01050018CITY OF CUPER'11NO
CONTRACTOR INFORMATION:
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BUILDING DIVISION PERMIT
.
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
APPLICATION SUB DATE
o—.SANTA
01050010
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PHONE.
SANI'T'ARY NO. CON'114OG NO.
SORPSWAT - _
Z ARCH1'1LCUUN'GINEER:
- I 11 i2M1 i
0
BLDG ELECT PLUME MECH
LICENSED CONTRACF0R*S DECLARATION
Job Description
po I hereby affirm tea lain IlCeaud under provixions of Chapter 4lcommencing
W wllh Semon 40111,',1 Do ion 3 of thu Buxine.. unit P fu' ions Cod a nit y liven.
11 in full li+rte mA cjly'It r 3 C'
Q
LwG-�1TO- Lic. p
O Lirense Ins
Oate "Qf Contractor
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N
DE LARATION
d -public records -
g I undcund my plops fall leased
IN GR O Jh D 4 TfiPO SA
O Licensed Pndussionul
I,DER DECLARATION
OWNI!all
oIse
1 belies When that 11. cBusi n Than Ne Cusum,
ist
Anne Law orthe
Ceff a
]NLA Business and Profession, Ca le: Any city a,county
followinguire
sa planar(Sell
a permit improve. demnont , or repair any structure
um,wa, alter, inn
Owhich,,(,
fl n
to nt ria,
� priormlts inmancc, also rnpuires the npplicum lar xuch pcnniuo Olcaxigncd xmtclncm
S Ft. 0o Ar
- Valuation
- that be ix licensed purwannuer eromot of the Clmlmcmr's License Law(Chapler 9
(co mimingwish Sectio 7000) of Division J of the East nal P..I"""' Code?
or that he is exempt therefrom and the basis tor the alleged cscmptia f Any violatiof
of sectio, 7031.5 by any npplicum for a pem,il subjects the nP"", f to a civil paa:dt
tuber
ccupancy Type
of not ones, than Eve hundred dollars ($50()),P
❑ 1 nn Pr IMnr r re r c m g: a> m ,annul o.
ReC1UlC 111SpeCll )ns
or--will tit, the k d the structurenot intended or offered tor sale(Sm. 7XN
1-
B+, d l I' own L 1. 11 (taut I I L n Iplr It t
E,fp pony Whobuild, p vc the d had , h ,bili '
or tthrough ti anpl y - p Jed than such p met not - intended o
nftmW Iia cele. If however, the buffo, or umional ), iv cold wt hid nor year o
35704.053. 00 A
t
nprove for Tho nwncr-huilJv+will lona Ibc hos Jun of proving that hu AIJ not builA or
��'S(l�i
Improve tut pamo.e or sale.).
103 — UFE R
171, as owner of the property. all exclusively contracting with licensed contractors to
.,strict me project (sec. 7044. Ensues, ,at PoaA...i Codc:) I ife Coomnhiea
104 — REBA R
iuuproves v stun.
]Teen • Law d«m . net apply an ow net of propenY who bona, a N
and .tun comma, for such pnjen, wen a contractors) licensed pu cam to the
107 — POOL/BONDING
Comrrelar's License Luw.
[II.Ill aseaptI der Sri. .B&]Ic for this r`a`;er
301 — ROUGH PLUMBING
Owner Dane
304 — ROUGH ELECTRICAL
WORKIR'S COMPENSATION DECLARATION
�OE — FltdAl_ PLUMBING ENERGY
Iheehy allinnerjuq .,file, Penalty of pone of the hallowing dcd... I:
workirrs
_
503 — FINAL MECHANICAL ENERGY
El lave and will andulain a Cemfim ea, of Consent self-incur Par
me Lana Code, Isar me
506 — GAS TEST
Cmnpan,a(of, I ,calmed fear ny Slot o.1 3710 of
perrinfance of life work hl. which mix .it is -ficd.
51.0 — FINAL PLANNING
❑ I hull and will nelimain W'orkill's Confpcnsafion Inwnmcc, a, rcyviml by Section
is
911, — FINAL FOOL
3700 d mdlamrr Code, or fee pmTounarie of the work for which Illis actual
issued, MY WorI.`� �Ca�m `�@m inwrnnce carrier and Policy number are:
S Y�RtnC��
Carrot �.. _ i'ollc Na'
e -
1E — FINAL BUILDING
CI ti7i1 fAhoN Of I?%I!MI'TI(1NM1 UM WORKI!RS'
-
COMPENSATIONINSURANCE
(Thin section need not be completed if the fat is for one hundred dollar,
151(X11 or Ill,.)
_
1 realty fns in one performance of the stuck for which this permit is I... ed. I
shall not employ any person in any natural so u% to become subject h) the Workers'
C...np...... I Law, of Caliliani. Dam
,
Applicant
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NOTICHTOAPPLICANI:If. after nuking this Cernfica, of Exemption. you should
hernme subject o the W'nrkids Confperounion previsions of the Lahti Cash. you mol
.� tLnhwlle comply wish such provisions or this perch shall he demncJ revaked.
CONS 'rRUC1'[ON LEND] NO AGENCY
I heathy affirm that there is a construction lending agency for the perfommrce
til Ill,! is ill Ga which In, perm t is Ixvucd (Sea. 3097. CivC.)
QLcndcr's Nano
Z Lender's Address
1 senity flea I have ,,it lei, application :rod ,all leaf the above infatuation is
[r correct. 1 agree n, comply wilt, .11 city and c,,,any ordinal .... ani xutc laws uulaing
U to building conslmclion. and larchv authmLe representatives of this city use enter upon
W the ahwammtioned Progeny for imPection purposes.
A4 (Wil agree as a,l, indenmi I unit kill, harmleo the City of Ca,diao against
VI liabilities, judgmeu¢, antis and expenses which may In any way uccruc against said
Z City is cum...ence offhe granting ser this profit.
UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
Date
APPLICANT
Issued by:
Gr
P
Re-roots
_rSiJ�i� J
Signatt-re nrnpvh.an✓cmnmanm nate
Hann o, DWS hfATERINS IlIhCLU5 handl
WIIIthel finuru hnllJCo te. Inamety
Type Of Roof
Code. Chapter, 212, unA Ill 1leullh unit Safety
Tec Cu cniuo CharnsonorhnnAll I(MIll it
us Ciftlntll
r p fiery,
t �ul
Cole. 0cyan 35321417
th. Se Yea
All roofs shall he inspected prior to any roofing material being installed.
Will llaapplicall gar ranine l+bud'mgolue,art use ennlm+aennor dcvi`ox wlfich
If a root' is installed without first obtaining an inspection, I agree to remove
emirs huvrdnus allcnnuml nTrfrs as leired by the Buy Arca Air Gualinyhfanagement
all new materials for inspection. Applicant understands and will comply with
District? N,
❑Yes NXII
all non-point source regulations.
I hall read nue eacert] mamrla6 rcyuironenn ander Chapter r.95 W the
California Health & Safety Cal, Sections 25505.25533 and 25534. 1 undersmnd that
if she building does inn currently have a omen, thin in is ay ne,onsibility to utility the
uupam of the r,lierntenl, which oma be unci pour ea esuance nl' u CertiOcum of
Oc y'
arcus Ctn s—o�—��
Signature of Applicant Date
All roof coverings to be Class "B" or better
owlfe, oraadltiri,rd:fgel„ D:Im
OFFICE