01030083 WY i
4 BUILDING
IL crBN1G DIVISION NmNCH IPERMIT CONTRACTOR INFORMATION: �t103�tTES s
uu11.DINCADI�3NER GINA C ET AL PITOLITNO. 03'/15/2'001
�
WNEIi'$NANE�. APPLICATION 51113 DAT,
ZONE, SANI'PARY NO. CONTROL NO
C Y Z ARCHITECT/ENGINEER: PUT DING PIiRMI'IINFO
Ow C BE ELECT PI.IIMN MILCH
U DENOL_ITION
LIGI NSI DCONTINC[Olf S Ill_CI AItACION
Ih by E r btI I' sell 1 o rsofClaPl 9L `rg JO I eSCr tion
h -w wills ( nlD foothill Et II'fc.n �� 1O
0.ie ill 111l( ss,n"I Jfc
O5, Ilceiuo Class Lich
Dmc GantaelAI
w 5 w y ARCHITECT'S ULCLAILA'I'ION
I unnm smut my"lance nbull herself av Public tsnrds
MOLiunvel I'Act on:d
cc OW NI'R-RUILD131t I)FCLARA'I'ION
W I becley v nnu ILII I hill excoPt fine the Cinla¢lOn n 4eeneo Lew fnr the $9500
H Z following re r.(Simon 7051.5,unsinee mW Pefell"H e Cade:Any city a col
which rnlaires a Pimm Ill nmsmmh Nlea tall, e,dmnnlien.or rettlrany smlalln:
m 'It bills 'dt y l 1110 hili Il a �rII T dMnllne,l
ballIPChi0
5 O II [Ill IheC ler1 1 ICh lner9 Sq. FL,,,j@Me ,5. Valuation
Peniall,ileciageolin Sown 9000)Of Divkten 9 of the loomcss and Professions Cadet
Or that he fel onetnm Iherefmm and the half,let the alleged cxanrttion.Any"'Lleion
of Sec, Or 9031.5 by nay rpneo m fm'a,omit null the eppleum nr a civil Penally
nllaallahire lIltill nadnddnuar,($50n). APNIsjjyniggIGNED IN PE CT I DhWcupancy Type
El 1,;,,oi of IN ProPnt&nmyreiployee,,till wrol In,lhcirenlcaninpenxnlinn.
will do IIN wink,hind the nnicatm is wt itmtnel or Offered fnr side(Sec.9044,
11 ties,and Pelt.innv Cc&:'I9w Cceeetnr'x License Law sacs not apply m air Required Inspections
r nfproPeity Will'hans o
dr impmvo nd their L,Iwhen Imes ouch worA Itnnclf
leirnagli his awn cnpJoyecs.Provided her xn,h Inprmeturts are not inendcol or
opined tent sole.II',he-e—,lac building... nrpnr cot Is sold within n a Y,n Of
nL,I,rh n,0,I—on,,hai derwill I...O the huabelief roving lil heard nal build nr
totally,fnr pro,...c I eine).
❑I,as owner of tic P.,Perry, it,esdt,ivoly comnning w'ilh licensed contractors to
nene,the ra lest 1Se:.711,14,lira td I'ndcs s Cam:l'Ihe Canbane.,
License Law doe not apply m ani cif p rpcny who builds or inrpnr c,ihtt,el,
end who eI Iract for Inch P lines with a cannaeetLq hurled pursuant till tic a
Carlon,,Lone,",Law.
1:11 an exelnm tndel see. ,li k P C for his lesson
Owner Dore
WORKER'S COMPENSATION DECLARATION
J ILLI,lbyafl Prorhy I frilly one It he hollovingdeclinations:
J 1 tell aridinain a CcOnficale ill Consent er wil-looLlear Worker's
Cn P , ;s D 1 I by Sra t E]I'LL of Ih Labor Cnle, lot
nr [be
part INC Inn lI I'ch Ihis lrai.1 LI'LL"] -
❑I hone and will nillnldn Weise,s Conpcnemiou Insurance,uv reyulral by Section
9900 of the Lull Cold,Or tial IroHbruaoco of the worry fur which this permit is
Issued My ' C�I'l lel Inst a tit Jj�'no
I carnet anA P dJ�y�t /n�lyma ai'e:
Cal tier:-C(y//�/—�/�rliLl:nVO .
Tillil ICA I'1 ON OPE%E PI ION FROM WORKRII
COMPENSATION INSURANCR
rI In,suction nttd not he contFIL if the Pinnnfl Is fm one fal l dollars
(S loft)or fell
1 cc,lily Incl in Ire jr,harlinjach,of the work f r I.Inch this front,is ed,I
,bull mai cinPlily any person in any rmnner m us In become aine"It,the WadnF
Cnutfrobortion Ltws of Cl Dull
Applicant
NDTICE'10 APPLICANT If,atilt'Looking this Cenffnnc of 1: "L nn,you shoeld
becnne object ,,the Worker's Compensation novieions of till Inihor Code,yen Inst
her nhwiIll con iply with rich provisions er this Permit shall be domed rank ti,
H
V�J CONII,,,,DC'r10N t,II len Al
I Iloeot wal 11,hich Inas won isss ono](Sl e, 3097,ng agency for the perfunmmce
W of the wad all which this Pcrniu is tolled(See.3119],Civ.C.)
A Lenders Ncnc
z Lendor's Arldmse
V 0 I cenlly nam l have read o it o'li i,'htion inn xtate shat the above intnrntanmi is
lvel.I office In comply with all oily and unity mdfmancxv aril Mate Inwx relafng
0 Chili to frilling cinstmdiia ,it hasl..otuhorce reptioNeralles Of title city ler enter npnn
;h. W 'Ill al In aeitnanelpmpeny fnr iispcelian pnpows.
O. (We)Ili to)see,indemnify and kce,lianall e the City of Caperinn against
V2 liabilities, udylll .ends Ind cxPcuscs which amy fn oily way auric ago said
C„) City in Inheritance til'Ihn ntells,of ill[permil. /"�'
P PLIC ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT /J �/
,uNe:REOUL to s. . Issued by: Date
$, lamanl ttlnini nmruemALS DISCLOSUDISCLOSUREr Oat Re-roofs
I IAZAIIUOUS MATE t
'all lheaPeb,anteronntc bis lain,,Igoe eerro ler handle lar,...I lnnn'lal Type ofROZ,
ied,nnen by till C11,11111.10 Municipal Chose,Cramer,9.12,titan Ihn Health and Safety
Code,Set 25552(h)Y
0Yes ElNo All root's shall be inspected prior to any roofing material being installed.
Will'Ill aPpftcan°a""aa,I lIsclePanlal.trltifer'litnaIll fill. If it roof is installed without first obtaining an inspection, I agree to remove
'mit ballerinas 11.amcnrluantx is dc0ned by the Hay Arca Air Qtallty Manognnenl
netriet, all new materials for inspection. Applicant understands and will comply with
°Y" El No, All non-point source regulations.
I helve read Ire htvardmw OwtnluN reynlrnnen s I di Chapter 6.95 of the
Cal',fornia Heullh k Solely Code,Scutions'_5505,25553 and 25534.I undemnnd dist
if the hnnAing docs In currently hove a mnon61hnl iI is np respansihility m nuuly the
cup.nn ill Nc ru4u'unnontx which mart he mel"itis m Isewncc of t Cntilinuc of
Oran, 1O y
��iGp Signature of Applicant Date
owner,L nabadaw risen, Dale All roof coverings to be Class `B" or better
OFFICE