00100170 BUILDING ADDRISS; PERMITNO. .
OLIVE AV 00.11001.70
OWNER*SFx lr �" APPLICnoN still DATE
10/25/'2000
PHONE: S'l - SANITARY NO. CONTROL NO.
n eeZ ARCHI'I PC VENGINLER: BUILDING PERMfI INFO
EPC
- BLDG ELECT PLUMB MLCH
IRPV
N w a =1 f`-1 CI CI
LICENSI?OCONTRAC'IOIt'SDECI,ARAI10" lob Description
Oy 4— 1 hernhy nflinn lhal frill Invented unpnit,, ei,ion,ofChirpier 4(cn,mneneiny P
ml- with Se.,rm AXM))Of Oneis a
nn3rflhe Brnt..and Profn,en.ioCndn."'In"It..nm
o tail ton end 111"i
r'z6a lean.,rr ❑..a - REPAIRS
oG Da,e cnnrra.,Or
e. AIICHITLCI S IXCI ARATION
j I J l y,l 'h ll er,ndi r,,tildrolor J. 100,
�S: Lnon,rdP f '.' 'I
OWNER-BUILDER DECLARATION
u1 1 hereby..If 1 1 p f h Cont -I Lisw f r Inc
! ,, y .fS ]a A.5 1f t l C A y -u-•, O
e, I l @ II , 'II l fII p, y ,u.arc
µre m Pnt non wam.'H'tyrhe thenppns el theCot ohprnl, Ie,orLw`,(ChBnel
....noo,nln it pr, eat name n,o1I .lite conrnan,rn LkcteLewon,C ,4 Sq. FL Floor Area Valuation
ma I,e,een Suernn]r i end
v non fm elegedc,anJion,Any vi Code)
ar�Se ho h 31.5 b e; y a, I and the bu.i.fur me alleged,as,;,,pro;,,Any l ention IOWA
of Sarins 1(131 5 by any uPed(bol rnr r prnni,wnjcds,nc uppli,um w a dvil'onvlry
- „rnollrnremrnBvehordreddedw„Iss[x). APN Number Occupancy Type
xI.n. .e m, oo,Illy.o,my nn'my...will,wage,n, he,,.nm:oo'n."inn"
11 do the work,old,he w'uchne i,nor lmmled or,thrid,or salt(Sec.7H4, ..r._
Ilu.fny.and['Iorc..olll.code:'rhe Correctors Liccmn Lrw doe.nor apply 1n Io, Required Inspections
,r r of p,owry whit beddt o,in,Pn,w,d¢reon,and who the” ,let,work tinsel,
- �Onough his own nn;elnytt,,provided fha,inch nProv entt ire nor in,nnaed o
miYea for sole.If,oowrVer.the nodding or hnprovernetnn'u told within one yer or 1.01 — FOUNDATION
Io;opl,ann.the ownerhullder will hove hod hurden of Proving the;he did nor beim or 7 0^e — PIERS
n,pruvI,h¢purpo e of tele.).
71a, of In,prop,rl,a ,dull", nre'llllg wme anell,ed eonlncm,.In 103 ' — UFER
IJ,...m¢l enc prided iso,.9044.Rosin...nofi prnfct,nolw Codel Tire contractors 104 — P,EBAR
cen,e Aw(file,nor aPply n)fin ownn,or p;op,Jy whit I n iN nrLnnowl,thereon.
and woo contracts Io,titch pndeCIN wepl r,ontm,wn,l r,en.ed pntro ran no th` 105 '— ANCHOR BOLTS
"
ContraGin Liter l,aw.
o 1in,nnnl't nrd- Sen. B&P C for this ree,or 105 — SEWER 8. WATER
°'°s,1°r_ Lion, IQ Ii/I
ISNSAIIUOECLAHATIUN
202 — UNDERFLOOR PLUMBING
NUItKER'S COMI'
I hereby alliin nnJcr penally ni',,fury ono of the Lllluweng Jed:mniont:
203 — UNDERFLOOR MECHANICAL
%❑ 1 have n fainhon a Certificate 1 Consent in t.elf insure for worker. 204 — UNDERFLOOR FRAME
- C,IrI r . pie 1 1 f by Section 3700 Oil the Lrh ef ror the 205 UNDERFLOOR INSULATION
perfinneinneolll -ark f L h it i ,len 1.
1 Wren nrw win II,ael,lmn wnree.t cnI„pun„Iron m.nrnl,fn.rt revrired ny snclion
301 ROUGH PLUMBING
� Al A 111,Labor Code.In,the pe,ronnanw of the work for wind, Jr,patina is 302 — TUB 8 OR SHOWER
'atd.My Wod.crt eompcnsrin,Ii lose,..I Berner and Pnh„noothl a re: 303 — ROUGH MECHANICAL -
cr„e,. XEMT .
CERI'11dCA'I'ION(1P EXEMPTION FROM WORKERS' ',04 — ROUGH ELECTRICAL
COMPFNSMION INSURANCE 305 — FRAME
rrei, arnnneed rI(beIo;oplalanftire pe,ndIsI n,throdreddwlart 3015 — 1-IOLDOWNS
ISIw)of le”
I candy he,in he perli,rinnnae of the work ror.'loch Iiia p,nml is ..L I .307 — INSULATION
.hell nal nnpiny any pe„a, any nI. „n,I,to beenen,.alht,.,ro nae Worker: ^GB '— SFIEF_T ROCK
Comptm,mion Lm.,of Crllfornin.Dmc 1eto 3
Ap'licao,
NO[ APPLICANT.IL eneron,km
'Ing lois Cnnifine of ,m
Enpron,yon.hoold 309 — EXTERIOR LATH
[I
n„olne.nhk,lwmo worker,cot,eni.nron pro...on.nfrhe Lehnr code too rent[ 310 —' INTERIOR L.ATI-I
Q hmhwilh amply w;Io,om'mvr.inn.on In,ryerrif shall be de,n,d revoked.
Z ^ CONSTRUCT ION I.FNDING ING)NCY 311. — SCRATCH COAT
I hens}allirnl I ill rh�rein noungruariun luruling ascncy forthepedtn'nnnee �
s > E,nwnrkln,wlnd„hit 1.3 — ROOF NAIL
E
'ernes In Imucd(ticc.31W9.Clv.C.1
y c 1.l,^(lertN;,Ire 501. — FINAL ELECTRICAL ENERGY
Lender's Add,.,
U O 1eerily III,Iheea,,Ito,uppint,InorardtIn,wmnmuthoeoodorm,en)h1, 502 — FINAL PLUMBING ENERGY
m ,o
P vert.las,,olnaenplywithIII ,illrr]1
n, inrtr0, oil han, .,relndng 503 — FINAL MECHANICAL ENERGY
O [) ¢a hoilding cnn<Irnaron.m,III h,,eh,of,hn,V.tTlre.erooiw,a,, 1,,,try,,anter ury,n
die ahnnn ne.I;„„ ty ho"n,pnn,nn Pnrn 504 '— FINAL. BUILDTNG ENERG`,
F, 0+
(We)alien hI rove,inde,n;,I,find keep benne.,the City or CoPnnin,age n.t -
In IUInIII lit.i,Idgrnnnl,.o.r,rid copen,c,whlnh n,ay in any wey creme aFnin,I.rid 505 — FINAL ELECTRICAL
Com.) ti city in mnvcyuamc of rhe gmnling of til,pnn,Iil. - ��,�
APPLICANTUNDERSTANDS AND WILL COMPLY WITaALL NON-POIN1' IssUedb 506 -” CS-1f49�EST Date 16)"3/—Ut)
SOURCE REGULATIONS. y:
Sl Swlum of A,,h,nrVC,nation Date Re-roofs A .
HAZARDOUS MAI'LRIALS DISCLOSURE 508 — FINAL MECHAN I CAL
Will lk a'hmmlor It o,nn2Ja5ngo,O,,,.lar,is h,nme h.Ir;ndoa„nennelTYPe of Roof
defined by In,Cupemmu Molt Code Chap,,,9, '.and he Helm olid Knife,, 509 — FINAL GRADE7
,tile street_553zoH” - p I f,='�IoN�>l'hl fi
�Ye'` ”" All roofs shaliV Sl s ec&T lgr'to a I * material being installed.
Will nonrppliee.IorInners,boddinpo,e,,onnrteeynint,, lirdeei,,swhi,h If a roof isinstt5lle$With(Vu FRobRl �1t .1ISin43eFt1h)nn,, Iagree toremove
nit norden,wr,mtranlrems r,defir,d by the it,,Aar.Air I]eAlry Mm,e,nol l
nitric, all new materials for inspection. Applicant understands and-will comply with
C vn, %�No all non-point source regulations.
t., I has toed,he Ma,do, ttnelion rcyni nnla under Chnpmr 6,45 oldie
Call lurnin Helth,@ Safely Cod,Salons 25505,25533 and 25531.1 endenland IIIA
if rhe beilding arca no,currently have it Iamnr,[lint it is Iny re,pniolhllhy Io noriry the
cmep not lir the redui,r ncntt wind,Inuit he Incl'11111In it.nanne Ur a Ccnllteme ut
�J Signature of Applicant Date
u„lie,,,,not,nrn„d„gni,, rifle All roof coverings to be Claes•`B” or better
OFFICE