00100030 cJ OFC DPER nrv°
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: 1'ERMIINo.
OWNER'S NAME: APPLICATION SUIT DATE
21598 ROSARIO AV 00100030
DONE SANITARY NO. CONTROL NO.
CONNELLY THOMAS J AND DJROTHY 10/04/2000
7i�
RCHIIECTniNGwGER: BUILDING PIiRMrr INFO
BLDG ELECT' I'LU 111 NII.Cll
LICENSED CGNfRACfDR DECLARXIION cls" Jab Dcscri 11On
lDias Cod 9ndnyl iceIngPith S , 7gX11 f D .' l f,l Ihy 1 I - ,s Cmlc n l ny Iu nc
ce a' int llf 1}�}h -ccn.vve//�(f� f., aj [�/ � � C•nnlu. — �r: � A Ir:L]r5 UECLAHAiION
t==OS Tun nJmylam shall he used as public record, REPLACE EXIST. WINDOW/DOOR OPENINGS IN
ALL:
Licence Protcx,innal VINYL FRAME WINDOWS. NO CHANGE OF SIZI
i p O
'sf Oat I air 1UR,OBR DECLC RATION
W= ncrcny iJrrm Ihn, 1.a in,inl form IeC l.... ld Code:ALecny r ty.. rad ins
M�.� followingaim'.(Smat71131.5. .1tewand1'ml m,nolinorAny citynr nmmy
E F p which rc4ui«w a permit m con.Irvct ahec imnrave Jemnli.,h,or rdvir unY vWCW,c
ce
ad prisnnin..iouance.vlso rcyuircn the uPPlicam fur,uch penniuolilcasigneJ smmmem
that he is licensed pursuant o the pmsi%ions of the Cann me /x Lia me Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7pp)of Division 3 of the Ilu,ina,s and Profmdm,s Code)
ar that he is exempt therefrom and the naris for me allegall c�cmPniou.Any violation
of Seel ion 7031.5 by any applicant rar a pcmauvbiecLv the and a civil penalty
of a,,,a altar Ilse htualmd n,ywm($5(X)). APN Number Occupancy Type
❑1,a,owner ofIhe pronar army to loym+w an wage,a,their sole cnnyemanion.
will do the work,and the structure is not intended or offered for sale(Sec.76w. $8500
Buaoe„and Profculnn C dc:'ma Gmnmcmr's Liccmc law Joe.rot apply in an Required Inspections
my of Pn,,ny Who nand,or in,nmves nnereon,and who Are,such work himscif
or
owner
Nl own ansa"Yee,.provided that such.Onwal ,sola i not intended or
oRcdcd Ire sale,a.bowcscr,me rebasing e.mmrn<mcnt i,,old within one Wild or 3,961.91l 00
cai'o,c ot-inu own of-le.).
will h:,vc the huNon nl'pnwing Ih;n he die non Wildor
01 Itb P " 1 -rvd) un I yw'ilh ficciPcdConn.".'In 101 — FOUNDATION ! /
construct thep j I(Sc Ito a R . o and Prof u il d :)Th C Im mon. O
see h a t suc h n with a Icor h nand n thereon 102 — PIERS
and n contracts f can p Ica n' do contractors)licensed r - I m ma
Contractor n.fn„e Lew, 103 — UFER /
❑lath a,ndp,node.S.c. .B.k Pcfill mi,.eavnn 1.04 — REBAR
Owner Dale -
WORKFR'S C(MIVENSATION DECLARATION 1.05 — ANCHOR BOLTS
I hereby a(fm,under penalty or parjury one of Following declaration,: 1.0E — SEWER R WATER
I 1 base and will maintain a cenirn"tc of Consent to,en-in,arc far W..ker', 202 — UNDERFLOOR PLUMBING
pc„dpan,adou, a, pmydcd tor by Soo o 37(X1 of ma Lahr,, Coda, ter the 203 — UNDERFLOOR MECHANICAL
.lem,amc of the wen:ter which mi,pcnnit i,i,sncd.
❑1 base and will Workers Compensation Insumme,asreyuiredbySL1n(,. 204 — UNDERFLOOR FRAME
37M of me Laser Coda.for me penimd..ca of he work for whim this pandit i, 205 — UNDERFLOOR INSULATION
n:vee My 'o to r',Comcemal n ln.wmn/cpy� Ald Pony number are: q/
' (,;i h,Jl ,h LtL(�/`��� ^ [ 301 — ROUGH PLUMBING
CU IFICA'1'ION IIP RXEMPTION FROM WORKERS 302- — TUB & OR SHOWER
7COMPENSATION INSURANCE 303
303 — ROUGH MECHANICAL
(an, need not he cou plct,d it penai,is for ane handree do
llars
dolla -
,s -
(SIOrmla".) 304' - ROUGH ELECTRICAL
1 candy that in he pa,marrunce of he work Our which this pcnnit i,issued,1 305 — FRAME
,nail net employ any person in any manner so ns a,become,object m me W'nrkcri
Cnmpen,ahien La.—f carlhmia.[),,anne 306 — HOLDOWNS
Applicant
Nonc110AIINACAN,It uporn,akingm„carnica,aofe,cmpdn".Won.heam 307 — INSULATION
necen,e,uwant msec Worker's Counen.atioa provision of let Labs.C,xlc you mud '08 — SHEETROCI:
O O fonhwith comply with such provision,or this parent shall he Jcnned revoked, s
Z CONSTRUMION LENDINGAGENCY 309 — EXTERIOR LATH
aIherchyaffirm that them isaconstruction lending agency far the arfornmrim 310 — INTERIOR LATH
rim work for which this nerrail i,iouad(Sec.NN7,Cly.Cd
a Leo&,'`N°"" 31.1 — SCRATCH COAT
.7 7 Lender',AJdrnv
1canily lallhavereadlhuapPlicannnandsm,emnlmeaN,vemformann"iv 313 — ROOF NAIL_
cornet.Iagree mcomPlyw'Inhall city and county ordinances ads,am I....alining 501 — FINAL ELECTRICAL. ENERGY
O V u,Wilding eon,waion.and hereby authorize representatives of this city to enter upon
y t,,) me abuseormunionedproperty orinl<cJonparpn,e,. 502 — FINAL PLUMBING ENERGY
F G, (We)agree to save,indemnify and keep harnde„the City of Cuperninoagainst
m B:mimie,.pal,nanm,foto Conn o,pnwhich may in any way anmc again,said 503 — FINAL MECHANICAL ENERGY
U Z Cny'm whitey"a"ecorI ha"a 1. .,n Cosi,n�nit.
"' APPLICARSTA N Wil'HALLNO•"yA•,,V,1 Issued by: 504 — FINAL_ BLIII_DING U1'ttEP,GY
SDUR [GUI.ATIO' �!1�,` —N -
sig a of maMC"ntmcnm (� Dan P Re-roofs
fi ALARUUUSM51'r:RIALS DISCLOSURE 506 — GAS TEST
Jl the applicant or future Wilding occupant m,ra or handle hazardous malarial Type of Roof
as dermic ny he cupcnmo Man"llial Code.Chapter 9.12.and the Health I safety 507 — FINAL PLUMBING
Code,Scctinn 25532(a)7
oYc, 0N" All roofs shall b51AeIectc&pTiW- 1) atYlEl5ili iki irilElial being installed.
Will the applicant orfmorc building occupant use equipment or dcsieo,which If it roof is install¢0t*ithOUFIT*Ifttapnt 9,05inspection. I agree to remove
emit h r lou,air contaminant,a,defnN by one Ray Area Air Quality Management
Di...Oct! all new material6QonspegtiTp4p�pppgaMpWT#I lids and will comply with
Dye, ElNo all non-point so e ula '
p � PIVAL PUBLIC WORKS
1 have read the h:manlou, oclin,lx 505,2 ,533 a under Chapter aisla of me
itCaliforniaehIlcalth N$afcc Cody,Saftioit 255(19.25511and25534 lay"I mmnd,hm
if Lhaantofnt Joe,notment% yhoveast he et its,mymcance ofityenotifythe
recuPanl n1 the rcyniremenn which mu.a M1c ren prior to is,vanee of a certificate of '
° ° Signature of Applicant Date
r ror nathr.. ��`[' >� All roof coverings to be Class"B" or better