00120055 . i !(•
CITI BUILDING tISIONN.. CONTRACTOR INFORMATION:
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-
]Ill 1LIi1NGAUDRF.SS: PERMI'I'NO
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:77 818G
OWNER'S NAMIi: - ,. ' ♦ ' „ APPLICATION SUIT DATH
11(INF: t SANITARY NO.- CONTROL NO.
9 ZO ARCHITECT/IiSOINEER: - - BUILDING PERMIT INFO •
.INTERIOR REMODEL. -*T IrVIHIS ZNOV{I',
z S N Z LICENSED CONTRACTOR'S DfCLARA'1 ION
I hereby affmn th:n 1 am Eremitical under provisions of Chapter 9 J(J Descll tion
oz-o rer fenmylic...c P -
Fy�J i in
II forcemetnfDivision Jaf the Hnsiness:mA l}oles,inns G,de,dna mylicense
in full force unJ crc«I. r-
Yd < Date.m clam � Lica w
Dole
ARCITELT S DECLARATION ARATION
CI-`Oj 1understandniY PP . e
shall he used as asECpuhl b'
dp0� Lc d Pool . Of OWNER-BUILDER Df CIARATION _ I
so I h M1y all" n that l I x ape f the C t a License e l f th
Z< billowing Secular 7031.5,Business add 1 1 .Cal A 5, ly holy ^ ////�/,,
€� 9n I I ttl :t I 'at r 1':h p afy.l i `r ��:,4J5�
I I 1 1 p 'ppb II I p mut 11 g dal em '
lair licensed r 1 In p of the C e l/aLic 1 Charter9 k.�p L Valuation
loom 6 with Sec 7IXID1 of Division J of the N dl f Code)• Sq. Fob' r�.i l�i`1 ;m� _
nr tl'1 he I, pl lh r fn d th basis fill In'i Il ged a pl Any t: n -
DIS Y' n703l5by' Y III 1t "II tsubjectsth ppl II 'I II ' _
n e n I l l l l u D500) .v APN Number r
Occupancy Type-
❑Ia Ilhap p.ny. r Ye employees -th g as I pcn't
101 — FOUNDATI011
ill J ton
h k d the.unichore is oth intended it offered f (Sri.711,44, G ._
- Ian, dI r c>v Th,c t : e 1 I "dyt - - lquired,lnspections '
orlh fhh:inw employees.Who II. p c Ih d h I . h work Ir � 1.03'
ger.the
building
that:mh nement is
within
na intendedyear
1 04 — REBAR
codes for sore.IL habuilde rhe l ha a or improvement ml i,dill within non year of _
impletion.❑,downer-builder will hive the burden nl gracing tam he did nm builA or -
aa,,,'eby.....s,enr,:tle.l' '• 1,05 '—. ANCHOR' BOLTS
I,ssownernrtne p,npeny.amc.,koivelY contracting with ransed[anaemrs l0 106 —• SEWER I X. WATER
'
Ymct the project(Sec.7044,Business and Prhrc.uon,Coil:)The Cnmmcmr's'
Ikc. L I t pplyl rnrp p.ny hobullL p dcrenn- 202. — UNDERFLOOR PLUMBING . .
who
l t I rL j I.' win It'ma :_03 =- I-INDF_RFI_DOR ' MECHANICAL.
❑1 ,e, rr Sec
e 1&l c am,ma"'° 204 — UNDERFLOOR FRAME "
Owner ��G���{'vjc{t rP-N' INuf�.A !IA��— PJS IJIIIDERFI_,OOR TilSl•II_ATION
Ihemhy arr unilvr pc11'r tvn�ne of the following declarations:" 301 ROUGH PLUMBING
I hr,calul en maintain a cediricald ofe ,I- .eu for Wake , 30P — TUB R• OR SHOWER {
'Hoods,cmEtas u.tfnuwakletwhichhinpelT1l tVsued. I I ' c 1. Inr the t- 3171" ROUGH MECHANICAL
❑I haveandwll maintain Workers Coloopi br nee 1 any SnYu 304 - ROLIGH F_LECTRICAI_ -
3TA1 tona 1 n r Cod f ih p f o e f n work for which this l iron t is 305 ! FRAME
istredMyW l,TsCo i rm ' dPnliy the,are: .
cams, robe>na: - - :306 — HOLDOWNS .
CERTIFICATION OF EXEMPTION FROM WORKERS' ' • 303 — INSULATION
COMPF.NSKI'[ON INSURANCE ; ' - it
(Thi.,<etionNedn„Ibeenmpleleaifthepennhisrnra.ehuurreddollm, 34'JH` - SHF_EfROCN•
Islaoorles,.) 309 - EXTERIOR LATH .
1 nrrmatinm H •nrmew'drkfrwnchd I lI,soea1 •31.0 -' INTERIOR:' LATH .
,boll Ilya6yp,: any t r,na,llne<nne n,ell dn�wnrAaa 311 .-SCRATCH COAT.
Compensation inn Luws of Cnlil'umia,Dmo Inc .Applicant SCRATCH '
I NOTICE TO APPLICANT It, 11 p., gth Crff I fCaemrCo ,'Ou ell 31.3 ROOF NAIL_ -
z hacume vublttl mtbeW k!'C goal p Ince 1,Imr Cndc yn msl
0 0 rnhw'mao nal, i1h-arich y ,son„rih 'Pen lsbadbcaaerrd...rk,d. - - 51D1 '—'.FINALELEdTRICAL ENERGY _.• ..
502 FINAL PLUM
— DING ENERGY
fON51'RUCf10NLENDINn AGENCY I
ori y1 hnchy sultan IId 16are isitc,ded!(Sec lending agency fonts pedi,miance
nnele",Nam whlehmi.,pernnili,i.,hallsee.J(rzcie.c., 503 — FINA_L MECHANICAL' ENERGY
L q' Lenacth Nutnc ! _
p z l.craer',Aadres, - - O04 FINAL BUILDING ENERGY .
leeniQ'that Ihave read this apl,beam,nadd,'lot, hill he above mlarntannis 5.05 - FINAL_ ELECTRICAL .
LA f” nit re.l,I ngfm h.eon,ply with all city unit camty,onlinancc, I I,lite laws mialing , _
O U enrildmg eannmatmn.amu berenv antbmiee rent'e,rrad,e,nnhia eitYeennler npnn ,.rllf6 GAS TI.:S'1'
y w neabo< t t os pude .,f nr 507 FINAL PLUMP G
E.. a er,j g t s indemnify c'nti keepn 1:.the Cirynrrid,rgiagainst B „ FINAL MEC + .I ..Al.
rn Cry11, : l Ig I costs 1 p which y am� y.ncerne aga nit,a n r
4
Cry a:DERS 6 SA DfWIL"nun'. .
APPLICANT REGULATIONS,
AND WILL COMPLY WITH ALL NON POINT pp,,
SOURCE REGULATIONS _ ISSDCd by:,
Date
D Date
signalled of Appbcanvenmmctor 4 Date Re-roofs ' — 51 _ 1 5 5 •.
HAZARDOUS MAffR1AI,S UISCLOSURli 514 - ' FINAL PUBLIC 'WORKS
Will tau appllcam of fame building herupunt stone or hm ddc hamrlous material of of Roof ,
Its defined by the CuFenlno Municip uJs,Chapter 9.12,and rile Health and Safety
cool Section CS¢T""? / .• '
C7Ycs 'F,
, All roofs shall be inspected prior to any rooting material being installed.
' "ohme, ppluml't rlltmrehmld"" �:panl use AeaAircrelay°,magemi,in If a roof is installed without first obtaining an ins ection; I agree to remove -
• 'it hemvinu,vir hclad E I roc by the!lay Area ,eluent or Managcmem - P
all new materials for itis ection. Applicant understands and will cool 1 with
ore, Np P PP P y
all
non-point source regulations. - 1
I base read the hnmNou,nutic,irls rcquircnncros under Chapter 6,95 i,f the
C.-Afomia Health&Safely Code,Section,25505,25533 and 25534,l undemmad!hal -
`- Hach tld'n 1 ecu tly have tend I thinit . yrc,p 'hT151 notify th
rip M f r I: 1'1 trust ha I I s, -aC cure r
n nP'
0 SignatureofApplicant Date
Gwn�• I,nnn �" D;,� All roof coverings to be Class 'B"or better. ,
OFFICE