08040138BUILDING DIVISION PERMIT
IBu1110767n BROOKWELL DR I TBD - TO BE DETERMINED I 08040138
NAME:
& MAUREEN PAVY
[JB gl C1l-3aar\IP
ADD 403',FAMILY
1 hcmby affirm Nal I am licensed under pmnstons of Chapter 9 (mmmeming
with Scctimnde ecDivirion 3afthe Bntinm and Professions Code, vnd mylicenseu
k full fume and effect.
Data. Contractor ataase sans
DaDELL
Ats"I W TS DECLARATION
1 undersand my Plans aIW I W used As Public records
Licensed Pmfwianaf
OWNER -BUILDER DECLARATION
1 Mreby M. Out I am exempt fmm tM Contractors License law for clue
following Masan. (Section 703 1.5, Business and Prof amus Calc: My city or mumy
which .,at. a permit to crostmm, alcor, improve demolish, or .pair Any slmcb e
prior At its issuancc. also "at. Ne appllcam forwch permit to file a sigmed summent
Nat he is licensed pursuant to the provisions of the Comraetor's License Law (Chapter 9
(commencing with Section 7000) of Division J of the Business and Pmressiou Cade) or
that he is exempt themfrom Add Ne buffs for the alleged exemption. Any violation of
Secuan 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not Mort Nan fin hundred dollars (SSW).
❑ 1,uawnoofthe property, army employees with wage astmusokcampmuation,
willdothewok,andtheawcmmunotNteMdoroRomdforaale(S".' .Bt ruess
And Professloru Cade: The Comeacmra License Law dao out apply or an owner of
propenywho WiMsnrimpmves tWmen, and whodoesauch work himvlfordtrough his
awn employes, provided Nat such improvements art not intended oraOerW for ale B.
however. the Wilding or improvement u sold within ane yearof compktion. the owner-
, Wilder w(B ban dm When of .,ing Out he did not Wild or improve for purpose of
S71. as owner of the property, am exclusively emanating with licensed contractors to
construct the ptojem (Sec 1000, Business and Prole cions Code:) The Cmha:mrs U.
ewe law does not apply to an owner of propcny, who Wilda or improves the.on, and
who contracts fm such pmjecu witha emu sccor(Q licensed pursuant to the Contractors
Lana
oar:
] I have and will maintain• Cen fiam of Consent to self -insure fm Workers Campo.
nation, As provided for by Section 31W of to Labor Cade. for the peefoemmce of Ne
were: for which this permit is issued.
] 1 haw and will maintain Workers Compensation buunnx, u acquired by Section
31W of the Labor Code, for tho parn mantt of the work for which this permit is Ise sed.
My Wmkcrs Compensation Insurance carrier and Policy number are
Description
Required Inspections
COMPENSATION INSURANCE
Obissemlm need mt becamplemd if tie permit is four hundred dollars (SIBD)
or 1.)
I ceaify Nm in the perfarmame of tW work for whicM1 i"
pemtit us iuued, l shall cot
employ anyperson in any manner.,,,t bio �syb at totWWorkerecom
Laws of DLllfor111a. (YT� I �J16 1 Pwadon
A.Aanh
NOTICE TO APPLIEf�W:117after making this CcnifgRO f Eacmplion. you should "
become subject m the Workers Compensation provisions of the labor Cade, you mus
O forthwith comply with such pravisimes or Nu Permit shall W deemed m
evuked.
.Ziy CONSTRUCTION LENDING AGENCY
[-v l hereby ARtm thus Nem u a coutmction lending agency for the Pmfurmwcm or
D: > the wish for which thus permit is issued (Sec. 3091, Civ. C.)
fs70 Lenders Name
7 z Lenders Address
U Q 1 cudfY Nat I ban rad this application and sate thus the show informatim is
IL ^ comas I agree to amply with all city and county ordinances and sum laws Misting to
.C) lS.'J building conwunion. and hereby wNoden Mpoccnulive, of On city to cnmrupm Nc
.hove -mentioned Propcny fm inspection purposes
6, (We) agree to can, indemnify And keep harmka the City of Capture against
to
liabilities. Judgments. costs sac expenses which may in any way accuse against said City
V Z in catu mium of the granting of Nus permit.
APPLICANT
Type of Roof
type
Date (j= ,:'h
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class '%¢" or better