00070132 CITY OF CUPECONTRACTOR INFORMATION:
BUILDING DIVISION
sum pEKMIT
BUILDING A11 121 RAINBOW DR rIf4ARl4
vl:Rnul Nf) 00070132
OWNER'S NA1' APPLICATION SUR DATE
VWOK �YG/ 07/21/2000
'11ONE. file 4 1SANITARY NO, CONTROL NO.
❑�' RCHITECf/EN'OINIiIi R: / BUILDING PERSII'1'INFO
00 11.1 _ ELECT PLUMB MECH
an
FaN
FFH'G LICENSED CONTRACTOR'S DECLARATION Job Descrip on
O O t-O 1 humby a0inn that I am of theesl under p and
P...m of Charter 1(comnaevo,c
atm witnseeron]avnofnroininn3mmexanma„awvtr„ionaGxm•nndrnylmc'ae DEMO
x f is len 11 forte mini cl. .S /�-/ 3 _
s 1 se A. _go Lic.. l-9
fie'Oma ):ec 7_�I� cnnlrncforr_._ —
u1'3 a v I YY \RCIII'I'LCI"5 UIiC1.Ali NON
Ca O I ul dersland my plain shall be used us public records
�Y
a a O Licensed Profcoiunal
OWNERDECLARATION 1 million that 1 innt r,,,up,floor the Cnro
luta law Era the
- ir following (Section oBoniest mai %ion,Code:Any cityofcounty
which astatine,.pintoconsumer,
nA mr,ah p ve.dertartary ra<tmre
fio,to, , I1 0 applicantl � np t), tl ss dstatement
�3
Ilrn he is licensed p - an l 'he p I t (7f' t L Law Whapto-l Sq. Ft. Floor AreaVal I' t�J�0
1
mommene ng with Section 700[))of D vision 3 wl the Bu:i ess a d l f: s Codc) �'
or that he is eaempuherefmm and the hats for the alleged eacmpaion.Any violation
of Section 7031.5 by any applicam for a permit subjeets the applicu „
no a civil penalty
of inn mom don five huridrcd dollars(Eslm. APN Number Occupancy Type
21
3E000F. 00
01,as owner of the property,or my employers is iah wages as their sole mmpcnnation. -
will do the work,and,he arveum is win intended or offered for sale(Sec.](W, Required his eCnOnS
Busincxs brill Professions Code:'I he Contractor's Liccnnc Law docs not apply to inn q
rofprowl,Who hwm.orltrio,•ulharcon.amlwhodoes_.uchwnrkhim.elf NO ASSIGNED INSPECTIONS
n,mrough his owa employeev ptvlied that such imrrovcomm,arc not intended or
uttered for role.IL however.the building or improvement is cold within one year of
completion.the ow,ncobuflder will have the burden of proving that he did no,build Or
improve for pram,,of able.).
❑Las owner of the ptpcoy zm eaelnuss a commninH wait licensed eonlrvmott to I .
consumer the project(Sec.]Of J•Haunts and Profusion,Code:)Tate improves
thereon,,
I!icI l Law dna not apply m a ulnar will
prop I. who built,or improves thereto,
I won comic'„Ina web pmjecry with a unmm..urf.v) laranoal purxuttm m the
Cnn[ractor's Liccnnc hrrw.
01 am exempt under Sec. .B&11 C for this mason
owner Date
TINS
WORKER'S COMPIiNSKIION DECLARATION
thereby Rorderpenalty of"jury one labeslowing..,f declarations:
Worker
11 J ''ll f C I I D C I
bit m t provided s by Seen 1]0) f 11 Labor
M Code for the the
rf n fah weak for Jti�permit' J
❑I thrve and I ll nuall"aral Woke,:Coni,orsation In' mac required by Section J`
3700 f the I h r Cal f Ib pc f vin I d ink I lu I this p......'t s
is.weJ.My Worke(s Compcmotinn Insurance carrier and policy number arc:
Climate: Policy Na: Cal
CERILI FICNDON Or 17XFMIII'ION FROM WORKERS'
COMPENSATION INSURANCE
(TM1is section need net be completed if the permit in for one hundred dollars
x5100)"1Iles.)
1 certify that in the plertomunce of the work for which this remit is issued.I
,hall boa employ any prawn in any m r as to becoe subject n the Workers'
Compensation Laws of California.Date
nnc no m
Apphcnnt
NOIlm suj APPLICANT Workr%altermaking Ii i,Ccnons of of Laborstill
youshould
Moor,,comply the Wurker',Cnions of tion provisionsofN,d LaMn CWe,you tun
Q O mnhw'nh comply with such provisions or thin permit,hall M JcemeJ revoked.
�+ Z) C'ONSTRUC'IION LENDI NO AGENCY
7 I heathy affmn that then is a amswclion lending agency for the performance
film work for which,his permit i,iswed(Sec.30],Civ.C.)
0. Q Lender's Name
.7. Z Lender's Addrus
U Q 1 certify that I have mud this application and amvc that the nMwe information is
correct.I agree to comply with all city and county on inanees and%late laws refuting
Q U ar building connatetion.and thereby trutnorim representatives ofthis city to enter uplift
the above-mentioned property lic Inspeofon rurpnes,
FLa. We msave.indemnify and harmless the Cit rCu n 6' t
a ( )agree Y a^ r yrs ac ldn" n
N Cabllitie motaperce eons and npof1r which may in ony way amrve agate,saW
U Z Ci,y i I<onscyucnm R the grmnimg of this permit. 7- ^� /�M
APPLICANTU )ERS US AND W/I}',LCOMPI�' "of ALL�'{ON PO��''rr Issued by: Dale / F/ V
5 RC C 1 j�.J— /� 7/Z/ 0-V
ignawre of dpplican✓coin or �� J /L— / Da Re-roofs
HAF.A ))IIS MA'1'ERIAIS DISCLOSURE
Will file opplicot ori umre building Ovcupunl 111111 or handle hwarduusmtherml Type ofRoof
as defined by the Corcoran Municipal Code.Chapter 9.12.and are lIvAth and Safety
code.Seclio 225532W)P ❑No
All roofs shall be inspected prior to any roofing material being installed.
Wiuthe appramormnnt,fi 'ngoeewpautuse ayuirinenl ,,daiee.which If a roof is installed without first obtaining an inspection, I agree to remove
emit humorous air comaminans as defined by We Hay Area Air Quality Management
Dntricrr all new materials for inspection. Applicant understands and will comply with
aYa El No all non-point source regulations.
I have read,he humorous materials requirements under Charter h:)5 of the
California Health&Safety Code.Seaitem,25505.25533 and 25534.1 understand that
it me building does nn,currently have a tenant.that it is my renpmeibilny In nrdily the
ccupmd of the raynh'cmunts which must he me,prior it,iss'i n u leen 11 icttfe of
O p�/ / Signature of Applicant Date
I
7 Z/ / oD
Owneru'aah..."d gena 1a,r All roof coverings to be Class'B” or better
OFFICE