00100061 CITY OF CUP.ERTINO ,a , , ,
BUILDING DIVISION ,'PERMIT '.CONTRACTOR'INFORM O '.
_ HIIILDINOADDRESS:. a' - PERMITNO. s• ,
_ 10240 BUBB RD DOME CONSTRUCTION ,• ORP 00100061
OWNER'S NAME: APPLICATION SUB DATE"
DI 60. CARCILINfa STREET '10/09/c000
,
DONE' - - - SANITARY-NO., 'CONTROL N0.
('41.5) 664-6'140 '
BUILDING PERMIT INFO
a00O ARCHIFECI/ENGINEER ,a
ca— n BLDO .ELECT: ,PLUMB MECH
=N
m�
St•a�a¢¢ CFN51D CON'1'NACTOR'S DECLARATION
fhIca'arg .
'Job sDescription
Ozf3hereby
"y"lith 5 t afD' 3 flhe Business
IProfession,Cotl amyl
edoRe I'
for force L « DELETE. STEEL FRAME/REPL-A.,6, 0 WCMU ( ,
BLO k
O a U '•Dole Cioulacuir
3 H ARCHITECT'S DECLARATION
br 01 mdentnnd my plans shill M1e-used ns public reeoNs - - -
�ce p O Licensed Prde"unall
OWNER-BUILDER DECLARATION
6' e 1 hemhy urban marl am exempt Nina,,the Contractor',License Laufar the v
fallowing reason.(Section 71131.5,Business and Profession,Cade:Any oily.,county " '
of G which requires a perait to construct,alterimprove,dennallsh,or repair any structure • `
w pro to its. ane l 1 re.m ppl'm IIr hpermn Ile 'bn dswteinenl _
a 3 mon .r pursuant tr to provisions o nl e t t L L (Chapter9 •Sq. Ft�Floor'Area - - Valuation
fico ech,wthSwi 7yt of Division 3 fin B dP'helium,Code)' ,
or that he'sa apt m reran and The bit...' for the allegetpo
d a nm Any�clumn -
r -
_of Sealant 7031.5 by any npnlicam for a per not subjects the aDnficam too civil penalty - - -
Lr nal anL�b Isom rwe nandred nauom css(1o). t - , APN'Number,, Occupancy Type
Ella,awnernf nne property,m cry employees with wages Its weir sale compensation,
will do the k d the t t t intended or offered forsalle(See 71144 - -
Bra , I Professions Code Pla,Contract.,',License Law I ,in, i,,Iy te in Required Inspections '
r of propeprty Who 'I I omen
r ntpru,thvon and ol J s ouch wank himself
orvthrough his own employees.pmvidel That ,all improvements are all intended
offered for fila If,however.the building or improvement Is sold within one year of
Iompletion,The anenbstaldcr,will have the burden of proving that he die amt build or „
wmprove for""Pa a ml .. - t711,as.ne of aha radrenty,am exclusively connecting with licensed contractors to it, - .
consumer the project(_Sec ](144,Business,and Professions Cole)The Contouors
.License Law does nal apply m an owner of r, n who huilds ar improve,Thereon - +
PP Y p 'per -
Ca who crnhamf for rush r 'ads with a rnmnmmrW license)...... to the + -
rLl ran
C I ban ex'f].,came Luw. _
❑l am uem a unlet Seo B&EC for this reason '
p .
Owner Mule
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of sectary me of the following declarations.
] Ih d 'lin ntinaC lean 'CConsent to L : fir Wo kers'
Coope :afro, as.pr n'Acd fm by Section 3]W of m Labor Code, far Ihc,
perfimm�nce of The work for which this permit is issued. - -
01 have and will ntaimain Worker's Comlwusutloo Inrumnce,as required by Section i, -
3500 of the Labor Code,liar rhe iurfornwSn or the work for which this permil is
sued.My Worker's Compensation Inwmnce carrier and Policy number area
Carrico Policy No,
CER'1'I17ICATION OE EXEMMON FROM WORKF.RS'COMPENSATION INSURANCE
('Pili,section need not be a sphand it he.mold is f)t(n,hundred dollars
ISK0 :Hess.) - ,.
,1 every that In rhe perrormmbce of Ile work for which this Tamen Is is and„I
..shall not employ any person in any son s as to became subject m One Worker,' I
Coopmamtion Laws of California.Data
nne -
` Appllctml.
NOfICETC)APPLICANI If, n k ,this Curifitsural Excerption.youshoule -
become Infecturnbe Workers Comparmaliamp a,of he Labor Code,younnst s f'
'Q forthwith cofPb with s.all....:,inns to ri,pvrn'I to dl be du;me:1 revokul.
CONSemUCTiON ral lambing
AGENCY - s
I hereby or.Broth ul ad(S n l n ling age y l Th pcaomtanec _
a � Leah kf which this prnlis evuel(Sec 3ti9'!'Civ-C.)
Leader s Name i
..'..
.V Z LcnJ A ilv'
1 canify that I have readi'.application andal that the above information -
LL t.n correct.1 agree to comply with all city'nl county ordinances and.t t laws selling
mntedingconsthroam.and hereby mlho rneandi s, full,may m"'ImUm
the iblea-munflorcol property for amiefsteenp p. .
ry (W) g t 1 oily ndkeep f the City fC p n against
t
liabl' dg ls,costs and expenses which ,:aid
U City cyuenee arab ymm n6 of this P rmu. Y -any y ago ns t
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT / p p
SOURCE REGULATIONS. Issued by:.- Dater
Signature of ApphcanUConmcn;r Dare Re-roofs z • . - Y ,
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fuimc braiding acomia)ware of handle hazardous material Type Of Roof
a4 defined by nne Coleman Municipal Code,chapter 9.12.and the Health and Solely
e'Code,Seminn 255321x)”
- over 'ON. All roofsisha-Il.be inspected prior to any roofing material being installed. -
Will the applicant or future Inaldirs,;voculand,use opurrion,or deoicesduch If a roof is installed without firs6obtaining an'inspectioil;I agree to remove
emiriamrl u tr cant i a : Icfined lyre B yArenA Q al iy Managomem -
awHna . - all new materials for inspection:Applicant understands and will complyjwith
°Y, ' °N `allnon-point-source'regulations: '* "
1 base rad The narandens material, I re cab and CI pt 6,95 of The
California,Health As Safety Code,Section,25505 25533 and 25534,1 understand Th t 1,
if the be id,ng does'lot ctnently have a tenant that h is any responsihil ny to aim:fy the - -
n,a..am if he calculations 1 ch must be ren p,for issuance n f C ttifibme of t
a
Occtpnney -
Signature of'Applicanf d - Date d, . .
Ow net ormilitarized agent - - Date > ;.N All roof coverings to be Class"B" or better ,
OFFICE i.• '