Loading...
00070027BUILDING DIVISION BUILDING OWNER'S CONTRACTOR INFORMATION: PERM] INO. PHONE: `O6 — ',�ris \ Op I •—�• --- _ _ _ _ ISANfI'ARY NO. /N�)L/ FI.............................�t�/I FI S rAE v � G �'A/yl I BLOC r1.licr PI_MH 'METE LICENSED COM'RACTOR'S DECLARATION I hereby .flim.'hl. 1 sun licen.ed under provision. of Chapter 9 lcrnmnencing with Scedi 7000) ill' I lillslo 3 of the Bu,inc,sand Prsfmsiom Code,:ted my 1111.1. an,, llnec^ t _x'07 is ill Class1r1c_ .,t, Dam C(mwmnr ARCHITIECI IS IffiCLARA'1']ON 1 undemand my plum shall W used as public recons Licensed Is lesional OWNER-IIUILITER DECLARA'T'ION I hamby inti... mal I sun elan." ronin the Commcwr', Idc.nne Low Lor the hollowing upon. f iccuo. 711.31.5, Bol muss' and Pmfc,ninn. Code: Any lilt or 1„only which re,mrc., "i m umnmall, aIle, improve, den list or repair any stmeture pnor m its issuarm. alsorequires the applies m Por such pemtltopic a signed statement that he is licensed pursuant p, the previsions of the Commemm License Law (Chapter 9 (,. nirencing wall Section 701X)) of Diskom 3 of the Rmia.ss and Rofe,in., Code) or that he is eeempl thcrdmni and the basis for the alleged em n,non. Any violation of Scolio 7131.5 by any cliff team for it Woof subjects the appf coat to it civil penury of not aura trim five hundred dollars ISS(,). ❑ 1, an owner of me properly, or on, employees with wages as door sole compawalion. will do the sunk, and the structure is not intended or ancrod for sale (Sec. 71144, Buz nes, and Pmle,kno, Code: The Contractor v I w,m le law dues not apply W an owner of propeny Who build% or impmsc5 thereon, and who does such work himself r through his awn employees. provided that such improvements am not intended or offered for all. If, nnwcvcr, the building or imp nvenaml is sold within tete year of mplefln.Ihe owner -Budder will have the burden of proving that he did sun build or .sun umwve or pm pow ol',adc). ❑ 1. av owner of the propeny. all exclusively contrading with licensed cmnraanrs m Lonamm the project (Sec 7(W. Business and Protessfon.. Code:) The Commew,. icense Law arcs not appy to an owner of propeny who holds or impmvcs Ihi and who contmets for such projects with a contractor(.) licensed pursuant m the Contractor's License Loss. ❑ I not unn.pl antler See. '.B&PC I'm this mmnn owner Date WORKER'S COMPENSATION DECLARA'I ION 1 hereby aflimt under penalty of Perjury one of the following deelmationz: ❑ 1 have and will ntaimam a Cen Oram of Conant to ssibinwre for Worker's Compensation, as provided or by S,,,l 1 370X1 ill the Labor Code, for the perf man. m Im work fill which his permit is i ... all, ❑ I have and will mainmin Worker's Cninpenmtion loo moe. as reyui red by Section 3700 of the Ei Code. sur the perk ...... cle don, work for which this pc,,gl is asuN. My Worker's Compensation Insupm comer and Policy number or (Thi, sect:... need not he a Mad it the Pc Ion is rte one hundred doll... (51010 sur le,,.) 1 certify that in the performance of the work for which this pe.it is i ... ed. 1 shall not employ any person in any runner m as to become .subject to the Workers' Cnmpenwuna Laws of California, Data Applicant NOTICHIO APPLICANII If, utter looking this Ccndilme ill'Exemption, you,hould become object It, ill, Worker ', Cnngmnavuon prnvi,inns uIbe Labor Code, yon nngl forthwith a m ly with such prosi or, ar this permn shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby arum that mere inn cnnswmion lending agency for the pemmnance of the work fo. which this µ,,mit is issued see. 3007. Civ. Cd Lender Nome Lando', Arlie, 1 certify that I have read Ihis application and .ante that me above clorn.Wnn i, ,omen. 1 agree e. comply with all city and county ordinance% and state law's relating m building encs'. 'ion. and hereby amhorine rePlnenlativev of this city ill enter upon the aW,e.memomcd property for mspecimm parol (We) agree to save, indemnity and keep harmless the City of Cupcninn against liabilitiesjndgmemn, costs and cyxtwe, which nay in any way acwe against solid City in cnme9ucnee of the go infling of permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. Signature of ApplicanUConlmmor Dole HAZARDOUS MATERIALS DISCLOSURE Will the applicant er future building occupant Ston or lemlle Wel material a, defined by the Cupcnino Mnnicipul Coda Chapter 9.12 and the Health and Safety Code, Seclimn 25532(.)! ❑Yee El No Will the applicant or future Wilding occupant use equipment or desires which .mil hamrdo., mr cnnmminanrt az defined by the Bay Arca Air Quality Mawgemem District? O Yes 0 N I have read (he hamoh us materials requimnenls under Chapter 6 95 of the Culil'omiu llvuhh&Safely Gulc, Sccunm ZS 513 mud 25534. 1 undcnund shat fmahuildingmc,mmc, mntlylav• wnL t it in uy nn lanaihilitynoundly the curate ill he rcquiremmts .mita he met prix issuance of a CeniGeme of Oeeu� ��� ADDITION Job Description Sq. Ft. FIlYr. u 0 1 f a 102 — PIERS` 103 — UFER 1.04 — REBAR 105 — ANCHOR BOLTS 106 — SEWER R WATER 202 — UNDERFLOOR PLUMBING 203 — UNDERFLOOR MECHANICAL 204 — UNDERFLOOR FRAME 205 — UNDERFLOOR INSULATION 301 — ROUGH PLUMBING 302 — TUB & OR SHOWER 303 ROUGH MECHANICAL 304 — ROUGH ELECTRICAL 305 — FRAME 306 — HOLDOWNS 307 — INSULATION 308 — SHEETROCK 309 — EXTERIOR LATH 310 — INTERIOR LATH 311 — SCRATCH COAT 313 — ROOF NAIL 501 — FINAL ELECTRICAL ENERGY 502 — FINAL PLUMBING ENERGY 503 — FINAL MECHANICAL ENERGY 504 —' FINAL BUILDING ENERGY 505 — FINAL ELECTRICAL 506 — GAS TEST _9,27, — FINAL PLUMBING Issued by: SA F I NAL ' MECHAN I CALI),teq —/ ©- () v Re -root's 510 — FINAL PLANNING Type of Roof 514 FINAL PUBLIC WORKS All root's shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Applicant understands and will comply with all non -point source regulations. Signature of Applicant Date All roof coverings to be Class "B” or better