01050096 Cl 'OF NcupeRONPERMIT
No CONTRACTOR INFORMATION:
BUILDING ADDRESS', PERMIT NO.
21999 MC CLELLAN RD GS GROUP 01.050096
OWNER'S NAME: APPLICATION SUB DATE
TOORANS MILTON TRUSTEE 8921. MURRAY AVE 05/09/2001
PHONE. SANITARY NO. CON'I'RD[.NO.
(800) 653-7172
z 7 ARCHI'I'ECFENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUME MECH
azo, 1-1 1� i—I r_I
Gee
N_ firm that
I a COp"IRACnder p DECLARATION Job Description
_ 1 hcrtny affirm tem I tact licensed under rrnviaiom of Chapter 4lcnmy ti'mee
O/- wllhgectlon"Lld"nof Di mol lhcBwincss anA 'Cadc,pnA mYlicenm
ng
W 111full force anddlcct /
S��a< i�ieumeclo„ Ln.k_ �( REROOF/SIDING & TRIM
3 c u nam conlranor
Ov ARCHIL HCI"S DECLANAI'ION
5 1 understand my plans shall be used as public records
f yr_
hkcn.cA I'ro(aeiunul
UWNEan RUII.Ij tri DEthe Co4'I'ION
I naso.Mirth on 11. cavn,pt from Incatesu c Col License Law eo Inc
,=a whichingmresa permit to W1.5.9a,inc„and Pmfnxion,CWc:Mycity oIprcduy
S O which myuimn n rearm[re conmrom.alcor.improve,h wro sh,ore asig any Mecism
n a m ag pct t t also4 .,h applicantf I pc a signed t¢then[
math '.r nSe It In p . nn Com I Tire. I (ehtwe,4 Sy. Fl. Floor Area Valuation
le b II Sc I mal) Itheoas fist li II f: -l lido
10
lir n,:n he r,a,e:np,tnemfam and the h.I,ta Ibr(Ile alleged e,emy o,.Any vDrat a„ �, $10294
of section 7031.5 by any applicant for a pemat%objects the applicant to a civil renally
of not mom an Cost hundred dollars LS5wl. - APN Number Occupancy Type
m
Dl.of rerdow prowny.nrtny employee.,with wage,as meirv,Ie eompensa,ion. 5 1
1 00
,.It It,,Lha work.and the sl ma,u'c ix all intended or offered tin sale(Sec.7194.
Braine,and Fmle,ion,Care: [he C.... tar',Liet,”,Law do" all triply 1,1 Required Inspections
orr of proreny Who build,lir improve,thereon.and who does such work himself ?05 - FRAME
through his own employee%.powided that sacs improvement,me not intended or
offered for%ale.IC howcvc,.the bonding or impmvemeal i%%old within one year or 307 — INSULATION
completion.the owner builder will base the barren of proving that he did not build lir
iterative tor purpam"f''ile'I' 601. — ROOF TEAR- OFF
D 1,a,owner of he 11,11,,.am c,elu, Imelir,s n;In riot%ea n,l,lraelnrs It, 602 — ROOF PLYWOOD NAIL
onwrua the pmjml I 7194 Basinev e s Prol'e„im„Code)I'he Conlmcmr's
Unro.e Law d«,or trots of ,perry who Wilds or imrmve,there`'"' 603 - ROOF BATTENS
and woo.emmcts m ,pa ul n ;m comnmwr(.+l rcen,eJ par%nant the
cdonclor,uce: el.aw. GOA — ROOF IN—PROGRESS '
❑I tun c,e:upt ge,Sc' _ - _ .N k 'G Ihl r..
Owner_ to / l
'UR :R'S CO IPEN.ATION DECLARATION
I hereby ofirn,under penally of Perjury one of the following declaration,:
D I hnvc and will Innlnitin :r Cenifeale of Col„calm ell-ioune for Worker'% FI N ALED
Comper%stmn. as provided for by Section 1700 0l Inc Lana, Cole. for the
,e fomnanre of the work or which Ili,permit is blood, NOV R 7
D I have and will main din Worker's Compensation Inwmnce,as required Q
•`O• O ” `O O1
3700 nl'the Labor Coda,fol the perlbnnanee or me work lar which thi
i"red,Aly Wnn(ke�kr�',�C�'nal ln,tmnel caniur uaA I' lie number hi
etnier: C .71GNf111f:%EicyNDN-'lin-„�,-�o ER,' BUILDING
COMPENSATION INSURANCE
IT l ix,eclian need all he eI i'lcred if the rernd'Is lot nine hrndred doll:¢v
SI Nd o,less.]
1 certify shut in the performance of the work for which this Ili is i,wed.I
,Hall not employ any person in any manner,o a,In become%object at the Worker'
Congvmm;on Wwx of Caldurnia.Date
Applicam
NO'1'ICIi TO API'LICAN'I':¢utter nntking In„Cenlliete of Baemnlina,you ebauld
Z hecanm whim mdse Workers Con,penvlinn provision,tone Lahr Cade,you all
Q O funhwitb comply who tach provisions ar this pennil snag M1e deemed invoked.
F ^ C(IN Sere i IaION LENDING AGfiNCY
work
ky al whiten Ina,there ixs ksacd(Sec. Icnding agen,y par Ne ped'ormuneu
of ort„oil.fm'which tin,per n: uad(Sec.ala)].C's.C.)
1 Q lender',Name
Z lender's Address
U
01ceniry thin l bane read this application and tat he abwc information I%
a
W. Ey c:.It
m I agree eatnply why II city:rod I ans nllo and'nne Ili”111-Eng
O f..l In,d dins can,Imcdan,uta IIlynm e p In Is of 11111 city m caress",
nhovo-nmmlomr sm. y lar. , u c
.C• G 1Werdgme t, ,inJe :rya d eP :n::In the waofenn a ilig' at
vl
liabilities.iaasmem%. ,l, e,pt� , tan in:: an war teethe a � IT
fJ Z City in come4uem a the Indoor1, a ,la lin.
^ APPLICANT LIND NSTAND ell C 'LYWITHALLN � Dale
SOURCE REGUI 1'If 'S. Issued by(
SigralumofA , an(Cwm or {/ Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
ist the applicant probe milding«'ccFxsnl arm or handle hmalloue mammal Type of Roof
a,delined by the Colmnino Monarp.,W.ad,Chapter 9.12,and the Health and Safety
Cola Section 25532(u):'
ElYe, w: All roofs shall be inspe ed prior to any rooli g serial being installed.
Will the applicant lir future Willing occupant use equipment lir device,which If a roof is installed thout first In ' I In
Will I agree to re love
emllier? dons air contaminants as de, by the ltaY Area Air Quality Management
Disme,r all new materials f inspec t dersatnds and tail cil�ot ly with
13 yr, Nu all non-point sou e reg , ion'.
I.have mail dm hap ga:Iet ma rmdor Chapter 6.95: the
Cvlifomia
Health&Sat C a 505.2. 3.,and 255X.1 rnJ ata thus
if the holding J,e, nl.[bar n,ibility , a is tnc
ecnpun,of the r- wh! , nmu..a of a eat re If
O"""ncy' ,mr Signature o pplicant Date
Owneretire
- -- - - l 0' All roof coverings to be Class"B" or better
OFFICE