01090064 CI BuOF ON CUOPERT
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10825 IN ESTATES DR ROBINSON RUSSELL H AND NORMA 001090064
OWNER'S NAME: APPLICATION SUB DATE
ROBINSON RUSSELL H AND NORMA C 09/17/2001
It I HONE: SANITARY NO. CONTROL NO.
GOO ARCHITECTIENGINEER: BUILDING PERMIT INFO
wpy BLDG ELECT PLUMB MECH
H<E C1 I__I IJ LJ
FF LICENSED CONTRACTOR'S DECLARATION
O w Z I herb Rrm that lam licensed under v n f Cha+r 9 kmrome cin Job Description
iZ-p Ya groisio so pc g
,,e fl withSenion]andefect. on3ofsheBusinessandRof<aionsCale,andmylicense REROOF.
is in full fore end effect.
'9�'< Date Cssa Dc.a INSTALL 40 YR. COMPO.
:Ou. U Date Contractor
T u.n I ARCHITECT'S DECLARATION
O n 1 understand my plans shall be used as public records
To
i z p O Licensed Professional
OWNER-BUILDER DECLARATION
. o, 1 hereby affirm that 1 am exempt from she Contractor's License Law for she
?< following raamn.(Section 7031.5,Business and Professions Code:Any city or county
x�p which requires a permit m construct,
otter,improve,demolish at repair ray swcwre
a 3 •Pna t [ Im q the ..I cunt for such pennn T f k signed ssetemem- —
(commentcpsNphviutoThep7o nsoflheConimnnrsl'enxLawonsCoe) y aS ,Ft FloorAre� 35 I alua[ion
(commencing g wiih SecT 9 ]1Y.�))of D vis on 3 of the Business and Professions Code)' y f} 1 7� �?9 i l / ? .1 2. V r�6.1
or Thai fie is t6opt themrrom dna the basis for the alleged esempdon.Any violation - .
of section 903125 by any applicam too permit subjects she applicant n a civil penalty'
of not mom than Bva hundred doom,a5W), A um er 1',R!: ':.+ Occupancy Type
°L vs owner of eland the structure my employees wish wages fe ed f sole le S c:-7
will Jeca'ano the wurofessi the odeThC not inamkd a urtLad for sale apse To To l
.are, and Professions Code:The Cscifit is Liana law does nos apply w an 307 - INSULATlhtD[Jired Inspections
wtrrughhisoopropeady Wlw Wddsarivided That
such andvemdoe.ar�ht intended or 601' ROOF TEAR OFF '
or through tel own however.t provided Nes such improvements are not imend.or
oRcad(oi sale.If,howevtt.the building or imProvcmemeis sold wimi�mTB yBar ter'- 6 02 - ROOF PLYWOOD NAIL' ' - - - -- - - -
compledon,Nc owner Wilder will hese The boNrn of proving that he did nm Wild or '
impruvefnrpurp°xofsale.). 603 - ROOF BATTENS
,osnwn.none propengam Buri:eaeyenmmmngwith Code:)no onrontrn 604..— ..ROOF IN-PROGRESS • . :':•..; ..
mnswn the does
n (Sec. to a Business and Professions Cede)The Contractor's
andLicense%n Low Jms not apply man owner of progeny who builds or improves thereon, "
5 und.who cnmmns for such.projects with a romrucmrp7 licensed pursuant to the
:: Cumrannrs License Lo
°lumexcm fl`derS - " '' "' // '��H&PC for revson
(}irper' V ISATIOT/CLAAI ATION
G��1�9L�LhC�D
+1 hereby air=under pi uslty of pmjuii,,oiie of The following decbmonons:
f•° 1 1,6;i add wilt maiot im alCenificaso of Camaro self.insare for Worker'a OCT 0 9 2001
)L Compcnsmion,-ss provided for by Section 37W of the IaMr Code, for the
perfairm,cc orthe work for which this permit is issued.
°I have end will ir5imnin Worker's Compensation Insumncc,as iequired by Section BUILDING
�®'��
3700 of the Labor Code,for the performance of the work'for'which this permit is BU
ismed.Myl Workers Comps sation lnsumnce carrierandPol y be are: ,
Carte 5�d iP� 3 . )+ PulcyN ,
t , T YII„Uv —
"'I lY t CERTIFICATION.OF EXEMPTIONI ROM WORKERSr - e 3 t }�' B r\
COMPENSATION INSURANCE' r .,..,...._ _._ ' ._... ... ..-.___.
. Permit is for one hundred dollars..,
lig ITh..),on'neeJ not be comple¢d if the pc
IEI W)m lea.)
n .. _.- .....-. .._ ..,. .. ..
1 nfrthat nthep moody max heel ort fbe which this Permit i! infe,l It
C.impm emplo1.y any ofB if+it any manner so as to become sab3at m,the Workers
A li cnaTion laws of California.D--
-Neri10ETOAPPLICANT:If:a@rmaking,his Cenincmeof Exemption:ywrshouldbecameeubjen to the Workers Compensation provisions of The Labor Code,you must
forthwith comply wiTE such provisions m Nis permit shell la,deesnad revoked, t
_ -
z. 'CONSTRUCTION LENDING AGENCY -
a' 1 h by Krm th t then a 'ssmctlo lending agency f theperform Te
of the w k f h ch This permit ed(Ser 309] C'v.C) 'I `
-Lend rd Name ' ,•` �._'- - ""
Lei.
d.9
T..) O n r a
.:,: 1 cmJy thmi,ha a rad Th s applic Y m a+d rum thm Th obove informnt n is'
conn.I agrte m,comply wiTh vll ciTy end county oNinunces.ond smm laws relating
ToWld ng consonnibn 0h rtby dthoni rtp esenm[ives of lh's cry mercer upon L�'�
'�., r� the M1 <mem oned p pony f r in peri n p rpnxs _ >/p//Y////�//'—��
C., IW) g emcee Tdemn ry mrd keep harmle sTtie Cly of Cuperi no eo.said
.�1 h lieb hu )dg ems;c ser aM penis h h may in any way Basic egmnst said
'Ue City m<omeq of she gnnun '
APPCIGAM DERSTANDS g LLCOMPLY WITH ALL NONPOINT
snare i ton '„! Issued by: Date 1?—/ 7-��
.. _ 4�7a -
_ signet a r�ppuranvconraar` -�D a ,' Re-roofs
� ,HAZARDOUS hfATER1AIS DISCLOSURE
,: Will the applicant or Tamm Wi1Nng occupant m re or handle haaardous
material Type of Roof
p defined by th C pen no Mumnp I Coda Chapter 9 12 end Ne HeelTh and Safetyf'L
Code Secy n255+32(e)T :r4 .�.trs. 'y {'.' .. ..�V riWi
°Yc _ All.roofs shall be inspected prior.to.any roofingmaterial being.installed.. .
_.
Will the apps od,o,ful r b lding pan. - cgLigmemo deviceswh'h� If a roof is installed without first obtaining a6'inspecuon;'I•agree'to'remove
emithzN s omm era der edby th BvyAea'A rQu I ly Mition,ernend,
Da[ T all newjpoi
materi Is for inspection. Ap icon[understands and wilPcomply_with
oY I, „' .' al] notirce regulati T' i ,.ai ::;a a rt'dhe h xaed a teriel qu' d and r Chipar fi95'otthe Cal fo H uh&Sary Cod `Secdons25505 25533and2553a l and mrdTherftlie W11C gel not ml h et hat yrcspom bd'tym ad"theTh rt eat heti mus act dr Ta sonce f a C nitrate ofocgnpanry Si leant Dat
!%7�' PP All roof coverings to be Class "B”or better'
O�+o mage Tss. /PaT ,.
1 ... t ..
OFFICE ,. _