02080126 CI BUILDINGUDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10289 BRITTANY CT 2 g
t�
ORT?T ME.UMERANI c g DB
An k
PHONE: SANITARY NO. CONTROLNO. .
ane O O ARCHITEC IE.NGINEER: BUILDING PERMIT INFO
yUWUW BLDG ELECT PLUMB MUCH
t-_1 1— I LJ E.J
LICENSED CONTRACTOR'S DECLARATION
z u y 1 hereby affirm that I am licensed under f Chat 9(commencing Job Description
Di_� ra provisions Chapter f g GAS LINE
F,y1_• with Section 70001of Division 3 of the Business and Professions Code,and my license
a m y�j is in full force and effect.
°C m z a License Class Lic.g
3 a oft ITCTDate Contractor
ARCHES DECLARATION
a g I undcrnand my plans shall bu used as public records
�N
aces np p Licensed Professional
s OWNER-BUILDER DECLARATION
Irx+R m I hereby affirm that 1 am exempt from the Contractor's License Law for the
f z a fallowing reason.(Section]831.5.Business and Professions Code:Any city or county $500
i-O wh h q rc Perm t t st t II r improve demo)sh.or repair any structure
i 3 m pct^ t ¢ wmm<also th applicant for with pemut m file a sigaM stammenr -
that he ncing with
Sections
e no thepb si ns Division
3 e Contractorusines and Pr law ons Cor 9 y o ii )3 6 3114.�f fta- , f,.q f Valuation
(c that he ng ri Secb rom r The smn 3 of the Business and ion An ons Codd r l:i 1 1,•
or that he its exempt tan applicant
and the basis t subjects
cts she exemption.Any violation
of 5«tion 7031.5 by any applicant for a pemat subjttm Ne applicant m a rnil penalty- Occupancy Type
,of not more than five hundred dollars(amb). 202APFN jft�g}gRFLOOR PL MBING P Y YP
01.as Owner^fthe property,or my employees with wages as iheirxole compensation., 301 — ROUGH
will de's and Pro ssi the deTstructure C not intended of c eredLaw roe salenot apply
to an 502 - FINAL PIFJ#BrLFi Qs0aMEi5RGY'
`will do me Wei
add Code The is n t sten License Law dues not apply man
owner otpropeny Who builds or improves thereon.and who does such work himself 506 - GAS TEST
or through his awn employers.provided that such improvements are not intended or.
-bffePWfor sale.If.hdwevii,the buddingornnpiobemnnia>oldwithinare yearol' .. .......__ . ..507 ---...FINAL PLUMBING -- --. ..._.-- -- - - --. --. .
completion,Ne Owner Wilder will have the burden of proving that he did not build or
improve for puryose of sale.).
OI tie oftheP Pent I sic Iv t f g -th Id vacs t _
is ewn the project(Sec rola Business and Prossfeons Codc:)de l The Contractor's
License Law tract nm apply man owner of a corny who Halide or improves thereon,
and ho contracts fo ch.Project with a.comracmrtsLncensed purswm m.th< .__.. _.__.-..... -- _...._.. ..--`.-..._
..
Cn t t 2s License Low. �� ��� .-_-
❑1 < rapt ndar s ,Iii P C for this mama
OwnerDid. .
WORKER'S COMPENSATION DECLARATION 11 O fjOOq
I hereby affirm under penalty of perjuryone ofthe following declarations: pVP Cn1PL
I � O I have and'will maintain f Certificate Se i of Consent t se Labor nv Workers BUILDING
Cnfossrnioo. as provided far by Section 3]88 of the Labor Code, for the
_ perfnomance of the work for which this permit is issued.
_ — ❑1 M1ave and will mainiain Worker's Compensation Insurance,as oequircel by Section
'37M of the Labor Cade,For the performance of the work for which this permit is
issued.My Word's Compensation Insurance Cartier and Policy number are.
Camrnr:t, It ::'r .I`.y Policy � �rev t i 1. It. •a, s f a Y'1?
n CERTIFICATIONOF EXEMPTION TIONISFROM WORKERS,' - .o... j iv I>. x, .. s J._1s.1. +,! +,,: +, •'t
' COMPENSATION INSURANCE.!" -" s '
En!a un on need not M completed If the permit is for one hundred dollars 1 i
($100)Or I s.l
s
I
centf that in theperformance • '� "'�' ' ` ' """'
y iin the work for o ch a ct 't 1
'shall n employ any person in any manner so as m become subject m the Workers • f^1' `f
Comicant on Laws of Caiifomia.Date'
.. Applicant:
NOTICE TO APPLICANT:If,oo Compensation
n is provisions
ofof Exemption,you should- -
Z 'become subject mthe Workers Compensation provis ons of the Labor Calc.you masa
� forthwith comply with such provisions or this permit shall be deemed revoked.
" CONSTRUCTION LENDING AGENCY
I 'work
which this then its construction Sion lending agency for the performance
'a
of
Name'-. . _ s pgtnit is issued ISec:J89],Civ.CJ ._. _. _ .__.. . ..... .. . . . .... ..
Q of the`ork for which this...L...... ..... _.__.__...... ... ....__- _... _. -. - .._. _. _. . ___ _. .
Z Lcadc,sAddmsa - . ...
cenify that 1 love mad Nis application and state that the above infommum is
cramect.I agree to comply with all city and county ordinances and state laws relining
to building construction.and hereby ambdrite mpmsentatives of this city to enter upon
,the above-mentioned property for inspection purposes.
6lW'elegreetoe.ve;l.demnifyxndkcepharmlcz{she Ciryof Cupeninoagainsi
Cn liabilities,judgments,costs and expenses which may in any way accrue aRut s,said
U%Z City in consequence of the'gmming of this permit. '
APPLICANIT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. 1 Issued by; Date
Stgnammof Appncanvcuotractor. rt Date" Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'S
Will tie aPPI ant p fm Funding tic pan store or handle I„o.nm:s material, T e of Roof
e d f reed by theColombian Municipal Code.Chirpier 9.13 and theHc.10 and Safety Type
- -
Code Sen '25532(x) T \ 1 - •' �s _i A •, Y i s•:$Q'YS S TTt't
vp _.
ONO
,installed.
P Pg geto
want applicant or fw building P t eequipment desires which all non Pint source re treasons.. understands land gree to remove ...
All roofs shall be.ins ected prior to,any.roofing
e sthazardousrcontaminants asdernedby00B yAreaArQu ItyManagc Management
[f a roof is installed without first obtaining an inspi 4 a
Diet"" all new materials for inspection. Applicant un will complywith
❑Y ON. - - -
- - 1 have read thebeawdous materials mquiremci is under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533 and 25534.1 urs
ndetand that
if the building does Hat currently have a tewnt.that it is'mymaponsibility in notify the'
occupant of the requirements which must W met prior to issuance of a Cenificam of '
a'
Occupancy.
._.... . Signature of Applicant . -..__ ,_- --..-., Date _
,Owner rauthonzcdagent Date All roof coverings to be Class "B"or,better
OFFICE..-.. .