00080124 CITY of cuPua'rnvo CONTRACTOR INFORMATION:
BUILDING DIVISION ' PERMIT' y
BUILDING ADDRESS: r •a. "' !- PEliMIT NO. -
T)P
OWNEk'S NAME: °�' - APPLICATION SUB DATE i
2000
HONF,: - 'ei SANITARY NO. 'CONTROL NO.
Oe4Z ARCHIL CCI'IENGINLEk: - BUILDING PERMIT INTO
.• F p E • " t BLDG ELECT PLUMB MECH
tr x.-
I O 0 Z LICENSED CONTRACTORS DECI ANAL ION _ Job Description t,
0,atI Orehy a finthan l licensed! d p fChapter 9( 'ng _ t•„•.
FZC� 'wi ih Section 7000)nfD of 3 o the Bu and Pr fe',' ry Code and le
aa$.'�a is to fall force and effect '
a a License Class Lia,q •in
o Date emmmet,r ,. REPLACE WATER HEATER-
w 3 e.y ARCHITECT'S DECLARATION -
S 1 understand my Plans u1m1I he used as p,,hlie mcords - - ,
vu�{ s
va ¢i6Q0 1 : IProfessional
OWNER BUILDER DECLARATION
c,�=soA he eby affint that l a.exempt f .in C nt was L e. Ur,for he
I-Z a following rear,n.(Sect 7031.5.Baxine and profession,Calc Any cry a r loamy' -
❑ which eq 're;a from,ic n:t al, npr e demolish. ,,mintir any Tmuctum ' -
3 m pre, t t s e L 9 P,oa,,lamn tf hpe to fl n bo
- mato ae im . atop ranee t 1 La (Qnpter) Sq. Ft. Floor Area - t Valuation -
.,, nems whoSection analof DAIvan3of In a Buono, Prol Anode Cnde) _ _
M - onhm he is exempt WarcGom applicant
aha Penn( the,Ia the
exemption.Any I"rally'
r any
of aSection7031,5 ep y olSes($5 i t. bj cls the appl til t civet pcnWty` -
ern t m r hundred d n_. ($stro). A'PN Number _ ,.` :Occupancy ype
❑I re, fthe Upretty, Y came myced,siff, y. ,dichwle a.at prosmona, '! „ .•; .. .,
will do the k I the a t intended or ffdmd for salesta,70.14
'
B.,hoo,met P f e' C J .TI C vectors License L d t ,,1,t an _ a "'Required Inspections • - ,
own f p pe ty Who budd,at ine,nove.,ffieworn, 1 whomw, rich weak hi If - .
offered��,ale.Irnopevun;e bmldingnor that
improvements
is sold within one oney rot `56''x.—•`FINAL PLUMPING ENERGY
tmpler�on,the owner-ndtMer tilt nave the burden affecting tRtbndid aoa hmldor "� - • -
euraaie.l.
GAS TEST
�mnr, ,
❑I,as owner of the property,aM axe otiosity contracting with ilecnwd contractors a;,condo507' FINAL: PLUMPING i
P Y 6
License
et the project S¢ 91144 owner e and Professions Cnde The ontmrats,
c ,
P l [ ) t
License Law does not apply mad owner of a contty who builds or paries the 'he - ,
and who ,nicens for uch'pr jeea-with v nmrvmOr(s)Ilcen(ed pars nm to me
Ed I a exempt
de Law. `
Lice,. r
�1' bpi under Sue, � Plh
,B& Cfor dr,reason •_, „
Owner rDam u
WORKER'S COMPENSATION DECLARATION,
• I'
Inercnr•rrrm d'-p `;tear nenay,ne ofthe f,u ige Ivar,n,: ` �,,, ',r' .;
I have and if, oweren a Cby Se ti of Consent it eeCohenm o]orde for
Coffmisma,o is powered d f by Section s wi f the Labor Code fur the . .u' V I'l
perfarmance of the wo k f�veli ch this pa. ti t ie'ssund. //)
I•.,
❑I have he Lab maintain or the .e Co tip :i I q ted by Scamp a r t
J9oU of the Lobo,Code for Ilio 'ba, arae of file work for
rumb tar fern;t'x
listed.My Gmt en,rnnn Insurance carmunnJ P,IIe nnmher are.
Y P Y
i
Curren Ponc Na: -
k
Y
CER'TIPICACOM OEETION I S RANO WORKERS' _
COMPENSATION INSURANCE - • `
('fin. ar a nand col tie at:tpher trite permit,,mrote hundred dollars
ny• • , '
($IBB)or -
1 certify mat'in[lie performance of tire work for which Ih permit is issrnd I -
shall not emplov any person in any manner so
as to become subject itthe Workers'
L'nlnpensatlot Low,or California.Data ,
' Applicant ..
NOTICE TO APPLICANT If,MIT making th Certificate of Exe bpi on you should'
birmrd Orkrapn the Workers Cona,mation p flhe Labor Cede,you untud
r
C fonhwem comply with act,p,v's',us or ths prem shall be deemed rcookd - - '-
F CONSTRUCTION LENDINGAGENCY
I hereby nBrn treat there st t lending age,Yf_the parRantance
W of the .,it for whrm this pant's ls,aed(See,'3099,C'v.C) _
a Lender,Name
V z Ixtl Arctic,• ,,
I cerlify that Ihim, Il': ppl' f and.rt thnh 1information is
C(Irt,C,I agreeto C0111ply 'Ili all cid,itiod county' rd' d tude laws oclan"d rI '
O V toholding nd nior,and hereby author ize representativesf But city to enterp f t >
then menunlpfK tyf ' .Pt p1 r • >
Fy pat (We)agreet J pe d k p h sn the City i C p ri against
rr h Lab I i m judgments,et d pauses h may in any ey d against d � a
V City nsT UNDERSTANDS
of theNDS tg D this Pe n I v '� 1���f
SOURCE REGULATIONS.
AND WILL COMPLY WITH ALL NON-POINT C.f/ _
SOURCE REGULATIONS r ISSUed-� � Date
signature of npltuaant/Commmnr,' • Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 1
Will the am,likarat or future hm ld ntiocc pre,dm.,lannall,munmou,nowdial Type of Roof. '
d,def red by the Crpen n t Mun d p.l Code Chefrer 9 12 a td the Health and Safety, -
Code;Section 255320^. -
°vee .oNn - '- -- All roofs shall be inspected prior to any roofing material being installed. . y
Will the ppl_ ntorfumrobaildns occtpdnt use cgbl ,at' la,wa,e each If a roof�is Instal led without first obtaining an inspection, I agree to remove
On h do s ii common dints as defined by the Bay Ara Air Qu Quality Management t
isamenall new materials for inspection.,Applicttaunderstands and will comply with; .
❑Yaa °"° albnon-pointsotirce regulations . " '
' I have road the ha :1 nrerial'requirements ander Chapter 6.95 of the
, : '• 7f
California Health&Safety Code,Sections 25505 25533 and 255341 rude cad tam -d
If the hu'ld'ng does not errantly have a tratint that m is my fe.potsibel ity to ratify the _
ntpant of the lonir mems which mud be mat prior 1,issuance of o Ce"diaate of
°cerp:mey. . Signature ofApplicant ',� .Date'' '
own r honad San[ t Date ''All roof coverings-to be Class "B”or.better
.. ' OFFICE ':" -