00100223CITY
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CONTRACTOR INFORMATION:
UorNUIVISION
BUILDING PERMIT
BUILDING AIIDRFSS:
PERMIT NO -
%G(%)i? EIA:1d WY
(" %' D
FFd_:I:'IY18 Ct71\I-3TT1`I_If:T101+10(%17.t%I(;h'':3
OWNER S NAME:
-'
APPLICATION SUB DAPI:
I AIVI uFJE K CAFWL. Fi 11T• CiL
237CA!
I-01 ... E:a C..
PHONE
SANITARY NO. CONTROL NO. ,
(51.0) 2254
J AHCHI','I.C'1'7ENGINEEH: -
BUILDING PERMIT INFO
RLW ELECT PLUMB MECH
LICENSED
cesedorerpDON
ui m
Job Description
I hI iflirm that l am licensed
Chapterg (commencing
with Section 70000f Dim,mdloflheBusino,s and Professions Code,und cry license
i. in full Blame mW t. �� �` `/
a Lmemwc,a" Lia.a (dJ
(-}I)I)rN�1\I'IT)I_.
JI-PWI ,
m nmo n -'
c::mtnl�ni,.
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a1., 'nig,
I understand my plan. Ins as Ns
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O Limned Pmlbsvimnul
y OWNERdfUILUEk DECLARATION
SO
to I hereby affirm that 1 am exempt from the Contractor's License Law far the
following reason. (Section 7031.5. Busidw , and Professions Cldc Any city or county
which requires a permit to construct, alter. improve, demolish, or repair any wrunare
prior to its issuance. also require, the applicant for wen permit to file a signedstmemem
- but be islicensed momma Inthe poor d.mmofhecontmerm,Licence I..(Chapter 9
- Sq. FL Floor Area
Valuation
(comineacing with Section 7080 of Division 3 of the Business and i'mfcssimns Cale,
or that he is exempt therefrom and the basis for the alleged exemption. Any violation
'�?-j
of Section 703 1 5 by any applicant for a ler nit subject' the applicant to a civil penalty
ofaotmolwra(s
rethimfivehundredr500).
APNNumber
Occupancy Type '1
D,, mowner ofthe pmperty, or my employees with wages as their we compensation.
-t'(:1'sI
i':)'I ilfd
will Jo the work, and the someone, is nm intended or offered for .talc (See. 7114E
-
Required Inspections
to e„ and Pmfe,.dmn, Code: The Catraetor, License Law doe, not appy m an
of pmpeny WM1u M1u JJs nr impmvex thereon, and who due, suchork whimwlf
arr
through his own employees, pmvidM that such improvements am not Intended or
:E fS).J.
—' F-OUNDATION
offered for sale If II.eve4 the Willing nt improvemcni is sold within to year of
nfilled an, the nes ncrbnilder will have the burden of proving that he did not build or
1,02
•••. 1;y1L• 1'i Fc; '
improve for purpose of role .
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D I. ao'na,n, it, pmpcmy. a sdc,.vcly contain.
onbannm
ni, wish llwd aonloc, m
,
Lm,tatthe Impact (Sec. 71314! Business and Professions CeI The Contrncmr',
- :1. U4
-- 12F'Et(-}li '
icense La, does am apply m an owner of property who builds nr imp nra<, Ncrcom
and who contracts for such project with a commotm(,'Banse pursuant m the
05.
,
\ C•
.. AI J(:1"Jori. BOLTE)
CII i.c.crepaacmde Lux".
❑lam exempwnder sea. .B&Fetor ores reason
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E)
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"' iF 4IIz I'\ & IaIFS TI_li
Owner Hata
ii2Cl'
UPIr)f P'tF'E_C)(:)E'i+'1'1_(.11*UCtTIdG
I WORKER'S COMPENSAI',ON DECLARATION
is?03
-- 1.11+11)1'_1-tF°I-.C10fi: 1'IIEC;I•IfdI+I :I:C:(-11-, ..
herebr mmrmt ander pendty nfpurjnry nna none I,ur�wing deaaradmn,:
204UI`IC)icitii"
kfil°Ik.
�.D I have and will maintain a Cecontain, of Consent m self -insure far Pbrkei s
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uCnmpersmimn, as pmvidcd for by Section 37M of the Labor Code, tin the
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•.•. LII`IT)E:.FIF'L..(Jf.IFI .F I`I �:il-IJ... (•7I.I (al>J
cimfoance of tho work,:.which dors permit is iiwed
32):1.
1
''-� 1�0UGI•J F'LUI"Irt:E hdG
P1L
'I have and will maintain Worker's Compcnwtion Insurance, a, requite! by Section
3710 of the L irr Code. for the perfnrrttence of the work It which this permit k
110(;; 8 f:IB.[ I,IG
,
issued My Worker's1.Comparsinon Insurance carrier and Pal icy number are
nI
l \
I'1)_LHAN ICA(_
carcr:ST_ GA-. Policy No: _�
CER'r,P,CA','ION Op l3KEMP HON FROM W DRK ;kS'
3C)k
COMPENSATION INSURANCE
30.5
,
F ItAI'II-
(UtiI"IIt reed art he connected i I hi, vrmit is Intone hmtdred dollars
(SI WI m lcss,f
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,-- F101.-1)OInl l+lfd
1 cenify that in the pard moo of Ne work for such this t is issued. I
perm:
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T J. IaI.�.)(•11•.�} T ,I• (.I1\1 -
,'it nut em ioon
p Lie,," dp,'r,mt y ntanner,n:t to res ,abject m the Worker,'
compansulinn f CaINsB�eeDme
�; m
e
__ it.1RI` Y'ROCI; '
—
APNmant DLII
:i3C)`JX'rfa;:FOR;
I._f1TF1 -
NOTICI!T1IAPPLIC/ f.nf¢r reeking rhos Ccntlwut of lixempuun you nhotdd
f ...a'"abeetothe orAisComlenwtionpros'iuionsofthelaborCd,lcyoumwt
fnnhwith cnmplywith such prnvoinns or this permit .hull M JcemeJ revoked.
s:3.1,OQ
—• ,I,1+Illr..l'\.I.(Jh
;•di;>CFtnrCll C(JA:i
CONSTRUCTION LENDINGAGLNCY
1 hcrehy uflimt ohm there is a cnnsmction lending agency (nr the performaree
31. s:)
-
-- F(0t:)1= 1+1A:1:1_ '
d of the work for which this permit is issue) (Sea. 3097. Civ. C.)
der', Name
Lender's Address
50I
.__1,11ERGY
.302
h�J,Plf}F_ 1-'1_.).1111{.LI>IG I".h11.FtC'lY
I I agree that I have read this application and ion my drdm that the above :naw, reline, g
correct. agrcemcomply whemvmini
+
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F".L1.1(}I_. IYllr_CIIAI\IJ.Cf}I_. I'_bll:_IRGY
iemnttyadinanea,atdstmytoenerupon
I to huiiJing con named mond hereby minimize representatives of this city to upon
pmpows.
the above-nsaII an pmpeny for ify
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'— I` .1.1`I�}I_ X'.a 1' \
1.1._I):I:11(a T:::IgITf?(3Y
t and keep
twmlignam.a...I,ad.cs,and whib:rmtkss mcchynromemnm ag:dmid
hies judgment, cows amt whish may in anY wuy acrnc again., sai!
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City
City in consequence of the gratin of this
n a the
APPLICANT ON F'RSTANDYWILNgN-POIIyT
rt
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soukcla RE - `/' D//D
Issued by: _ _
-
—., Date
s�y.r rcnf nppr ntico RLiy rata
IIAZARDOUSMATERIALS DISCLOSURE
Re -roofs +:-,
dill
...
•••• I-J:INFdI._ Iallca::F16•}I`I:I:CAI...
win ore applicant m frnnrc M:ildng a.<apant.mre or haeme Headnas mat=t;,,
c
rhe Cupeninu hlunicipelCNe.Chaper9.12. and the Headband Safny
Type of Roof =•
•.l (�':�,
i Ell (-)J., GitnD1L' -
Cde, Section
Crde,Section25532(u)7
D Ye,
+.
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All roofs shall baa s ectedgprtQj,SQ
- 1:�'[ HAI- FLA J1`I:I:idr•)
I)stemeappraammrmmrenmadingoccupant nwegmpmemtorum;ceawhich
ate, r or(1 In t a in • installed.
If a roof is install, ithout fiFS+ffdbtaihilrf 't5n�ih5 bee
mit ha,minma[rummminum, l, defeat] by the Ray Ares Air Quality Managcmem
ui""coo
L( ttp� a [o remove
p gr
Yens 'k
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
1 have mail the hazardous nmmriaN requirentents under Chapter 6.95 of the
J„
California Health A Sa&y Code. Sections 25505, 25533 and 25534. 1 understand the
�.
if the building dues not currently have a tenant. that it is my re,ry,n,ib,lit, m notify the
occup:un of the mpou'rov which anus cum"ani?''I'Licanc of a Cunifcam n
i
-
Lacupancy.
Sig JtureofApplicant
- Date
O
_ All roof coverings to be Class "B" or better
owners- �otnd.ed a•' Date
OFFICE
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