00070042 CITY (IFfO[6# I(TINO• - ..
BUDDING DIVISION CONTR TION:
PERMIT - '/� '
�. 0.. — , PF:RV11'I'
BUILDING Ak)DRES':
I
66.
OWNER'S - E' q" - .\ a •. APPLICATION SUB DATE ,
:/•NONE: _ — SANITARY N0_ CONTROL NO,
r72-S7— 16 n2 , FURNACE
Oat, ARCItI'I'ECTIBNGINF:f;R: .,'',! BUILDING PERMIT INFO ,
O❑O `1 •- .. - BLDG 'EEECT'' PLUMB MECH
ZO 8O LICENSED CON'fRAC I ORS DECLARATION•' `
4G I hereby urrrn that l an Y ed under provisions I Chapter 9(eo no g 'IOII DBSC1-Ipt10D. "
rrtoHw with Section 7000)�YfafD.-.. o3nrmaB
otdP6f7rW bdC2J3,an2d ry:'l'
leL .w lull c
I, Firer, ce-= 2� I »
cDat �• i -
..
C ntmw r
ARC CUT'S DECLARATION r
O 1 and rvUU�`((—,JIaaI� pl��pprs un d P M1rc records '
r � y . ��
ea 4 C Licensed
OWNER-BUILDER DECLARATION 369].30S�. IJKr
II hY affirm that pal' the Contractor's'I' La,' tor fl,6
,
�ZQ folovi.,reason.(S I 70315B : JP f:: Gd'AY rily,crounly
Y Z D
which requires a pernot to .t' t I, demolish,carrier, y sompure 1.• ..
a3an pnorto it, 'alkii re1 ''.anapplicantl h c '1a fl- s. i.lmmenl. .
IhaI h d pursuant the p fll C a f L 1 (Cn pt 9
w Sq. F ooCA ' n .Valuation
(cnmcenc„gw m Section 9000) fD' 3 fm B dProfession,
f s .ce). j.
or that he is exempt th rnn and me ha. f (halleged ,npf rAnr s'nII' ..30s —,' ROUGH _'MECiANd CAC. "
,.1 Sovann'AHI5bymyipli air fur,parrot. b)nsmenppl It civilp Iq
lir not more than five nandrea enlmrs($SfNp r .AMMunibeiROUGH EL'E T-RICAL Occupancy Type - -
ly-eofineprf ro v ply m �. In ' , l p am,, 505 — FINAL :EEE TRICAL"
a' If tire aI I I d I' an civil 7B4.
tIL 57 FIN{ egEdhse eI r 1
L
we p nld. p It. richwork nIr ' — "
' orih through
yh h: .cemployee,.P I llntat,ap rot intended .508 FINAL MECHANICAL
'd' r- -
offered fIf.he III,b 'Idg Z,improvementis'cli Within",year of
_ applel file minnuhaldr,vvillk Ira Introdeforphwin,thath dianchbld or
improvi for Parrive,of
El II, fth property, exclusively contracting with licensed c l ve :I - -
o , t ah p I I(Scc )Ilia B .'nc,.,ad 1 r fc a :C 1)The C a I r
.
Lincoln Law doe:rol apply I vneror proper)who builds p :thereon, c t
and who contracts for such projects w ah u comrecmr(s)licensed pokumot to the - k -
Co
tractors Licarea,Law
1l,er coar't order B&rcr ,hi,ociomis
I Date'
WORKER S COMPENSATION DECLARAI[ON.
thereby oftirm once,panall,ofp.i Y runt the punitive gd larafon - .t•-
° I have and will maintain ,Certificate r Consent to Self Insure for Worker's
Compensation, a. provided f by Section 3700 of,the turner Crelefor the
- perf nonce f the ao kf r wniah this p ,I Is'sa W. - � + ..
°Iha rnJ will once hit mWI C o,apeidtioo hencrow,a inquired by Seefirc, - -C V .
3700 of the Labor Cnde.for the patlorm irce of the work for which di,s far,ni t i4
isiLeJ My Workers Compensaltionlsslanee carer/f,�ad 11.�llncy r�n9ben��/e )/
.Carie, ePlk�l Polcy Nn. LWI%SL� !_G-/LD'1
CERTIFICAI IO OP EXEMPTION FROM WORKERS' y. -
COMPENSATION INSURANCE; `' -
(Tirs section m,oil na he completd if lie lwrmit is for I ondral dolly,
(11100)1,,less.)
1 con ry,lhat in Ino perlor lienee of the whrk for which Ih p ,a is i,,uctl,
k1u11 n [ „plry any
person Y marme,so us to become table 1 to the Wo kers - o
Chro'catimmin Lows of C I'ronir Data
A,mhlrul
NOTICE TO APPLICANT Ili afterk g this Cerrificate efEwindion,yo.should
z❑
bee I I I Workers C p t p [ie Core,y a forth �ilh comply with -'with : rIh M 11 b c I,tr1 roil asoked. ',.
~ CONS I RUC I'ION TENDING AGENCY,
E~ I R"by had there I,a coushorheintlerafi,nbencYI is,the perform c,, f "s,
work for which W of lh ,1
Cr,r
❑
Leader,Nz Lender's Addictsame
-1 ..
1 Yve 11 111 dal' tya f and.laa athat res, above f ( s
W r.) un'- a.1 g t ply with 11 cityand c t} Jnan olid stnm Lwv rel ti g• -
Q V ,the rowinto, ...ared and I by a th p Y .of ah s city mpmcr upon
�y rW the ah We) I' cop v,ime p a purposes.
[y - (We)ag eel av, ndenm lY, Jk keep formless the City [Cupetp against,
Vi liab a :' lgn a. sl and c p n . i h may In un,way against 'J
U.G Cay n n. qucn<e of In % mi 8otm per
.- /p/ c` , - -
APPLICANTUNDERSTAN N s OMPLYWITHALLNON-POINT Issued by: `•. G.�•K.. Date
SOURCE REGUI 1 _ '/cam p _ y
'isnamre.1 A,pheml/Comowl., / Date Re-roof§
HAZARDOUS MATERIALS DISCLOSURE .. - I% f _
'Will the PPr a or future building Wenpa n store or hardle haurands I _.. 'Type of Roof.`.
_ Is defnul by the Cuperllno Mon...pal Cala naptn 9.12,slid the Hwllh and Surety' s ,
_
Code S fla, 25532(x)7 - _ -
°Y: , CCC333 All roofs shall be mspecied prior to any roofing material being-Installed. '
- Will the ppli lit r famre b 'Id'ng hecheild use equ p tg J which
emit hazardous air contamlmunaa l,a define the Bay ryes n,r Quality Management It a roof is installed without first obtaining an inspection, I agree to remove
`District, all new materials for inspection. Applicant understands and will com I' ,with '
°Yea - . z,I�, ^'� P PP, - - P Y,
all non-point source regulations.
1 hasc and the Incautious an,ae'.111 topprohneol, d 'Clbrqpwr 6.95' f the
Caliform.' H Health&S f ay C 1 S u n.25505 2553] d25534 I ,' d ah t -
if the million,dT currentlyh ti tenant,that l :onymp T ItYa Tryoc a It
clip fin q ' M1hmost n aI f a Certificate f
Occupancy' / �.' /-0'„ Signature`of.Applican[ 'Date '
..All roof coverings to be Class 'B" or-better
w authorized agent dI, Date' ' �`
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