00040056 CI BUIOFN UPERTNNO CONTRACTOR INFORMATION:
PERMIT
'u""T
ki..: PERMIT N '
OWN'R'1 .. AI'PLICAf 111 ,
IONIi: — � SANfI'AItV NO, CON'BOI.NO.
—2
O-OZ ARCHITEOnENGINEER: BUILDING FERMI I'INFO
0 BLDG ELECT PLU,\1R AtIiCH
r I =1 I. _I I..
m j I.ICENSEO CONTRACTOR'S Of
o y c ncrchy amrnt that 1 ant Eeansea nnant pmvisinn.m clropler o f,rttmtan`i°g ADDITION lob Dc crip[ion
J with Section]OIk))of Uivsion Jnflhe Resler..and l'ndessin I,Codau,dmy license
r Pi,I.full force and effect. /
Oa i U Liven,CltnCIE", I.I,.b +'t
3,y CP$v Dale L /
ARCHITEOL DECLARATION /•f
C��j I tmnerstnnn my plata.Hall be nsw u.pnnha msmth UX D
Hot,ce ce o re Licensed Prufe clonal /
OWNER-BUILDER DECLARATION
onnION
='a I heorti offnn on 1. .Inuvi f an the Cnnuuctw's Anye Law h,r me
>- f,hich rgmuern. penman ]11)15,Ifu,ine..and improve,
drions Code:Any city structure
—x p which requires issuance,permit to cons the al pli al ka,E,demolis II ar repair any.tincture
E. prinrinhscenseppursuant
rc[I)]he lheapplrso tiro,svehlxrtninohlnse Ucd sttnantnv
E. lmtneislinen.rdp,,,.uannntncpmvi.it�n.°rthec°manr,.rlian.elyw(chamerq Sy. Ft. Floor Area
(ennmencing with Section](""R of Division I of the Ift ncsa and Profndons CnM,)
a,thin he ix exempt Iherefr,nn and the hari,fnr the alleged uutnpnnn.Any vinlau°n
of Section 7031.5 by any applicant lin aperi,subjects the uj icons Ina civil penally
of not norm than five hundred dollen(S500), A (u Qtc: Occupancy Type
❑1,Its
owner al the property,.. my mnploycc win,wage,as their.sale eompenmtinn,
will do the work.and the structure its not intended or offered for sale(see.]two 101 — FOUNDAITiile4�Nnspections
BurinP
s.and vdesions Cca1e:The Conautrans License Law does nal apply m an
mpntlmrly wen n1,hd.m itttprnws n„Mono atm who ane,suelt wo hi aw 102 — PIERS
o,through his own cmployoc,provldm that.such hnpro.enent,
are art iatendea
offered fnr eale.If,however,the building or inip,ovanent is sold within ane yc:a of 103 — UFER
,mpielion,me owner.hapde will little me burden m
III P >tttg mm he Ita nm 1,1111 or.
�tpmae fm parnewcol sale.). 104 — REBAR
o1.nowneoflh,,operty,°tnc.namely ertnr-acting with rcca,ea cnnnaetnn u, 105 — ANCHOR BOLTS
Lmvrnct the project(Sa.]1w.Resines and Prolessions C ale:l'11te Coutmcu,r'.
ice.nehawdoesnna ya,an rofprrpertrwnrnuamrrimpm.e.memnn. 106 — SEWER & WATER
ane suRK ."Nar acepr„jetnwttnaonmranngsl hanged pnrauam In meCmttrl 202 — UNDERFLOOR PLUMBING
❑laliaerS 11 hers PC fonhia reason76wne203 — UNDERFLOOR MECHANICAL RK Hl' 1';, AI'IONUECLARAI'ION 204 — UNDERFLOOR FRAME
I hechy arrtm anll proally°fpel... rnenfthe III—,,declararnn,. 205 — UNDERFLOOR INSULATION
] I have and rill mamtaht a Cesifirme of Consent 1r,self-inure far Wake.. 301 — ROUGH PLUMBING
'mtpenwtiva, n po,aled for by Sttalon 3701) of the Lubar Code, for the
anrenceoftbework for which In,pcntti is issued, 302 — TUB & OR SHOWER
❑utasenndwillmrattan Worker.Compcn.,mm,hnamncc,.smq,t llbys«tion 303 — ROUGH MECHANICAL
3]("1 of Inc Labor Ctale.for the will nnxncc of the work lar which this permit is
is,.ed.MyWorkerseompn.atronhsatamecarrier aadPolicy another ant: 304 — ROUGH ELECTRICAL
canner: policy Nn- 305 — FRAME
CERTIFICATION OF p_CEMVI'ION FROM WORKERS'
COMPENSATION INSURANCE 306' — HOLDOWN`S'O
J-11I section road not he completed if the peril is for one hundred dollar, 307 — INSULATION
308 — SHEETROCK
1 eenify that mine pediamowe of the work in,which this permit is irsued.I 309 — EXTERIOR LATH
shall not employ any person in any nectar a°as m hecutne subject to the Workcr<
lfiuw
Cmnper,aL .nrcaliwmia.D:te 31.0 — INTERIOR LATH
bectiNOTICE
oCE TOcttoAPPLICANT:eWorkrsnhcrnmvatioueCeaihaam of Exemption.youshould311 — SCRATCH COAT
hcmtnesubjecta,theWorker
jell 's Cotnponwtion frovit I har(mc Lunar Cudc,you mull
O O e,nhwimen,ttplywint>u,hpnwi.lint.nrdd.perttat.nauneacemeam°°kad 31.3 — ROOF NAIL
F
CONS FRurnONLUN DING AGENCY 501 — FINAL ELECTRICAL ENERGY
weakfarc`ctI,i,.cmStc.309diIII aganeyrnrate rrnnnana 502 — FINAL PLUMBING ENERGY
Lease wod,fnr wNOM1 this I is ismeJ(Sec.J(M)].Civ-C.)
5 z Lender',Rdne
D z Lane,anaam.. 503 — FINAL MECHRNICAL ENERGY ,
U O Icenff that Ihas,oudmi,africtionand,mnmaltheaWe.infrretatienis 504 — FINAL BUILDING ENERGY
W. F a acct I agree to nuntply with all citand cotmty nrdinunces ana sone laws relating
O U :oharldingcon,tmcranthcreby.umoriserepre.emaave.eonhis citytnenerapntt S — FINAL ELECTRICAL
} w the a se-mentioned pro my for iwfice inn purp,w,. —
F y We):tsrcetnaa enmemnRy nakeepharnde the Of 6 GAS TEST
Z) habilis tdsmenu,a ...;,ad cap, .e,xeich stay int any way:mcnc agaitwl i'dl 7�— FINAL NRL PLUMBING
USG
city on e4uenre yyyn tannins renis perltih.
AlP,I A S WILL OMPLYWITHALLNON-POINT ISS L by: — L Dat
SO.R(I A O
sus aur of he tr 'recn, Date -roofs 509 — FINAL GRADE
HAZARDOUS MATERIALS DISCLOSURE ],0 — FINAL PLANNING
WIII me applicant or brute,brute,building occupant state or lecone hvatdoas material Type e of RoO
a defined by the Contours Municipal Crile,Chapter 9.12,and the Health and Safety 514 — FINAL PUBLIC WORKS
Cali, ent255321x1'! El No
All roofs shall be inspected prior to any roofing nmterial being installed.
Will meapplicantorltitumh,tilding°ccupampa°elaipn,ent°rac,i,c,whi,n If a roof is installed without first obtaining an inspection, 1 agree to remove
nit huwrdous air Ir nlaminmas ax defined by the Iiuy Area AI,Carl,Managcntvnt
otriH] all new materials for inspection. Applicant understands and will comply with
El ye, ONO all non rot sou regal tions.
1 have read the humid°..materials requimntcros under Cbaplar,&95 of the
Calif Ikalth dr Sarney C1 le Station.,25. 15.25533 and 25534.1 understand that w
ilf then ing dues nut currcn i,'=lmuut mall,is my responsibility tunatifythe
,ccupa.1 et dE trcm. eol be It prion°issuance of a Cenilicarc'If
a Signal e of ApWant - Date
sun tin ages Dam All roof coverings to be Class "B” or better
OFFICE
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