ooe hmldlcd dellnr,
(8100)or lcs,.l
Ic,nlly l hel in me perlaminnoe of l it,work for w ldeb Wit perm,'Ismd.l
shall nil.brry oily person in any nwnnrr m is to Beanie,ab,iecl ,,the Workers
Compclvs:,I ion Leven.(Cililorniw.Life
NOTICE
N(Iore ITOAPI he W01I':lls tillermW'al Phi,C'ioll' f ill 13xelnplinn,you hirrid
Beamer,object y the Wo"kefs C.mpi motion previsions of e l Libor Code,you nivel
Q � fnrlhwllh amply ill,such pmvkimu or Ihis pennil..hall he deemed revoknl.
F CO,Iheo.OIEONLENDI NOAOIiNCY
I bnnll Ilion that dmf ie a wird(Se..n killing ascney for Iho.per!tinnier:
G>a Lit ende work Ill which this peniw n inamJ R.c.9(197,Cie C)
Q Leb,11'I Ninlc
Z lundor's AJdrene
f..) 1...lit,Wal l Bove read fitappl'nn(mil and stove till the above'mforrnadnn is
cr"reel.I n9rer it,cnlnply wllh all city and county onlininces ind slnle Lw.e reWling
U To ldiog wn,unl.too.will hereby aullloriie repl.mnlnlivre of lhi,Illy 1ll enllnToll
iy ry] lie ah-e-ol rmnM prnpcny Lot nspmtlon pnmu,.x_
ti a (W)i” 'fyLLull6 plela. ImCity ifCl f ..against
VJ
liabilities, t I: t d espeows which 1,Ty'it any way l .glnn:wid
Is-
V City lit eonslyte Ir ill to gulls hilt 11111
APPLICANT UNDERSTANDS AND WILL COMPLY W ETH ALL NONr
SOURCE REGULATIONS. I'J/ // IFSLed by: _ Dat
6�
S,gumlvuof AppllaooAZAIC)"US ALS DISCLOSURE ra,IT1J 11C Re-roofs
Will The npplkart..l little mliiding nunpant.tnru or Ill hll,nnwm nlalen:,I Type of Roof
is dellnid by the Cupertin"I Nlmli.ipnl Code.Chaplet 9.12,and the Hirli t mN Si(rty
Codd.Srrlinn 25532(e)'!
0Ves 0 N - All roofs shall be inspected prior to any roofing material being installed.
Will If,nppliewnito rntrehooldinsnr.apanl n,eerpllpinenlill delieswill If a roof is installed without first obtaining an inspection, I agree to remove
anus he Ild"o'"I can WnOnanls Its defied by the Bey A.e:I Air Quality Menagcmnm
Di,larfr all new materials for inspection. Applicant understands and will comply with
°Ycs 0 N all non-point source regulations.
I I'll,, rlid 111. I I l I i" pl (J5 ,1 he
Cn I I o III k S ly Cost,,S t 5505 25533 1 5534 d n d 0 3t
if It,i Ido,l w1 I I I I y p oily .....r
neplt or The aqu'n mil,which nil be me PF ,eenli Len learn(
`mlIl Sig re of Applicant Date
nwAll roof coverings to be Class "B' or better
OFFICE