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00020142 TY OF + Cr BUILDING DIIVISNO IONCONTRACTORi\1 OR IOa�tMATfON: 'r r PERMIT NO. - .. PERMIT C Ci O`Z J 2� BU1LDTNGADDRESS: - - - v I SANITARY NO. APPLICATION SUBMITTAL DATE WNFR' NAME:/: L _ NIC I CONTROL# �t ARCHITECT/FNt;SNECR t 1 ' B 1}I GpL(tMI'i"INNO I.,O Z - LICENSED CONTRACTORS DECLARATION' ` ZI h by Kim Nu 1 1 censW under proton of Chapter 9(comtce g r ` s Job Description' a . wdhsecto ]000)ofDvsio 3 fine Bus dprof aromCd m;lianwis zaOcwV 'inuasnCLNoct. •L.meClus °It,40 �S t � w -w© •ca� J�"'1' .a J� , J Date Can car v.e O¢� ARCHITECT'S DECLARATION S 1 M nand my pl s sM1ill be uW m Public ttrorda + c r, se ti a g O Licensed Pfeu+nal _ mr +� r I OWNER-BUILDER DECLARATION m 1 hereby affirm'hit I linneampt from NCe Contracmis e Law far the E O following reason 'Section 1011 5 B tutus d prof ions Cad Any 6ty ce county ' a_Q wh ch t m w t all, demolish awn e 1eq x for ire y -$q,F,t Floor Area+ Valuation' panto. issuance,ils req N isw splicer, rsuch petoesUcto aw Uw(C"mens {.� thothmrelicchud pureuant to the provisions of me Convactofe lacenu law(Chepter9tha +- tcama,itou nfl Wan and of Wei,ofar th alleged ex,roat Prf onehemen or - Sec he' p. anrcrmm and the bests for the alleged ase p,t .a civil l Pena n of "APS N tut, oe s OccUaicy Type + not more, ]03I 3 by e y applicant Earn cemd.subjects the eppl c t t e c d ceneliy of (Q j ` L. o mhrc Nan five hundred propa ty,or (SNIT. , ` 1atawokof0epro.tarua imy smoimardled. hwagefor We sole compemeuon Required Inspections . a will doom Work.ands; eh Conscanoo tut dad oHo d for m apply (a an owner a . erW Profuaona Code The Conmetor s l:ce IV don nd apPIY m an owner of " _ propcny who Midda or improves Nercon,erW ho does such oh hrmulf or through e' i i mpl yiea pro'did that s cis impm met art of t t dad on Irr d for cele.If how the bu lGng orimpm ermm Id th' on y of complaron fie s iw bgidtt will love the ben urdofp mg vthan he ddt bo " ld or improve for Par- a). u ." •S r +" - Teale) I owns f Ne properly sm exduer ly nv s g with licensed contractors to t t 4 - o a N p jen(Sec ]006.Busrmvs rid Profeuro Code)Th Conmasm L q' cense la d apply m an owner of propeny who builds or improves thereon.and rte' ld - - _ k t who contmnafar'chp,mtswrthecontrecmr(s)Iicenaed punuanlmlhe Conirectots _ t� License ❑.I rte em n ersec. - .BRP ormis rcas n - n. ' Ownei Da.o t .WORKER COhfPENSAT[ON DECLARATION R . Y Pan ca ofCome t ofsto if-insow rWorkmfom ❑Ihave and idl for etion 37moft Labor Code,(rcfo Wok race of , Worn.as which to (pu by Section 3]OD of 0 L b r Code,for the perfomunI f th `I Work for a which Nis mountain n n issued _ ❑I have end or oda,f nWoM1srs CompensationInsurance:ch req d n i Secuon 3](rW rhe la. Code fortheperf irma a .d far which :sperm:.is is ed My Worker s Comcensetion Inemarrce celntt andy No.:number are ., . t' Lt s Curiec 'PONFROM `^ CERTIFICATE OF COMPENSATION N FROM WORKERS' t " COMPLmSATION INSURANCE (Th' sec( nudnot he mP1e.W'fm pemut i.forone h Mrcd dollars(g100) or Jr..) -. d'ii' - •• . 1 Iffy person serfnmar«eof s turn whbjetttothe arkers'Comper- 4 , notLemploy any pe o in my manner so ee to become xubjecno the Workers'Comsat set L (Cal fomia Date } - APPlroent NOTICE TO APPLICANT.If,a0tt rod ng this Certificate of E spoon,you should become subject 10 the Worker's Compensation provumns of the Labo Code,you most o t � fonhwim comply with such provisions or this permit shall be deemed rooked. r' CONSTRUCTION LENDING AGENCY y' b O Q, 'I wwwZiii Uj Ne work heo«r which tohihr pram, c N o esuceodna(Sec.306D,dmg agency(ahe perfomunce of t' _ I v, 1 Civ.C.) Lcndels Narne ��•', '.1. . •-- t„s 1 certify oho 1 h e reed N lit o an tat Nas Ne bo n6muuon ra ., p 91T, 0 turret. 1 g t mP1Y tAell 'ry c n rat:1 no 1 wee rclaung.o r - - 'U Obuilding uuct dh by rho re a ti, orhis tyo merupon Ne _ , shout mentioned pmcenY far mspecuu acs (0.'e)agree«Wve mdemndy eco u P h less the City of C penin,against _ a f,J ,liabl'ne judgments,cosre and aspens which may,inany w.yruclose ageAsuaid City } GTa in consequence of he granting of this permo + ` ' ”, j I .1' . `/.vz •'� . F Fw APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POI NI' . • 'j '• / +" VSOURCF REGULATIONS kn� sign. arAppfiaaHAZA DO I Dam ...IOL ✓-1ti7Jfc.VCGT - e HAZARDOUS Mdingca LSDISCLOSURE _ - - ^ Will theapplicant or future Wilding ,Ch tstoreo handl hazardou material Re-TOOTS ,. s as def ed by the Cupemno Mum el cad Ch pier 9 12 aM th H aim aw seer tr Type of Roof s . .Cod Sectt 11131fn)+ Will dre epplce torfuddmgo cupmouse<qup tarAevreeswhmh ..'All roofs shall be inspected prior to any'roofirig material lietng emtha rd- alrcomam:mnm defncdbyth Bay ArcaAv0uelryMeneg<mem installed. If.a roof is installed without first obtaining,am'inspectiori--• °'re "o I agree to remove all new materials fol:inspection Applicant Ye No d �,, Ihave ha' ue materials regmremrns under Chap«.693 of the Cell .`sun erstands and will eomplywlth all'non'point'source regulations.•` fomia Heal R e y Code.Sections 23303.133JJ and 23934 1 undenWld meo f IM ., a build gd n eptly heveat thorn mY«spotierb oo nobry the tutus m s, ? '' f I, - • (the y:re v c sob [}prq}y5� ofe �pccuP�, ' -Signature of Applicanty _, Date ' Owner or onzetl 8 m Date ,t 1 ' + a I coverings to be Class:`B"or better, All roof c g OFFICE 4b - 1