00020145 CITY OF jRTINO PERMrrrdo.
I BUILDINGDIVISION PERMIT ... T F t T I O 0.5-0
BUIUMNGADDRIISS: "r
r f �• - SANITARYNO. APPWCATIONSUBM ALDA
a'_E,
Oq•NtiN'. AME_' s a ,
/ L ,N/C CONTROLM
V1ARCIIInCI`/ENGINGER w P RMrf
°O •• 1
LICENSED CONTRACTORS DECI AOON ..
0-°44Ihmf y.Ret.tut I i�a�mmpFuviaouofCh W9(w�w Job'Description
'
F"Jt� wiWSmion N00)dDiHaim3dthe Buailoaavd Hof®am Code.mdmyliammu - - -
< qa wNit farm u,I aw. •. .
mYW
Oamm Clan -lic.a' �.
aodD NewEDC -two -cr�,r coq ra9�-
O S D� ARCInIELT3 YION -
yr InllddNaM my plan alWlle mwmwNm rtn«m , '
,0 LiceuM PwfeasimW (— - 7 r
N
t Ei lUm IFJI-NURD DEi3ARAnON
tSa�a l hm.M.IEw tbv .m mnnaa mm w cma,amr:l;aevw T,d r«ihn -
HISm folbwiof nam.(S m]0315.Bativen aM PtafeaNwa Cade'Al uty«qty '
whiw rtquvrs•Ivmit m`m.w"•NRr,imPm.e,ddmlm«eepir ani•amemrt Sq.'F1Loy�Area 1 2Valua[io
pli«to i4 issm«e.Nw aNeirta N[.pPlicwlr«wch Pvnulmfm.6igrcd slatcv6bl A �y
dal he a liamaed luuuAl m llup iuw ofd Camavofe Limae Lnw(CT.ptug .. 1000
PUm.AV viNaim d APN Number OccType
Iba he is thaefmm ad me buia f«ttie alRpd caen
S mM313 by myV hum(«a,d ,ubiece tle%10O ma6.1 pemtyd ®3• upan�Y.A
mt mwctMnfiw hutld,d mlTats(5300). .. � ,: Ll .
'❑Lmmnmrddepmpntr.«mrmvpoy«•.;iNw.a.„th.i..m.mll�lloraa. + .Required Inspections
- ,wRl mthe aat,avddrwoclmeisn«ivtm0odmdfvM rvuk(Sc.'ION.Bnsiven
' svd Hdeui®Cam:TM1e Cannanofa Ii®s raw me m apply m m onv d '
pmpaty who buiWa«ivlpeo dal h i sed who Doti such i Nntul(«mash _
hu own employee&Willi d IIIY such impinst w art od ileradW«oRued f« .
sa1e.1 howewe de buil dills«ivlpa Me ,,Out tv lhiW WiW dcompldion,the
,• -0mldd will low tM WNrn dprovinS lhNMdid mt buiM«inptose f«pv-
o u oro&d the P-Duty.set ueWW*ty C ft uvi w,h Ir caouston m -.. ' ..
the M.5(Sa.T0f0,Busiom and Hofmmw ComJThe Cmoclofa U.
cavae law dv«Inv lymuawoe dpmpmy who buiMa«ivwaaso thnem.aM
wM1ocontMar« pojdn wiiM1emnbwam(sl lkemd pmauantm the Caouena•s
01 Sa .• .BkPf71«lyiy�m
i"W6ROws'doMPENSAOON DEcl. AnON Q� -
'Ihaft dEmUM PemllY d Fcduga oflle fa110 ,,ddWNiam:
Ihaw mtlwil N,by
Mie of Ilk mmlr-I.lfmW«hel.dlJv- _
inion,u plvsidw f«by Semon 3RO d tle lab«Cade,I.me pafwmmse o(de
I
wvhaw”f«a11 mai aWn imrd.
❑ and will kt W kd C«vpvwetiov 1o>urav¢,u Iryuvet by S lion
my dlherebm Cade,f«they C.,ic Wftli kfm which Ibis pvmil uiaated.
Cirri. is Canryenulim lm«aee cosier and Policy vambd
dsd¢ Polity FROM
-
•CERfIFlC ON E SATIONINS FROM WDRI(FAS' '
COMPENSATION INSURANCE '
.flllisadlim neMmbccorvpinrd iftlepmmil uf«omhuodldddlm(f 100) � -
lmai(ylNlivthepeAameocedthew«Yfmwhichthu PNmil isissaed,IshsB ' , -
md^Moy avy Priam mnY naercrnnmbee«rc aubjed mwe
AppimmW«Sea'C«sWm-
wa of CaElmda Dace .
Applicant .
NOTICE lD APPLICANT:If.&ret nuhine Ihla Cmifmaw d Exemption,Ya Mould ' -
- •becmme wb3atm0e W«hefeCmpolxnim provixims dtM1e labor Code.Ya lnua ' t � tl J• ,
(mM1w•iN mmPlY wiW such provisims«thu pewit shall bemelmarevakN.' _ 1. -
.CONSTRUCTION TENDING AGENCY
O I mwhi6N P.W,k ac«uwwpvleodi�lg agmcyr«Nepafmlaoced
mew«Ilr«wmrn N.pmmil ia.:.:md(see
Lendels None . . •' ,
1Fri > -
(zi 0 T wtify ma 1 haw - I tsnc tlIN roe show id«matim is .• .
FI c«rat.l agrtemc«nplY witlh s'tyaM tY all autc4w rtWiegm
' ] z Wildiw c«nht..all lue yauthori teplmelllalvn hftNscily menet upm lM1e
ameamentimw psapdy f«i Pu mpuryana.
Ci t;,,, (We)a5ree mum inmamify and haphmmlua rile CitydCupdtimapinst ^/ C
"O V IiabiOtiu.ladDrmb,avuand eapaae wh nuyinmymyr a&muWRty
APPLICANT
TUNDE SIANSot Ibis WILL
F Or. SOURCE REGIMERSPANDS AND WILL COMPLY WITH ALL NON-POINT -
SOURCIi REGULA3'IONS.
ti Sipavve aApplkm,/Comnctu Dae
aA7 Wus MATERIAIS DISCLOSURE
Willihe applicau«N,m Nimin orrnpm mrt«haldk haxmmua malesial Re-roofs
u&flied by de Cupmino M ipl Code,Chwp 9.12,em m Hullh avd SNdy
. caae.s«tmnus3ant ' Type of Roof
❑Y Na
R'ilithcapplaavtfwwWil,;nra«npl,l„we9,,;p�;m,nrdn;�.h;m All.roofs shall be inspected prior to any roofing material being
emil1u 10m!a . Iwn%NmfiadbyftBayAruAvQu1kyMwgaenI installed. If a roof is installed without first obtaming.an inspection
Mo ' I a Tee to'remove,all new materials for inspection. Applicant
oYd No
LEM. Signature
un erstands and will comply with all non point source regulations.
.5M.d ifi ore of Applicant• - 9 Date -
All roof coverings to he Class"B"or better
OFFICE...