00110091 F
IvivoNNO' CONTRACTOR INFORMATION:
PERMIT: = I'P.RMITNO
BLAZINOWOOD AV 001. 10091
- APPLICATION SUR DATE
,UF_ LUEN 11/1E/2000
❑❑`
PIIONII: SANITARY NO, CONTROL NO,
Pa'OO -ARCfII'r1iLT/F.NOINHER: - BUILDING PERMIT INFO
EE 111.110 ELECT PLUMB MLCH'
wa ! I=I 1=1 I�
��.. LICENSED CON9'RACfOR'S DVCLARATION
'pzy= Inerebyumrm Job Description'
thvtlum licenced ander pruvi.inn.of ChaPter9lmmncncing
t',�: with Sechon7(HIO,,f Divi,ion3afthe llu.inessa III' lesions Cale.tend my license -
ei $� Nin fill fnn'c tend etlkc1
�a6a leat.ecln,a °� ue.u '�57��g' EXISTING TO (:GNP
Date Cannact -
ARCHrr[cr'S DECLARATON'
een O E --
Licensed
1 urda,mod my PI...hall'be used a,t.blia revords
or
�6po0 Lce dlrf. ' nl
OWNER RUII DI li DFCI ANAI'I(lN 4
I n by ff uh t lar pt l theC t t License' 1 for the
F' < follt g .(Section'7R31 5 N d Professions Code:Any city ounry - -
E O poor
which l ce.mm t o t t h improve. rmt t r y wcnrc ,
= prior n snsed p also syu res tnecisi(n o for suchCon rcc niuLimr,ao file a Law(Chapter t9
tmmhri,Peenwit pScetio tome pmvnvision 3the celuoin,sueenx Lawor%Cg 5 FL Floor Area Valuation'
(cnmmmaing co Scmml)opo)of ue cLN11 3 of rite ky0dexa and Professions cadet - q'
or Lira ha 1,exempt t;i,,, radflue Iawia Erz the objects
the
pplicanan.Any violation
of nem ion, ran e mrythrllcaatfor;;pavnit mhjemnthe upplicnm wnwlvil Penalty
of not mare arum live lmndrea dauam Iss1p1. APN Number ccupancy Type
U1.aanwnerafine trans army em,loyce,with wags as theowle ca.ur momint,
- burden ' ' b 3E '
oe
will the words, J tet ar tintended ff I t I (Sec.
.00
m.m d P e"(as c d Ther t 1 I ply to at Required Inspectio
nwnc 1p ry wb r hemor, 'I d k n
ooh kM1 n npl yc p J rtthat:ucrt nr t r o tintended or 305 FRAME
coc it,, If f o b'IJmg p t;. Id tit ry arof
completion,theaduW 11 the b d fl th th JJ tWild 1,, 307 INSULATION
improve rur
C/
O _
,
rumruarcoc of salel 601 .... ROOF TEAR OFF
❑la. uw:.rol'rhuprpcp,urn uJm'n.ly emaL,w6a,with l emedutnra,afsm
convme,the pojaci(ser.7044.Hu,ina.,and P.1..oriv Cade)The Cumowsm. 602 — ROOF PLYWOOD NAIL .
License law does not upply to an owner of properly whit builds or barriers thereon.
and who contracts fm such project,with w eontrrmna licensed pursuant to the 603. — ROOF BATTENS _
Cmntrsntr',License Ic w.
❑1aair"c;optunder Sec, 13&PCfor this realm, 604 ,-- ROOF IN—PROGRESS .
Owner Onto ..
WORKERS COMITNSA ION DECLARATION -
=�l hereby wRinn under penalty tel perjury one of the following declnraions: '
O 1 huve and will n;didain a Cenhlc:ec of Convent to 1c11 inwm Ibr Worker'.
C, peamhon, a, pooid,d'for by Section 3900 or the Lubar Code for the
perlarmnnce of the work Ibr which thio Ixnnit ix It. , +
01 have and will rWi.min Worker%Co nfemmion Insurance,us mgaired by Section
370d of the Lama Cale,for the perfommnce F,ha work for which this pcimit is. } -
fmmJ.M�yy��W.-�oorker's Cuntramation l:uomtmc camtennd Pol",aura",ore:U ,
Carriec�n f Policy No,:Z$-5=0� 1(..OI(�1
CLRTII'ICATION OF :XCMrT ION FROM WORKERS' 1p-�;�/
COMPENSA'nON INSURANCE. ,
i'I his section nocd not he mopleted f the permit is for one hundrcJ dollars' -
skgn nr hs,) - -
certify that in the radmonance ofthe work for%inch this permiti.s issued.) -
deIll not employ any pennn.in any manner so as at Ikcume sobject III Worker, -
Compensation laws of California.Dae
Applinnn _ .
NOTCH I'(I APPLICAN'P 1L nh,r,,d ing n licum nl'Exempt inn.yon should
Q 0 becomeatbjen ,,the W..lo,"s Cen"o,mio rrovisions nllhr Lubar Cole,you must
foMwith comply with Inch tmvisiom or this pemtit shall be deemm revoked. _
F VI COO In al
aNruclim NG AGENCY
a j I orcein which mI,mere i,s rmnmadc, leading agrnar for the perfarntanrr
W Lt of dte.vmk for wMrn dtix pennR;,L,ard)sues Jn99,ciy.C.) -
W Q
Tender',Addm
Lenders Address- -
t, 1 certify that I have real this application and state that the above information is
R [�. career.I agree to comply with all city end county ordinances and state laws relating
(j to budding cmamstion,and herein nutho—c miumsenwtivc,uOhn,eirym enter upon '
''y W mrabavc.n...named properly for nre,flnn Pnrynrce'. '
+� tY (Wel agree to save,Indemnity and kcer harmless the City of Crocuno r,mmt
L. h Imbllitic.,judgmm s,costs and experts,which may in any way.,me wgaina.said
C� ,Z City in consequence ml the granting of this permit. n,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH A{�LNON-POINT Issued by; �� .V
SOURCE REGULATIONS. h 1.!_ It _�1^� OJ y Date
signatumofnrplamUCuro ctolt441�7-A `l .VVV Date Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE - -
Willtheit liting fumreWilJingtceureausmmnrhandle nvwNtm.mamm.) Type of Roof
as defined by the Curenino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(4)? -
nn, - 0N All roofs shall be inspected prior to any roofing material being installed:'
will(hedom; ittonanninlm,torefure refund
ythe d yAe.Air emat hbo.fwnlch If a roof is installed without first obtaining an inspection, I agree to remove
nit hmatdnu,air amtnminanrp a.defined by the Ray Arcu Air Quality Mdnagcmem
"t`r"ores UNo all new materials for inspection. Applicant understands and will comply with
all non-point source regulations. _ -
I lave read Nc h,t nnlnts mm,6;d,remorcomnc under Chapter hp5 of the
California Health&Safety Cttee,Section,255115.25531 and 25534,I understand Na ,/t ✓_ I / Oc
if the building does oat currently have a tenant,that it is my s.prmsihility O unity the SArQt�Av�►1'W/A`a^',1V IV_
occupant of the agaireamnn which must be ran prior In i...ance of a certificate of
Occupancy.
{ E I(� k,,1 I1_��:j o� Signature of Applicant Date
owner mamhoo'eddwgau - Date All roof coverings to be Class "B" or better '
OFFICE'