01110014_f
OFFICE
CITY
CONTRACTOR INFORMATION:
NNO
UILD NG DIVISION
PERMIT
BUILDING ADDRESS:
PERMIT NO.
802 S BLANEY AV
01110014
DMIK2 NAME
5%12DATE
All,T0
20 1
PHONE:
SANITARY NO. CONTROL NO.
O O
ARCHITGCTIENGINEER:
BUILDING PERMIT INFO
u
BLDG ELECT PLUMB MECH
5
LJ I_U L -:J LJ
as
y `
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
"!11007 'c
ELCT SERVICE CHANGE.
C
with Section of Division3nitheBmin<ssa dPmfessi Ys Code. Imo ,
nr7
is in mu inrcc-nietfe,
n_ 7 73
(UPGRADE)
hes
License Cl uc.w
i
Date [LL Conlram,
uO1-
Q
--�%
ARC I CC'f'S DECLAR
r'
1 understand any plans shil be used as pabli reenrds
p zLicensed
Professional
ay
OWNER BUILDER DECLARATION
I hereby aRnn that 1 can exempt from the Contractor's License Law for the
z a
following reason. sctrion 7031.5, Business and Professions Code: Any eqn, county
_
which q f t a s la p l I h n Y mane
'.
- - �-
j 3
_p t , I 9 . toapplicantf hpe at fl signed t tomer
S - F1oorA ear pp p - .,
q' �.l.,at
Valuation
fi U9sf sed m It,lil is fheC , m Cce.e La (Chapter--
p
pppphvAaAn, Coden
sing tpi ,'on;ID00)a(Div onee
p,rj 5,s1V 1s. L_'aS
,
lie rAurin
and or aper fee Any
or thin he is exempt ,any Penton
-'7Y62.
apom
subjects the l
ofeea mo, than by anyapplicantfurapermit suajeas 0¢applieammaeivll paml,y
applicant
,omormore than lite nannred douars (aeon).
APN Number
� a , .. Occupancy Type
❑I,a, owner ar the property, army ampleyees win wage.. as tad, sale complaint..,
304 - ROUGH ELECTRI
AL
wil dhe work,an she
n ware. and me honctare is nam ct.,, am oBeaw m, are (sea. 7oaa
'Business Cale: The Cnerainten License Law does norare apply 0 4,
_
5 01 - FINAL E1R r�r$tJl J1p cti$AERGY' .
�u
or rofpmpemyWho buildsorhatem,eamento,and who doessuch work himself
505 - FINAL ELECTRICAL
th Hsown employees. p Id,hets¢hlimprovements, intended or
orered
_... .. _. _._.. .-_... _...__ . ....
IoffcrcJ for s5lb lLh th holding .-.
for ar mprovemen, Id 'th' rte year of
.. ... .... .
a the b h,) will have the butden of proving that hedid no, build or
prove fa mt, o
improve for purpose nLsoleJ
m1 fa p pe ,y ly ..t i g lllicensed n,.. t ,
ec t t the p l , (S 7041 H d Pmf Cavite) Th Contractor's
Q/
License La all apply, r fpr pent h I W p ,h
and h contracts f such projects _x th commaor(s) I d.p man, to the
Contractors L
111 an axe np, undc sec, ,B & P C rnr anis
O
/
Owner .. Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have ad will maintain a Certificate of Consent to sebiname for Worker's
Compensation. as provided fm by Scc,im 3700 of the Labor Code, for the
performance of the work for which this permit is issued. ,
❑ 1 have and will m anion Worker's ComPensmion Insurance, as remind by Section
-
3700 of the Labor Code, for the performance of ,he work for which this permit is
-
T
_.iaa dMyW kerssCC, p ica Insurancecontrail and b�e�1re^:j ',
4' I S(' /vl Y +C Policy N 3
cars /r� 8
-----
-
er . ✓f Y C
'
.CCR'1'Ir'ICATIONOr13XLMFI'IONFROMWORKFRS!
COMPENSATION INSURANCE;
s section need ntn rte mmple,ed if ,he perms in liar one hundred dollars
or
. , v. t ' 1 I t.
1
(slop) or lees.)
1'eempl mat m he Perla noes opus,s work for which permit issued,Workers
to
ti a
alio person In any manner sous w become sub7eet ,.'the Workers'
shell no, anon
"" '
L
ComApplicant ion Laws of California. Dam
NQintlesa'OAPo Certificate of Cory youshould
ANT If.Workers afteCentenarian
gtiltsnprovisions
'�
bermeh the r of the Label Code, you must
Label sees,
Coins
thou permit
�
corn, y with such provisions or
forthwith cpm I tti such provisions or this permit shall he Aeemed revoked.
prwi shad
���
/
CONSTRUCTION LENDING AGENCY. ',
- -
1 hereby nffrrm that mac is a connn,ction lending agusy far the p`ettormance
s.
�. ,'may
hem' k f wFich Ih p , issueJ,(S 3097, Cie C) "
QCele
Name -.. ...., ,. ... ....v....
.. __._ ... ._... ___
ZUnder'AMress'.
I certify that l have read this application and state that (lie above information is
'
E.a
(�
eokem I agree, to comply, with all ciaymad mtmty, ordinances and state laws relining
reposenm,ives of This city mentor upon
centionednropery
the
v' k7
alcove forinspection
the alcove mentioned propend far inspection purposes.,
v t1.nst
(Wjudgme ts save, i h
keepwhich Awa of
said
- - - - - - -
e in)
s
and expensfy es
ides, judgments, costs and axpelfle which may in any way acwrve against said
may lin an ems, againic st
z
Cilb
Ciry inconsequence of tM1e grnming nf,his'peCOM
,AP e'JI"U,N'DER$' NDS'A14D ILL COMPLY WITHaACCI:ON P01
sc
Issued by: Date
cEcul. to ^x�
- --5 a, re fAppl'caMC t , r', Dam
- HAZARDOUS MATLRIAI S DISCLOSURE '
Re -roofs -
Will the applic t f to building x P ,storeor handl h sol mmaterial
Type Of Roof -_ ././. -2 —�
as d fired by the Cup n n Municipal C d Chapter 9.12, and the Heath and Safety
.-.. _
--
"t.
Code, Sen wr 255326a7 _
Dues r. opo•
' t
_.All.roofs shall be inspected prior.to.any roofing material.being.installed . _..._
will th ippli a , f te milling pen, e q p t 1 seewhich
if a roof is installed without first obtaining an inspection; I'agree to remove
emth .'d arm, t. ai Ilio 467 ,h BayA A Q IiyM nag em
D , rt7
- all new materials for inspection. Applicant understands and,will comply.with
I ❑Y I ❑Na .,,
all non point source regulations.
41 I have read. the hawNous mammal. gmreatch. under Chapter 695 of the
.,
California Heart & Safety Code, Sections 25505, 25533 and 25534:1 understand that
if Nc building does not currently have a tenant, that i, is my responsibility to notify the
th of the requiremems which must met yrare m issuance of a Cenificare of
o=al
n
Signature of Applicant Date _ -
All roof coverings to be Class "B" or better
ran,nadaaeager •' - Da,e
_f
OFFICE