00060124 cror cuPr
BU CONTRACTOR INFORMATION:
uun.tnNc DIVISION
sukrc PERMIT
Buu.DING11t7ft BELKNAP DR flsRIMIN(iZ100601.24
oWNeR'SNMPING CHENG—HSILING AND MEI H APPLICAIRO&JyljsA'y;/2000
ONE SANITARY NO. CONTROL NO.
O s Z ARCHITECTHiNGINEER: BUILDING PERAII'r INFO
n 0 0C BLDG ELECT PLUMB MI!CH
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LICENSE1l C.ONTRACTOR'S DECLARATION
Z y 1 herd) tfinn Nat 1 am]ional underthri.......I Ch,dal 9 b,ouninearin, Joh Description
p gym w;m Section rixnd anrw,n,n?anns m.siaess and Profession,col and r„y eenasn PATH REMODEL
q ...a] n Bel fors.and not t.
g a z C Donmc Chsx C u
BO i 0 Da.c S DECLAr
t`n
ARC HI'TLCr e a public
�LLaS I J '.. dial pl .I Il be uN phis b: J/
� a0 Lc IPut : /
n'6 �y Oar NI N IfUIL01 R DI CI A....ho UN
v Ih bar I 70 nes ihC t' t L f 'for one
F%a which
following .ISI hosanna.
unc JProfessions' COJ.Ay 1 county
O wn I q pamO < nt t dl p d LM1 p . l t cure
�6m pr. . t t ass n4 the Tris l fill Itchrel-all t] 'g J.trnct
I",Ile' T v11 .�Section 1 1 .m ill c ,' n E 1 r UI'Cea St Ft. FloorArea
Ise 'g al91MIID be
...the3 of lire' co rlit lafAn, Code)milion I•
or that he is 31.5 b tang di and the Wahl"Tor the illegal pplicarr o Any dnlatinn
of Sedrnn]031.5 by any do ti dolt for a permit.nhjen.,hr opPiicam m a civil Innalry.
onan more min E.a nandrdt dannrs aslxl7. APN I�,0640. Lb0 Occupancy Type
❑1.as or Nn alleany,a cry cmph"s who w..ges),'Ile" m.ca..�per„u6a�,, 3PP
will ne the work, and tun aradIhe i,nM laicalLie a froJ for ale apply In JJ,
Ba,,ofondin nasions Chile:d 'Ino o:,Lstactor'. lands Ldn'Jct,notill hran 101 — FOANY'a LIN speetions
owner of m o Who WWII,or rm ,heuon,nnJ who A:w.wen hulk nimxlt'
nr Brough his own employees.prodded,h:n nuch rmpmvcmc ld will
nal rounded er
oll"al lion sole.il,nowove.,m,.nnli m napoffoo In sold whnid one held of 1.02 — PIERS
an....c for theownc fail cr will hvvc the bunion o[rtnv]ng that he did Lint bniW or
iTnpra.c for puq,.,,c or))less. 103 — UFER
❑l.:sowner(it the pultall cxdaslvelycontr,edogwith Ecducdcoleradonm 1.04 — REBAR
me Ploll sir,.nua,Bad.... ad film,.. ..”Cede,j'we Coanann 105 — ANCHOR BOLTS
LI<enw Iraw Iola not apply m an owaor of pmMdy wEn�bnildn or i,afro,as merlon,
ane wm,contract"Joe such propnts with a contractors)licensed pursuant to the 1 06 — SEWER R WATER
Canwmors License Laws
❑]um cxanpt unln,sec. ,B&P C 6,r his reas"n 202 — UNDERFLOOR PLUMBING
°wiciDateENS 203
WORKER'S COMPENSATION UECLANA'1'ION — UNDERFLOOR MECHANICAL_
Inereaffirnranecrp<•aaiyorpar linearIle rallawingdeclinations: 204 — UNDERFLOOR FRAME
I ease tial will oninluin .. cerNlnaln or Ca.oenl .a n,P as..re e.. Workn'e 205 — UNDERFLOOR INSULATION
C...,mcn,.frn. :.s Intocrdsd b.. by Seeaoa 3701 or ,hn Labor Cade, roe Inn 301 — ROUGH PLUMBING
performance of the work fill which this penind is is,rcrl.
0eon aim w'Ifca:Inmm WarkC's cou.pcts:.don Nsecol a,required l,y Section 302 — TUB R OR SHOWER
371x1 of mil I.am,r Code,roe die perfon....ow of he w Tor which d6,permrl 1, 303 — ROUGH MECHANICAL
null.My Woakd'n Courps Linn Insurance currierauJ Policy numberLiare:
cart 4G1AT�t�fND—PorcrNn.: � ]•j(/01400 304 — ROUGH ELECTRICAL
CI?R I'IMCATION 017 BXHIs VI'IUNP Il. WORKERS' 305 — FRAME
COMPENSATION INSURANCE
306 — HOL_DOWNS
(]Ills section nee]not oe i,oaad and if the permit Mill Line hundred dollars
(SIBB ncs,.) 307 — INSULATION
I ccarry mat in the rwranana of Ile work for hold,this froom,k......ed.1 308 — SHEET ROCK
.hill net employ nay person In.n.y munne.' ."to n c r Iger,,a he Workn'd
Conrfrer,.ulionLawsIfCal �-1 �e 309 — EXTERIOR LATH
Applicant
N HCH TOAff].1cn9r:�.s 'emrcatcofHoempdon.you shot dd 310 — INTERIOR LATH
heannnsunjw rotlw Worker's Compensa,lnn pro near rho Labor Codn.ra coast
C0 ram.wnhnmaplyoil,ornh.,..s.onsaI'll pe gal shall hm
Ile deeed.'aoohe].�m 311 — SCRATCH COAT
zn tum CONST'RUC'TION I.l;NDINGAGENCY 313 — ROOF NAIL
a I Imreby of irthere la aconantction]ending agency far the performmue 501 — FINAL NA
onhe will wrn
lto, a ,hinpxdnh is issued lSce.3097,Co,c.j L. ELECTRICAL_ ENERGY
a a `C11IefNNe502 — FINAL PLI.IMBTNG ENERGY
D z Lemlrrs Addr...
U O Ianifythaterns'erand [,is.,luanonunit odcmmthe abo.erational is 503 — FINAL MECHANICAL ENERGY
w p truest.Iagreetoco.adywithallcityandcoumyahmancesandsntteww,relect, 904 — FINAL BUILDING ENERGY
O C.1 la hailding loon n0oo,an,[nnmhyunmorice a,doornmtirl his city to enter area p y Ill III anin,r,y for refedra„1"'T1114e` 505 — FINAL ELECTRICAL
F. d IWe7 agree tains,last and keep hallthe City of Cupcdrno against
y liabilities,judgments,costs and expanses which may in any way acme against said 506 — GAS TEST
V z City in comequenn of he granting of Eris permit.
SOURCE RE"MaAND WILL COMPLY WITH ALL NON POINT 507 — FINAL PLUMBING
sau2ce eBG � �q--Bao Issued by: _ at
Sigamore of Appy—•'��ar r [)are Re-rOofS _ _
HAZARDOUS MATERIALS DISCLOSURE 509 — FINAL GRADE
Will the applicant or Nture haudm,of,usare,oreor final namnloux annelid Type ofRoot'
IIdcm.cdby1111ctq,ei M.nmost codfill(defter 9.12.iIhmI :ld,iISanely 510 — FINAL PLANNING
Code,Section 255521u}P �,�/�
13 yes V. All roofs installed.
Will the applicant or future hall oceupantuse equipment ordss;ah which If it roof is installed without first obtaining an inspection, 1 agree to remove
�II a hwanlnm:Lir unnnmimmrr un AcfincA by O.c Buy An:.Air Quality Man,.ge.ndn
a,,Tri.,^ all new materials for inspection. Applicant understands and will comply with
Cl yes Y. all non-point source regulations.
1 ha,,read the lac minus materials«qurremems under Charter 6.95 of Ne
Culilourn Herb k Safety Code,Salons 2SSf1.5,25533:nu125534.1 m,denwad mat
rnhe e.,iidiag doe'nor currently have a munnl,Its,it ralay.vsponsihrhly to unity the
os,eupanr of Ile e fairemcals which mrior m ast be and pkoiraa of a Cenircate of
ccupy
tLSignature of Applicant Date
oL„ - All roof coverings to be Class "13" or better
OFFICE