02110139 CITY OF CUPEIMNO
BUILDING DIVISION PERMIT jCONTRACTORkINFORMATION.
But I EsSHELLY DR SQUARCIA LARRY G AND YOL BAMI?%2110139
0DwrgQTSARC IA LARRY G AND YOLANDA APPLICATT11syB2x Y 2 0 02
`� .TONE: SANITARY NO. CONTROL NO.
ARCHITECrIP.NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
WOO LICENSED CONTRACTOR'S DECLARATION Job Description
wu I hereby affirm that 1 am licensed under provisions.!Chapter 9(commencing p
F,
with Section7olkqofDivision3ofNCBusinessandProfessionsCale.andmylicenseis GAS LINE
Zd in l In.and el feet.
Lil Zn� ul ccru Class I.it.N
O —a Date Comment,
=f!j ARCHITECTrS DECLARATION INALE®
<qbe
I understand my plans shall used as public records
Licensedpmfessi.nal APR 0 8 2003.
OWNER-BUILDIIRDECLARATION
I bcrchy nllirm that 1 am exempt I'mm the C.mrmmr'.r License Law for the $50
w—p O litllowing reason.(Scedon 7031.5,Business and Pmfessinns Code:Any city or county ®�' u
`x S lL which tequima a pcmtit m construct,alter,improve,demolish,or repair any structure
Fie prior to its issusaw.alsomquires theapplicarm forsmch Permit n.file a signedstatement
that he is licensed poruanuo Ne prwisionsof the Contractor's License Law(Chapter 9 3S-g9Hlff02AAIQD auatlon
Tr G (commencing with Section 70()0).f Division 3 m dra Business and Polessinns Code)or
y
Out be is ezempl therefrom and the buis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty or PN'N Occupancy Type
Out m..then fiv.h.ndmd dollars 0.500). 202 - UNDERFLOOR P UMBING p y YP
I,as Owner Of the properly.or my employees with wages Of their sole compensation, 3 81: RE)USH i18
will do the work,and the structure is not intended or offered for sale(Sce.7044,Business
and Professions Code:The Cmuacm's License law don our apply to as owner of 302 - TUB & qRLpfftions
property who builds or improves thereon.and whodcessuch work himselforthrough his
own employees,provided that such improveraenuere not intended.,offered for sale.If, 502 - FINAL PLUMBING ENERGY
however,the building or improvement is sold within one year orcnmpletion.the owner. SO6 — GAS TEST
builder will have the burden Of proving that he did not build or improve for purpose of
sale) 507 - FINAL PLUMBING
❑1,as owner of the pmpeny,am exclusively commuting with licensed cenuactirs m
consumes be pmjca(Sec.7044,Business and Profession Code:)The Conuacmr's Li.
cane law it.sol apply to an.wnr of pmpeny who tudds or improves thereon,and
who convects for such projects with a c.ntrachons)licensed pursuant to the Contracmri
Lic meLaw.
Ism axe sunder,St . .B&PC for rcn.
Owner i ate
70,1 ER'S COMP SATON DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cenifcate of Conncat to sal-insure for Worker's Compen-
sation,as provided for by Section 371)of she Labor Code,for the performance of the
work for which this permit is issued
❑ I have and will maintain Worker's Compensation Insurance,n required by Section
3700 of the"her Code,for the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance,carrier and Policy number art:
Career. Policy No.: _
CERTIFICATE OF EXF.M PT-ION FROM WORKERS'
COMPENSATION INSURANCE
(This seedon need not be completed if(be permit Is for enc hundred dollars(510X)
or lcsaJ
1 ec,my than in the ,bornanes of the with for which his Permit is issued.l shall not
employany perm navy manae�a�tubcuvncsubiac r1.Mhe]4s'rkcrs CoTiumiseti.o
Laws of Califor .D.se
//ss��'"' TTJJ
APplicans ✓a-.��� e?s I pis
NOTICE ro .IL mg sCcnrcme of Excmpn.0 yn oulJ
become subject uo the Workor.Com reaction powbions of the Labor Code,you must
OO forthwith comply with such ProbM m
Provisions critics Permit shall deemed revoked.
z CONSTRUCTION LENDING AGENCY
[r I firmly from that Here iso immmxtio.leading agency fonts pmfmmmmof
Ix 7 the work for which this Permit is issued(Sec.3097.Civ.C.)
Q L.nd.Ya Name
,a z Lender's Address
U 0 1 cenify Nut 1 have read this application and state that the above information is
�I,,,^P come[.I agree to comply with all city and county ordinances and state laws relatingit,
0U building construction.and hereby amhoyme reprcumatives of this city to enter upon the
r move-mentioned property for inspection purposes.
1 (We)agree to save,indemnify and keep har ircia the City of Copenino against
rh liabilides,judgments,costs and expenus which may in any way acerae against said city
U z APPLIcq NT UNDERSTANDS this perminLL COMPLY WI�'II ALL NON-POINT Issued by: Date
SOU CRVGULATIONS.
J/-zLwoofs
SilOntreo Applicontran.r ate
HAZARDOUS MATERIALS DISCLOSURE. Type of Roof
Will the applicant or future building Occupant store or handle havardous material
as defined by the Cupcnino Municipal Code.Chapter Y.12,and the Health and Safety
c.ae.Scent 255320a0' All roofs shall be inspected prior to any roofing material being installed.
❑Ycs (�(
tate tbe a beano.,mt.,l baildm If a roof is installed without first obtaining an inspection, I agree to remove
applicant g Occupant use equipment m devices which
emir havardous air comarroom.as dcfincd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs n
1 ve read thelmvardous materials requirements under Chapter 695 of the Cali for
niallca &Snotty CtAc,Scc6.ns25505,25533nd255klunder.mWdthatifthebuilding
docs t currently how:a neat, y responsibility u,ryidfy the Occ0Pm1 of the
re mens which most
e.n.i= meenracmdecate.fOcc- �� natureofApplicant Date
ti
Owner or motion, gem Date All roof coverings to be Class"B" or better