01020138 CI OFCUPERTNO
BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: FERMI l'NO.
01.020138
OWNI;R'S NAME',: APPLICATION SUB DATE:
02/28/2001.
PHONE: - SANITARY No. CONTROL NO.
G m% ARCHITIiC1'H CIN17FIL BUILDING PI2RMIT INFO
CO
w_ BL EIEC PLUMB MIiCI
ar _I
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�N. LICIEN5eDCONTRAC'raR'S DIiCLARnnoN Job Description
%. ✓'L i herchy mfirru mat into licensed under provisions of Chapter 9laamnencing
�mFw w'im Smllon7lXXhnf Diviousd 3ofthe l{uaineswnJ l'rnfessinns Cale.and my licenu
m i is in tido farce and effect. -
�m�� Lice,ncclas, Lie.# '1.051 LIVING SPACE, 577 GARAGE.
a nam Cnmmaor
a C fit ARCHI'I I:Cr'S DECLARATION
I P felon I my plum shell be used ax pothole records
i95 p p Licensed Pmeefsinrel '
c. (IWNER-BUILDIER DECLARATION
1 hereby ufOrn,Phut I an, ,,o Ion the Cornraco is License Law lot the
I-L>' following mason.(Section 7001 5,Bminess and Professions Coda:Any city or county
m 0
which y parrot t construct, It p J Ida p y structure
w3 Islot. t I: y ld ,Ed ,I : lop II i, I,ou tent
that he is licensed ,PP tt the p t the c , t :Licrien,L (Chapter 9 Sy. Ft. Floor Area O Valuation
m
(comencing with Section 70011 of Division J of the Rus ncss and Professions C Wc) 1 L711 Ci-77
or Phut he is eaentpt mcrcrdm and the bins/,for the alleged saver ion.Any violation
of Secrnn 7031.5 he any ap,henno burn pcnnil above,,the nppllcanl In a elvll Isnmlry
of nm more man Bee hundred dollars ESSEX)), APN Number Occupancy Type
❑Las ,r+c pfopeny... ..l,enTloyce win,wage.,ass their-lean....."tual
will do me work.and me structure is not intended or offered for sale(Sm.70,14. LAO A
Business and Poessions Cale:The Contdcmf'n License Law docs no,apply to an Required Inspections
w r of proltcny Whn End&or improves thereon,and wen docs such work himmlf
owner of
his own anpWyecs,printed tent,nen i.npcave.nen,are nor inmaled or 101 — FOUNDAT ION
offcml for rds.IL however.the building or impmscrn=nt is wild within lone year PI
tumpletion.fill the owner-builder will have the burden of pinning that he did not build or 1.02 - PIERS
er wnennpoveoteam.). - —
nathe pdpen&ant exclusively anntrucengasithlicensed cornncmrsto 103 UFER
construct the project(Sec.nu4,Business and Professions nxac
Casket 1ba Contractor 1.04 - REBA R
iV=e.r,e Luw does nm:yPI,.o air owner of prixM.0
nny who as nr PTnw,,Ibeu
er ...
and who connotes for such project,with a club conmmemr(sl licensed pursuer,In me 105 — ANCHOR BOLTS
Cnnunnuca s License Law.
C1 I anutracoln,..tderSal11&11Clet this .asnn 1,06 — SEWER & WATER
own _A�bPd .na
= lO202 — UNDERFLOOR PLUMBING
SATIO IECLA ATI)N
IM1e <d�rr erre none ralwwing deaamnnns: 203 — I-INDERFLOOR MECHANICAL.
204 — UNDERFLOOR FRAME
❑ 1 have and will nn.intain a Carltic:nc of Consent to rot-innum for W'orker's
C.... len, as pnnidcd nor by Sceaon 3700 nr he Labor node, for the 205 — UNDERFLOOR, (NSI-ILATION
perh,rrtance of the w'ak for which this l,ennit is issued. 301 — ROUGH PLUMBING
❑Ihave and MEitan.nin W..too,sCoul,enndnn ln.mance.as required by Seadnn 302 — TUB R OR SHOWER
of he Palm Cale,for he perhmtunce of the work 4,i which this panni,is
sued.My Worker'sCompnsatinnlnsurancecamr,aadpolicynuntne,am: 303 — ROUGH MECHANICAL
Currier: Policy No.:
CHRTIRCATION OF E%EMPION FROM WORKERS' 304 — ROUGH ELECTRICAL
COMPIENSAI'[ON INSURANCE: 305 — FRAME
This neetion need not be cn.opleted if th.Penni,is throne hund¢d dollars 306 — HOLDOWNS
(5101)or Icxc)
1 errffy mat in he rvdonnan,aa ni the soak for which this scan/is issued,1 307 — INSULATION
.eau on,employ any Person in an,,narnro,sen on or bacurne subject 1.me workad 308 — SHEE f ROCK
Co..lEs salon Law, d California Date
Applicant 309 — EXTERIOR LATH
NUI ICE TO APPLICANT:IL n@,,nuking,his Cenifcolc of Excdptioe,you should
Z hcrorncmbjecrtobeWorkersCompcnsatmnpmvisionsofthe Labor Code.you rawl 310 — INTERIOR LATH
0 O tndlo its comply w!,It ,,all pin....on,or,his/,.'tent shall he deemed revoked.
z311 — SCRATCH COAT
CON S'IRUCf1ONLENDING AG17NCY 313 — ROOF NAIL
a Ihcmhya he[,thin,ha=ins mned(Sil. lending agency for the prrhmmana ?
a nfinewn,k...a site,iaprd,nisisnaa(Sre3(xn,cin.c.) 501 — FINAL ELECTRICAL ENERGY
I London's Nano
= 7 London's Address
U O 1anifyn,a,Ihave n;.athis:tp,kinionand s,a,a It., Its rbovemb.nmlonle 502 — FINAL PLUMBING ENERGY
it, E. correct.I agree to canply with an city and county ordinances and state laws relating 503- — FINAL MECHANICAL ENERGY
n�bdddingenn,tral and hereby Pollnow mptcsemmives of this city w enter upon
W . rPLo nc...innedpnPenyrotin.peenon papnses 504 — FINAL BUILDING ENERGY
Imo" A. (Wel agree to saa,indemnify and keephadticss the City of Cupenin,against
rn liabilities,judgments.costs and expenses which.nay in any way acme against said 505 —
FINAL ELECT R I CALEY _ /C7 o
U7`y CnyincomeynnnecofthegraningPI his ,,all 506 - GAS TEST
A ]AN'r UNDHRS'I'ANDS AND WILL COMPLY WITH A hNO -POINT Issued by: Date
J
.gn- ..,,.'pplle:.nllCorna an - IAm Re-roofs
IIn1ARDOl15 n+ E,occupant
DISCLOSURE: 508 — FINAL MECHRNICAL
wII y dapphcatt en Munn hail ling Code,Chapt stns m drawler haealth an daftlybal Type of RuFif
Cde,SoJ M1y.he Cnpcninn Municipal xChapter Y.12.and the Health and
Sale,Y 509 — FINAL GRADE
Code,Saerinn a_5532(a):'
oxen ❑N" All roofs shall be `tgitiik�f�':te-1c p,Frcibttlb.�1(�S��fny.�rbeftp��{��I�f��L7,i(a�lpb�/eing installed.
Will(litalplin.nl'n,team la.ilJing rx:cupunnnc e,vipucu m its ices which If a roof is installeffiXrhhoot fElkiFtUnRbJBrFEd4p-eLRd1i,VFgree to rent Five
emit hazvdou,air cl tantinanls a defined by.he Ela,Area Air Quality Managonenl
District all new materials for inspection. Applicant understands and will comply with
ones 0N all non-point source regulations.
I have read the haiaNnus nutcdAn requirements under chapter 6.95 of the
Cali India Health R Safety Cal,Sections 25505.25533 and 25534.1 understand,hat
iI,hc fill d ng Joe,not uaren.ly have;I to that it/t illy mepnmihi l Pry to Pulty the '
ecupan of c reyuiumnicus which Pisa M nus prior to is neacc of a C'enificme of
Signature of Applicant Date
n—,u nn a �g=nI {-+-1 Ila a �- All roof coverings to be Class `B"or better
l OFFICE