00080140 CITY utoFNG DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDINGADDRF_SS: - PERMIT NO.
OWNER'SNA110481 FLORENCE UHAPPLICATION SUB DATE, 40
1
ONE ENMAI,.S DAVID J AND IESSWK t4j'a' DENT-W99D DR 08 1 1-/'P0171171
SANITARY NO. CONTROL NO.
C K z ARCHrrECTENGINEER: G 2 t 151 BUILDING PERMIT INFO
�O OBLDG ELECT PLUMB MGCII
IJ l`=1 L rJ
Z O O= LICENSEI hereby affino that llwulispliep id unde,nmekiOM RACTOWS DECLARATION of Chapter 9(commencing Job Description
on with Section AIIXpoflAwkinn Sof the Business and p of ssia CnI it my license _
LIn)toll farce anJa t.
icense Cbtsr 11 5_ I.,1 /��_J
a Dile C, Int... REMOVE SHAKES AND REPLACE WITH CLASS B
a Orn ANCI11'fECT'S DECLARATION
o 5 I understand my plans shall he used as Fabric records
OLiecnseJ Professional elf
i S y OWNER-1II?R DECLARATION
1 hereby afetal that 1 am.sumpum,ufrom the ConwnCo e:An,c Low for the - r]Q
which 4.0
fallowinquireia statiernatnn]6315. t,alacssand Professions Code:Any city or county a
ESC which reyuires a Fermi,m constmet,ohne improve,demolish.or repair any someone a
a 3 P,I t t, issuance,al: re.mapplicantr such pe 'u file a signicalstatement
that he u,licensed po, tt its,pha,,auftn CmhhowturLaccuseLaw tChapter9 Sq. Ft. Floor Valuation '
m nursing ]atm fulvi: tiT of the Basals and Lrolesvione Code)
,,,that he ie e.empt thumfiroon tied he hum,forme alleged exenq,non.A„y va,I.d n .
ofscction 7031.5 by may tippbcam ror a petrol,sohimm me n,liuma m a civil psualty
of not more than me hundred dollars(Ssw). APN Number Occu a pe
❑I,as owner of me property,nr my en,ployms with wages as their sole compensation,
will do the work,and the mmaure is not intended or offered for sale(Sec.7644.
Business and Professions Code:The Contractor's License Law does not apply to an G �` 1uired Inspections
oner of property Who olds or improvese
thereon,and who dos such work himself
orhthrough his own employees.provided that such improvenmms are not intended or
offered for sale.If,however,the building or ireprosnmunt is sold within one year of 305 — FRAME `
completion,the owner-builder will have the burden Of proving ohm he did not build er
improve mrpmpose ofsnle), 307 — INSULATION
El 1,as ow net othe pohnn""at exelowelyaontraemacwIII,hecnxdcontractors memnC,01 — ROOF TEAR OFF
icenseawothe esn(seplit,a,BoaeropodgoywhobildsorThevesthcspt ROOF PLYWOOD MAIL
License Law tract not apply m tin projects
w of progeny who halide se improves thereon, 8l/1't} —
ane who commas for men project with a erammnuns))tooted pursuant ro th` - 603 — ROOF BATTENS
01 mewls clearing
under
LOW. '
❑1 am exempt antler Sec. ,B&P C fm this reason
604 — ROOF IN—PROGRESS
Owner ENS
WORKER'S COMPENSATION DECLARATION
I hereby affirm tinder peneBy of perjury one of tie following drelanumns: -
Moa and will nudmnio a Certificate of Consent m se[Fitterc for Worker's '
on,penlinum, at provided fur by Scroma 3700 .1 the ].all Colic, for the
pcnbrmance of the work liar which this permit is i.oned.
1 have and will maintain Worker's Compensation Insurance,as required by Section
3 f the Labor Cuk,for the performance of the work for which this Perot is
issued. y�er'n '.C`ompeosatiun insurance earn JPali� cy num +OI
Cant +�l!•_N. PnlicvYo.: U
CERTIFICATIONOF'F;%FMPTION ROMWORKERS'
COMPENSATION INSURANCE -
(This semen need not he cI... ]I ed tithe,am n t 1,on ono hundred dullan -
(Smmorle".j
1 mmfv that in the scr i,mnnec of the work for which this permit is issued,
shall no,employ any Fordo in any manner so as,o become subject in the Working' a
Compensation Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become ecoe subject to the Worker`s Compensation provisions of the Lubar Code,you mus,
C Q formvinhcomply,gom such rockinnxonhispermi,shall bedmined invoked.
F ^ 1 CONS"FRUCT10N LENDINGAGENCY
a 7I hemhy affirm hal menu it it eonglm,tlran lunching agency further performance
w
It the work for which this permit I.Issued(Sec.3097,Civ.C.) ,
0. Q
Leader',Name
Lender's Address
0 1 mmiy that 1 have mad this application and state that the above information is
O [.. correct.I agree to comply with all city and county ordinances and state lows relating
U to building construction.and hereby authorize representatives of this city to enter upon
(� the above-mentioned property for inspection purposes.
E. 0.
(We)agree to save,inderanoU and keep harmlest,he City of Cupenin agony
71 linbilhies,, rations,toms and p rases which ey in any why came a ons,c d
C.7 z
city in c •qucnce of,bc gm t of,his pe
APP A TUNDE A . NDWIL OMPLYWITH AIyy -POI
EGUL sb Vf ItiSnOd by: ^UV/DaLC
Sig urea pp n nba, Uat Re-roofs -'
H 'A,'DOUS h1 ERIALS DISCLOSURE
Will me applicant or future building aTupam store or hand hudWn.mannal Type of Roof
as defined by the Cupcninn Municipal CWe.Chapter 9.12,and,he Hearth and Safety -
Cale.Section 25532oft?
°Yea ONo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or enure buihliag Occupant use cgtdpment or devices which If a roof is installed without first obtai g an inspection, I agree to remove
e
mit hniazardous an contaminants a defined by the Ray Areu Air Quality Management
i. etoret CI No all new materials for inspection. A icant understands and will mply with
'111.11011 int source regulations:
I ave read the ha.mdous materials requireo,entt under chapter a-95 of the
Captain's Heal,h xr Safety Cordes Seed..'25505,25533 and 25534.1 understand that
if the building does not company have a tenant,that it is my resprsibility m nmify the
occupant of,he requirements which must be met prior to issuance of a Certificate of
Dec.,.,
g r are of plicae Date
Owner orauthon,edagent Dale 11 roof coverings to be Class "B"or better