00070002 CITY or c�PFRTNNo ER I CON
TRAC*TOR iNFORMtATION r�
BUILDING ADDRESS: .- - 1 PE.RMITNO. -
- -
00171761710P
OWNER'SILY413 10 — • H + r APPLICATION SUB DATE'
PHONE: HINTH- -l—ILY - i, a SANITARY NO. ^ CONTROL NO.
O e Z ARCHITECT/ENGINEER: _ - BUILDING PERMIT INFO
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- - BLD EL VT PL B VtH
LICENSED y y CONTRACTOR'S DEC'LARATION - +Job Description[_iono4IhxbaffrM1 tloI' acunllop v: fCtrpt 9( cineE0 dPf.: :Cdayli license
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1I,i III Force and effe 1,
C.� -L1c aClass L' k -
° 3°ac pale A- z l o o moon _ •NEW, GARAGE., AT 525_+SOU FT. AND REMODEL L
F ,, ARCHITECT S DECLARAI(ON
¢f 1 a t a y pi :a u he uwd p Nia recoom. - 4'r_'0 SQ. F-F.
a_oc Lc ca Prof nal PINALED '
ES o N OWNER BUILDER DECLARATION - . ,.
Llierchyinficia that I araCoxempt firroor the Contractor's License Law for the
t F d roll g (S. t 7031 5 B d P f C 1 A) -ly army
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which q p erosional. 11 l den 1'.h,011seliclar,doctorle AUG 2�4 O
p01ro I t l y th applicator It p 'tt fl g I_I I tl - - ' tC1 l7
mala edl . �t d p rn C 5 tr 1 1 (CI' I y 'Sq. Ft. Valuation
'(co c¢ Section with Ser7000)of Divisor?rt the ersne and End . .
..too,Cd) -
.r Thal he is owerea therefrom and the basis for Inc alleged exemption.Any vichiion'
- of Section](131.5 hY tmy apPlienm foropannh'uhjemathe appliatnnon civil penally
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of a.,hence,man love httrifted dollars($500), - APN-Number '' - . e •_
❑Laa owii foldie 'loo :. ." •r - _ gp • , -
P perI"o nay employaex with woes as lhei edcic r,losmloa,,
will do the work, d the structure I intended or offered for sale(Sec.7044,' - -
- Bo. a P f,s c d Tn c t t :� L doe: I apply t- 4 ' (r,}?(quired Inspections .
9 n fp pay Whon 'li Tprono portion and ha does inch work nrlf
nua
:: Ihr mgh his ow we mnployecn.provided Inas sneh Improvements are not intended or i>L < - -
offered for sale If,trouser,the building(it imp.scrohnl I,..old within arc year or f.
�,mpletiorithe owner-builder will have the th rtlen orpowoU that he did not build nt
apmvero"alprsercale), 101. ,— ,FOUNDATION
DI : 111 p p (y, 'sly contracting ithl 1 t Irsns r I.OF' — PTERS -
Lim I I th -p E,1(S 7( 4 Ba,dhao..an 1 Prefes,hea,CodTI Contractor's
censei wa es not al,dyt f property who holds ohlpr6tei thereon, `tO3 — UFER
and who contract,forhpr ju7s with o eontraa.hsl nerd pursuam to the -
Contract.,LicensaLaw' 164,-,- REBAP, '
1:1 Fant O,ra,l at See .B&P C far this reason 1.4�iS'�:—w ANCHOR BOLTS ..
owher Dole !fie O _
WORKIRS COMPENSATION DECLARATION - lop FJ 1 SEIdER E' t3,IA (ER
nrerbyraftorah"'Porreally ofner)nryra,ofhefnuowingdeamrecia, 202 - UNDERFLOOR 'PLUMBING
❑ 1 naveand_will henosin a Certificate'of coaerm a.Seluldsut for Worker 203' — UNDERFLOOR' MECHANICAL ,-
Compensation, is l;coaded for by Scallion 3700 of'the Lahor Code, for the' - '
perronhence Drthe wore:for which his pencil is issued,' ' - 21714, —. UNDERFLOOR' FRAME
" 05 ° UNDERFLOOR INSULATION-
❑Ihave ane will,Codhanded Worker's Cmn;wnoof
f t Insurance•as which
d by Station' I— '
3700 0l the Laker arae f theperformtaca acme work h' h,m;s peal I's '
' 'soca M)Worke-sC p trin'arancee.I.errgePolicynrml,erare: �,ID1.-Iii— ROUGH PEUMBIIVG
. Ccrrrrr: Policy N.:. 3 ,2 TI_IIJ &' OR SHOWER
CERTIFICATION OF EXEMPTION FROM WORKERS' - ; — ROUGH MECHANICAL "
COMPENSATION INSURANCE -
+ianne 1 t mplweFnl pe mal>rarD, nn,aeddrnn: 304' — ROUGH F_I_ECTRSCA
- (ela))or 1.:.) t ' 305- — FRAME
1 aceff,t ri tire F,,tronance itn work for l- I (his pcariat :issued I C,06 — .HOEDOWNS:
'hull i ply y pe y nano s m hereon, object to the Wn'k-: : e �Af
CADnlpcuti I:xsofClforna.Date - 307,,.-L INSULATION a - .
NOTICE TO APPLICAN P If.after area,th Carnfirre,ol r G yen Ocala • 308 "- 'SHEETROCK
ben : bj a the W F Compensation pa t: fth Labor Cd y oral
•'Z.O"forlwth chh,ly wan cap : m parianall bola ned hooked ,30§ = EXTERIOR LATH
rr. CO NST RUC[ION LENDING AGENCY 31.5 INTERIOR-'LATH,
nr hereby R d tPn a nt Secti 7,Cie r,rtne n=rrarnmce :31'l_ — SCRATCH COAT
of he is li ch 11 nv sissued S 309] Civ.0 -
�„ z . Londe :N - e -
r7 z Leader'sAIL ss ' 331-.1•r— ROOF 'h1A11_
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I ecoff,that lna,oread this a,par.lion a I none that(]to abaseinfoari i. 501 -FINAL_ ELF_CTRICAL 'ENERGY
O verr' I I I d II I J t f d state I relating '
1.1 Aai gr, h,bnrlarryndhetrnyaamrr n p,so,h d.es lIleal)tornmra a 502 - . F.IPIAL PLUIYIBiNG ENERGY
w ,taab ,rit I Ipe property for mph' f ,n SQL^ --. FINAL MF_CHANICAL' ENERGY '
d (N) g l - 1 ly d A h il a Cly f c u ti 6a1nn d
.. n Lnat idgm may r,an>way accrue 5 14 - FINAL BI.IILDING' 'ENERGY
V � City m< n:qurnce df lh gralrg of this pe rl.. � �
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
SOURCE REGULATIONS I Issued by: 51L,cC FINAL ELEC fRICALDate
Signature rAppl' aUC t a Dote i Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE507. — FINAL PLUMBING
W,II Ih PpI n fir, l -kine gt zaJmm
. aiboard,Cas atchal -'type Of Roof
asdei IbY Ih Cp f M I''p.l Gvl chapter 9,p ana the Heath ana Sfety e -•
crar Scott,,.?ss3zml; - - ,,.r18 — FINAL MECHAN'C.flyAI
°Ye' °� All roofs shall TffispectddTplliii Lto fiif}!filWng material being installed.
Will m applicant Police b Ting p t ,equip t devices wnirlt' If a roof is m i M1 with tCfil�tl:obl ]ni±t�lhhIi9v14pection, I agree to remove
emilh 1 - ,onloar t dfnrdby(hH,AreaA Q Ity Maer,cmeu
DiSlr I all new materia f X ins A t e
❑Yr, , _ �Sl.9 plpc RpRL 1pk rMt Igli tSLa(�%nd will comply with. :
all non-point source regulations.
I c ead the 'd t I. "` - '
yle ds under Chili Est dthat -
•
California Health&Sofcty Chile,Secfons 25505,25533 an125534,1urdetsmnd that � -
iftheh 'IJ ba : u dyh t t O t'Y y .......'hilo,ar f fly the
ocrepanl of the rcptr I h month Ip'r m fu Ccrtleum of ce _
Occ'pray
Signature of Applicant ±' Date
owh%42�1r--- Da,e )' ' 'All roof coverings to be Class `B" or better' -
w•_ OFFICE