00120096A
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OFFICE
CITYOFDIVISION
PERMIT
CONTRACTOR INFORMATION:
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BUILDINGAAff y, Ivry INIEWSOME AVE
11 tCiy
PFRMIINO.
GO
OWNER'S NrAPPLICATION
SUB DATE
CRY BARRY
1E/15/2000
11'f{pNE:
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SANIIARV N(1. CONTROL NO,
ARCHIFFECIANGINIELK:
BUILDING PERMIT INFO
O
BhUG IiLECT PLUMB Mr:CH
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I J 1=l GI
LICENSED CONI RACI'OR'S DECLARATION
Job Description
I hereby affirm Ill., I am license,( under prn.i,iam of Chapter 9 (commencing
'
win,Srol 7000)oIDIvlslnr.3nfineStales„,rudPmrea.Inn,cna,.nlmyfirLnaa
UPGRADE '
fol rune yt71 f�`k .� 7
Lice clan C+_ `_ - Lie. s
Date �_��-1 -Q Conn.
Contac
y
AR )17 1
Ise raJeopl
g
1 understand my plan. %hall b(to, I v -
Liccnncd Protca,iarrl
OatNE nBscurld R m the RATION
I herebyng roa.(lien That I am eB-i,u from the Celia, C : Allow law for the
toll6 rel'aeeionsh. orreai city ormnmy
requiresQ fiecliun7031.5.
j
ca
which cournlivalte.empro va,h or reran any grvment
which Iesuisunµunit m,uim,ttet,aper,nt
ca
lot permit it
prior n,slcense.., xlu,nt.dasthe,morr,o Tor Bchpetminnfile a
Sq. Pt. Floor Area
uluation
- LawJ.aammem
he c elltoinc,,uneme law
pmsuummda p,1
on,Chirpiero9
romr,icnwit
(c:n
Division of and
Isom 3 of Inc
iss Blob
ic,ede.a
ionrAny vi lotion
ent and basis Any lineman
t inclement
or that he is camp( tM1mefmm and the beers fur the
t he
cts th applicant
of Section L5 bymy applicant for . pennil noble.. the apPlicvm b, a civil penally
than
J,rote fiyaa hmmr..I dall.rn(x500).
APN Number
Occupancy Type
a
nfm,I mum
3757,500R. t%IQI
01. ae owrc,cohe n.onn In res with wa cs as their wee colo Iinn.
pd r rear r e penia
”
Required Inspections
th Ihe Is not role f5te. 7(u4.
Bolo do the wads and the
duce
cto's I,ok does
Ilmsines and rmna.n,n, c«m:'rhe cnntmanre License Law nm apply to an
o,le tr Lie a
mvnerofpmpeny who build, or impowexthercnn, and who does such week hintalf
304 — ROUGH ELECTRICAL
or Thu mgh hie own employees. previdc,l That such impsmvaments are not intended or
oflacd for sale.11,uuoevcr. the htiddinb nr imrm'emell i, .nm within..ne year of
501 — FINAL ELECTRICAL ENERGY
nannpletion, tire onerbuildcf will have the burden of proving that he did not build or
npruveforpurposenf,ale.).
505 — FINAL ELECTRICAL
111. as owner of the property. am exdmivcly conm,eting with licensed emtlraelms or
con,wcl the pmjecl (Ste. 7044. Bu,inc,s and Profcsdnn, Cade:) The Con stars
Lnenw Law does not apply to an owner of pmpeny who bulks at improves therum,
and who contracts In such Projects w'uh o Lantmator(i) lican.ed rnanunl m the
Comment's License law.
❑ I um exempt under Scc. . B k P C for thi, mason
Owner Dem
W'ORKER'S COMPENSATION DECLARATION
I hmxbr affioo maho,coally of perjury une of the indow'mg dccluratinns:
❑ 1 have and will intention a Ceriticam rot Consent to velbineure for Worker',
Con. tort o, as provided I'or by Suction .1700 of the Labor Code, for it.
'
performance of the work for which this permit i, issued,
O 1 have EnJ will n Inmin Worker's Cnmpenmtinn In,mancerequired by S,11um
3700 of the labor Cole, tort the performance of IM work fn which this permit i..
sued. M WorA rI C pem:nion Imumrrcc comer and Policy numlcr ore:
m tl — A �, � 5a o.5
_ .huli
C1iRT11TICA'l ION OM1 L\EhIPI ION FIB Al WORKERS'
COMPENSATION INSURANCE
(This .action recd nal bi+complemal if the permit is foram hundred Jolla,
($ U10) or less.)
I emit, That In the µdormivae of the work fur which Ihi, petrol i. iswed, I
shall not employ any person In any manner ,n as to became subject to the Workers'
Cnn.pcnsnlin l Lawsof C.Infio m Ilene
A,Ir... I
NOfICF.IO APPLICANT: If, after making this Cmificam of lixentption, you should
Wcome subject n the Worker's Compensation provision., of the labor Cale. you n um
hounwith coo. fill will, such Pn vision. nr Ihie per nil ,hall be deemed mvuknl.
CONSI'RUCIION LENDING AGENCY
I hereby Minn Thal There is v cmnstmelion Iending agency Ibr the perfurmnncc
of fine work fns wAieh tins roil is i ... rd (Sec. 3097. Civ. C.)
Lender', Name
,
l
Lcndcr', Address
D1
ccni(Y that I have read this application and state that the above inlirntation is
correct. 1 agree m, comply with all city and county ordinances and slam laws relating
bb II 6 f for i harbynallli i,c c,rco,irudirvc,ot J'. 'ryI mrtret
is
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A
Ne ab i ed pre pend l : lir puq :
(Wel ge lya JAe the against
t w s I
aoy ya,mca at
Ibl 3Ih L.s I µ.e: hi,l,may i any against said
City m a "ucnec of the 6runl of Ihry Perri 1.
APPY.ICA TUNDIiRSIAND$ II 'OMPLY rH ALL NONicY)Wr
',RCE U.T NS.
I/"'I✓^'U
Issued by: Date
Re -roofs
nJ,.r'
Signamr a ApphemVC..ntmemr Date
HAZAREN)US MATERIALS DISCLOSURE
Will (heal,drant or forum holding.wcnpem slum or hrldle hunmlom .natcdal
Type ofRoof
as defined by the Cupeniro Municipal Code. Chapter 4,12, and the health .and Salety
Cwt Section 255320)'
-
❑ves 0 N
All roofs shall be inspected prior to any rooting material being installed.
Willlhe a,licamor form buildingocce,ou use eyi i,unerto, devices which
.
If it roof is installed without first obtaining an inspection. I agree to remove
•mil Iaaanlrns air com uninaum its ddned by the Bur Area Air Quality Marmsemenl
i)i,lrmn
all new materials for inspection. Applicant understands and will comply with
'
°$'es 0 N
all non -point source regulations.
I have read the hav:ndous rnamnals regniminettte under Ch:tplcr'b95 of the
Culifomla Hwhh Al Safny Code, Scaiom r-5505.25533 and 25534. 1 undc,rnd that
if fie Aing de,es not currently have atenant, that it is my responsibility to roti fy the
.para .1 IM1e regnlrcmenb n.n nor or lou,necof a Cenitic:ne of
A /X-lS=UO
Signature of Applicant Dale
All roof coverings to be Class "B" or better
Own Dam
sn r.nnmdaeaugem
OFFICE