00100141 CITY o
BILNG DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMI r NO.
OWNER'S Nit77'285 M I RA VISTA AV APPLICAII(H•I;I10.d1AT,' A l
HONr;: KING SCOTT R SANI'T'ARY tripVJ./20/CfJaUF11 "
1 BUILDING PHRMI II'VIINFO
a0 0 AkCII1TfLT/IiNGINCaiN: BLDG ELECT PLUMB MECH
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yj,iwJ I—U I--I CI I_I
S v2wi i ,.ICI;NSEDCONTR,kCIOR'S DECLARATION Job Description
O0✓,� hereby nffiun that I am licamal under provision,ul Chapter 9(commencing
with Semon 7l)CO al D":' int the Business d Pmfic,, ,Code.and uty license
C Is it+toll trrcff /nct o ���s
K < License Clash (7 l• Lic.M_
sa, Dane_y_ o_zoOC,- sDECLm-1 gCmtivei26oiv TEMPORARY POWER PERMIT '
INiI 3 w vFi �CII Ili''//�y S�U/ECpI�AR.A......
t'n g 1 uadcwand ,.�(((pp,,111��IrLL / al,
ii p p Licensed I�ao e+ n
OWNEILnl1Ihr DECLARATION
I hereby allinn ohm 1 con e¢ntp,Innn the Contracuu s Licenm Law Int Inc
=< following rc. n,section 7031 5.11 and Profcxsiunv Calc:Any city o county
x p which requires a wrinit to tl+mlmet,alier.iimprove,demolish,or repair any el um,
itc prior toits kwanve,also requires the applicant forsuah permit to Ile a signed samcnMnt
it: mal he is wensed p.,,.anlmme Rov,kibu-o the commcmr',Lunn,,I.—(Chapter 4 Sq. Ft. Floor Area Valuation
fcommeneing with Seetinn 701)1 of Div;cion 3 of tits business:md Prolc,ions Cam)
or that rte is esempl Ihvocti ; it(lie nazis lin the alleged ex,,ainn.Any violation
f Section 7031.5 by any applicant Ion a permit subjects the applicant to a civil penally
„ftau mnremanlive httmbcddoha..(s5o0), APN Number Occupancy$TJype
❑1,.%nwoerof the property,or my,,mph,tea with wages:n their sole compensation. - -
will do the work,and the swOte,is nod intended or offcm l lila.vale sec.71"4,
Bminec.and Profe,.im+.Cale:The Can tmmo„License Law does nm apply 1a as 35702036. Qf quired Inspections
owner of proirny Who builds or ;upas w thereon.and who does sten work himsal(
or through his own employees,provided that such improvements am not intended or
client lot ole.ll:hnwcver,the nuilding or in,$),cmmnt is sold within one ,.it of
completion,the owner-builder will have the burden of proving that he did not,toldor 103 — UFER
itnpmvc mr pmpaw of,alc.y
01.t,awne,of he prol+cnr.:I;n examively cu.,nog with licenced eornumn ,m 304 — ROUGH 'ELECTRICAI
mouses, he project(See 7044.Bminesa and Poulle,on,Cos,)The Cmm
twor',
License law Jazz not apply taint owner of prapeny who huildn or improve,thereon.
and who comma,"far such pmjmu with a aontrucvrtf,)licensed pursumn m the
Contractor',Locate Law.
❑i at,,eaongn under Sec. .B lit P C lin they n (�
Owner Dain v A
WORKER'S COMPENSATION DECLARATION 1
I hereby allinn under penally of perjury one al the bolowing dod—tion.:
❑ 1 nave send will maintain a CeniGcum alCoen, it .celfm am tort Worker's
Comrynvtinn, as provided lir by Section 370(1 of the Labor Code, for the
Iwrf.....mce of the work for wnleh 01in permit iv issued. �r/
❑I hauteand will ntnialain Worker',Conlpcnsation Iu,marac,ac reynircd by Scclion y
3700 of the Labor Calc,for the performance of the work for which this permit is
ismM My Workers Cnlnppen,dion Insurance Currierpand�PaaIicy number arc.
Cnrrv,$;�Te `f VO PaInY No.: 1✓1y471V
CERIIPI—cmior o1•hhEMP PION FROM WORKERS'
COMPENSATION INSURANCE
('this section need not be colnplelesf if the permit is for one hundred dollar,
Is 100)or lc,s.1
I certify thud in the perburraureu of the work for which this permit is issued,1
shall nul employ:my permn In any l.an ner.ten as,+become subject m the Worker,'
Cnlnlen,,ation Low,o'Culihnnia.Dam
Applicam
N(yfICE TO AFPLICANr:If,after making this Certificate of Eacmpdion,you should
Rmu
coe,objecn the Warks's Camlenwttion provivitu.of the Labor Code.you num
O Q forthwith comply with such mwi,iom or this Permit shall be deemed revoked.
F r✓ CONSTHUCTnON LENDING AGENCY
I hereby ottion that there so comtrvetion lending agen,for the perfnmmnce
Lit of the work for which this ry,,air is issued(Sec.3097.Co.C.)
1 Q Lender:Name
= z Lcndcr:Address
U O I certify lou I nuvcoined Ilii,alniealiolt and xna,its,,the abase fit nation i,
correct.I agree to comply with all city and county ordinances and se laws relating
O U building construction,and hereby uatharim reprtammtcves al this city to enter upon
� the above.mentioned pml+eny for inspection purposes.' y (We)ogre,,b-oo,,indunmify and keep hann4os the co,of Cupeninn again., �TT�
t0( Iiabiliaies,juJgmeof' costs and.. n.cr uhich InaY+ any we courses against suit 1 /O ZQ
U Cly;..anlsequ 8ramu ofthi,Penni 1 (/
APPLICAN F NDW PLY
WI'fp1AL1,NON�POINT Issued by: Dale
SOURCP : 'h ONS. w
s amR pphaa+vcamacmr Date RC-roofs
f1A%Ali DDUS M:JW
I.S UISCLOSUkIi
Will the applicant mlutteebuilding a'et,unlwareornarieleha,arJnn,mamtial Type of Roof
,,upas,by Inc Cupcnino Municipal Coda Chapter 9.12,and the Health and Safely
Code,Section 255324):'
❑Ye, 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future nuilding actrytnt use equipment or device,Which If a roof is installed without first obtaining an inspection, 1 agree to remove
nil hamnom.air conalnn+am.,as defined by the Huy Area Air Quality Manxgenunl
1iw.07 all new materials for inspection. Applicant understands and will comply with
El Y,, IDNo all non-point source regulations.
I have read the humrdons materials n:qulrcmcnu under Chapter 6,95 of the
Calilamia Health d Safety CW,Sections 25505.25533 and 25534.1 undc,aand thin
Ifthr.hnilAi and currentlyhersamnum,that i,is ny m,,u,ihihy to n...if he
Occup; d cnu uhich mow b: Prior Io i,suance of a ecnitiedt of
Dccn n v'r u n
Signature of Applicant Date
o— .rata,.+d,edag„ 1 � All roof coverings to be Class "B" or better
ateOFFICE