01010126 clH�toFNcurRaeNPERMIT
No CONTRACTOR INFORMATION:
s BUILDING ADDRESS: - PERMG`NO.
i'2%,B IMIC KET R.I.]J_ RD 170L.R F'rEA`,i(0IJ,5 R( JF :Nfi (e131Q1.(d1.26
OWNER'S NAME: - APPLICATION SUB DATE ' t
It1AI A EL 7Y L G45 1-ICIFk1"11:ItI0 ST 01/31./Mat
ONE'. SANITARY NO. CONTROL NO.
O O ARCIII'I'PC'17EMINVER:, '" - BUILDING PERMIT INFO
BLDG ELECT - PLUMB MUCH
O . C1 I—U C7
LICENSE[)CONIRAC'I OR'S DECLARATION 10b DOSCrIp[IOn
G S=0 1 hereby allinn that 1 an IicenxN under provisions of..Chapter Code.i @ommcncme - -
F_t:m with fullI ee and fDivisinn3nithe tlnsiness and i'mfessiam Code,and myliccnce
s dldlnrame" y 9-11bril E TO (MITUSIT,IMI
Date 0AR lirl'ECfSUECI.ARAI ON
� Lga:w�y��g 1 nnJemm�J mY Plmn shall be road ns PuNic records '
a a O x Licensed Pat nnal
OWNER BUILDER DECLARATION
¢Isit I hereby affirm that I:nn exempt from the Contractor's License Law bo the
fallowing reason.Sevin 7031.3,Bminlve and Prornsaion,C.In:Any ally or cnnnly -
G which atrium,a panni,to lnmlrvn.alter,unfree,deniolie..o..r,i r a,Mracmrc a '
n 3 m porboula itsan I: requires the applicant fih Permit tofficger lsituational
then he licensed p .0 t to the proviviturtaffolke Containers License La (Chapter') Sq. Ft. FloorArea - Valuation
BnS 'dS r ]fMHB rD'v: A fth B JP tc)
.Cu
or Retire 1,exempt m fire n war he be ter cit abeged e p m Any v alwn r $8000
of Seclinn rolls by any applicant far a permit subjects the applicannn a civil pemdty
of not mete than five hundred dol ($5mm. APN Number Occupancy Type
oLa.nwnernnnepropeny,ornryerrrphryce;. >dhwagesr.mei..bleeodrpamadin,
will do the work,and dm structure is not intended or offered for sale(Sec]RW, -
Business and professions Cnde:The Commctor's License Law does not apply to an - Required Inspections
owner of property Who milds(or ve
r impro ,mercmr,and who daca a.dr work hinr i lr ' —
mihmugh his own employees.provided that snch Improve dents are nm imenJed err 3C1 FR(1hIE
offered lin sale.IL however,the building or improvement is sold within one year of - !307 _, IIJSY.ILAT.ECq� -
completion,the owner-builder will have the burden or proving that he did nm build or
matineernr pu Mlw of wle.). ('01 — RU.-A-- TEAS\ OFF
❑1,as owner of the property,am exclusively contracting with licensed commears In UPRMF I-`I—YWCICID 1,11131. •,
Linsmuct the project(Sec,]1144,Business and Pmfessiuns Code:)The Contmcmri
cense Law does nm apply man owner of property who builds or improve,theater, 60,3 ROOF DATTF1413
mre
and wbdcono nor.such projects with u an "'an')licensed pursuant Lir the —
Contractor sLicense Law. 6(114 — R001: '1'N--FV 'il'JcSiS'
❑I am exempt under Sec. - ,e&P C fin this reason
!)wirer Uwe
WORKER'S CO Omar,\TION DUCLAItA'I'ION
Ihereby offrn underps rlty ofpsj ry if the fiol law in,d larouono - 2
❑ 1 have rnd'w 11 natinkoin a Certificate 1 Convert m sell I for Worker%
40 Comwn as provided r by Section
ecf ut 3iof he Labor Cal•, fn the
perforrona of the xo k f which this e t .issued,
• '
❑1 have and will maintain Warker'i Compensation In,oranca,a.c'moal by Sonia.
37M or the Whoa Code,fnr the performance of the work far which this pe.air is '
ward.My Walk""Cnmpemi . n Inenrunce carrier unit Policy number ancl.
Ca...- M^•�fsCprJ l..-. Policy Na' wE SYX0
7 ..
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSA'T'ION INSURANCE - -
rfhis sechimf need not be completed if the Iscrmit is lin nna hundred dollar, , -
ISlgdorkvs.)
1 certify thin in the Performance of the work a,which this permit is issued,I _
shallmur employ any Person In any Inaunnr so a,In occurs'subject til the Workers' -
Compensation Uses al'California.Date
Applicant -
NOTICE'r0 APPLICANT,If,utter..king this Ccnifienm of Emmpdan,you should ,
benm
cnte.xnbjee, the Worker's Compensation nor ms of thw
e labor Code,younm
Q 0 fonhwith comply with such provisions Lir this pcmdt shall be deemed revoked.
CONS1RUCTION LENDING AGENCY
a ' 1 hereby nllira that them is a amdmnion Icalinj ugunc'y far the Performance
of the work for which this Inrmit is inured(Sec.3(19].Civ.C.)
I,ender's Name
z Lender's Address
V .T -
II agree to t I havecomply read allcit and on and swat noeshat a d stat information reirn is - _
U totrect.1 agree in comply with all city and runty cmutw cc,and state laws miming
6.1 nrbaso'gcumtrration,unJ herchyaeoner teno'c" twee 0l this city to enter notion '
W the nhnvomemleeal pmpcny rra dke purPinea.
i d Is.jml,agree msavo.butternut,itcp ,va kttP]do
,myto the City of Cmeninna.said "® ,
Vi liabilities Judgments,of
rod grading
of
which . in any way acerve against said 0S
City in mnugnenm of the gmming of this permit. ^�� _
APPLI,ANTI"DBRSTANDS AND WILL COMPLY WITH ALL NON.POIM' '10� ✓1N�A..(`A,•,,
SO '.HF 1-ATIONS� J Issued by: 1/ fy _C'r Date
signal pplicmNCom�n�— ,I Date Re-roofs
I IAZAI<DOUS MATURIAI.S DISCI.OSI11tE _
wnldue appueantmrumreho�ldingtweapam,mreorhandlemurand.numerical 'IypeofRoof' -
a,definedbytheCupertinolaid prI Cole,Chapter 9.12,and the Health and Safety '
Cole.Section 25532m)? ,
13Yei All roofs shall be inspected prior to any roofing material being installed.
'
Will the applicant or fuIfil]ingoavup:mtmeequipmentardevice, turn If a roof is insialled without first obtaining an inspection, 1 agree to remove
mit ha'soouster ontamin:un.n defined bythe Boy Area Air Quality Munagemem
,intaer"
❑Y: .(r all new materials for inspection.,Applicant understands,and will comply with
N - -
I ha read the h Jus materials ti
q tent. undo Ch pteall non-point urr, regulations.fi 93 f the -
California Health 8,Safety C 13 r s'255U5235T and
25534 sponsi1understandlythe
if the h 'IJ fig Jae. hadcurrently tr tenant,that pfla m)responsibility C- n Wythe /may
., cecupant of th yu retnyy.x�h ch Host M. et pr rn m n e of a Cenifnne n( -
3�p� Signa re of Applicant .. .Date
Owner) antherrcedagenl ])ate All roof coverings to be Class "B"or better.
OFFICE''-
.