00100002 CI BUILDING DNPESIOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PHRMI'1NO.
OWNER'S NAM[.�0599 SUNRISE DR APPLICATIONSo@,1100001_
41 PHONE: SCHULER MARGARET SANITARY NO. I101O c;N'110 0
OZZ ARCIRTECIENGINEER: BUILDING PERmi r INFO
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LICENSED CON'IRACIOR'S DECLARATION Job Description
z 1 herch Birth that 1 um IicenxJ under f Cha 9(ronnn<ncin
y a pm,;,ion,n poor g
K==Q wish tall Naaaa') ofDivkionJ Orme lin,inesanJl'n{d�esaions CralcarM mYlicense
¢m 5� is in 11111 fora and "gia --7—yi a
z me se Clan,._ Contract...
onb
y a.6 V Dale S DUCLm
m301 ARCHITECT'SDECLARAecord REROOF/SHRF'SE TO COMP.
t_a O,g I understand my Plun„hall W used as public records
C�2+
ti ef Licenced l'ndc,xionnl -
ef OWNER-BUILDER DECLARATION
v 1 nonny.Winn i I am exempt fmm the Contractor's License Law for the .
C Z which r g reams sernifut 7733.5.Business and improve,
derion.GNe:Any any or county
�j F❑ which requires n Inrmit m comw<I,nllar,ilnpruve demolish.lir u it any swnure
6 Cam that heha licensed ,..an,
ulwrnpli me pookillelnl lou.mch pular', iwxn sgned 9atnuenn
matnei,nieenw,lSectiotnlid)ofivisinrmfbeB:emra.ianxl.awtenameru Sq. FL Floor Area Valuation
or that a is exempt
Sermonom and
Division3of thelegede exemption,
Any
vi Gtion
or thathei.cscmpt therefrom and the basis(or the os the a plicanoo Any vie natty
lito,atinn71131.5iv any lvd,anlfornpermit eunjccrs,M applicant mncivil Nnulry
mm.,loom nn:nnl ria lnanarw aolwra lSsfXn. APN Number OccupancpT4gf4
❑T,as..at of the Nopimy,or my employees with wages as their sae compensation.
will do the work,and the abunure is not intended or offend for sale(Sec.701
Nn,ina.,and Pmat,ion.Cmle The Contractors Lieanse Law does am apply to an 359].00410KI20)red Inspections
nl oniony Who Wilda t more a,thereof:.call who does udh work himself ,
offered fo his own hovel cr,t pmadin that such Impnneis sol within
not i one
or
comple for.ole.If,however,the Willing or uden anrnt n sold within one year of
mnpletmn,me nwmennuaaer will have me Wraen nrpmvmt rh:,,he did not Wad m 305 — FRAME '
`mnrnvefmpur waofa:ae.). 307 — TNSULATTON
❑I,o own,'of rhe pmpeny,.,It e,du.ivdy contracting with licensed contractors to 601 — ROOF TEAR OFF
tmlmc,the project(Sec.76U.Business and Prate„ions Coda T
che Contractor's
License Law dne.v not apply to an owner of pmpny who builds or improves thereon.
and who contracts for such prylacu with a contractor(,) licensed pursuant to the 602 — ROOF PLYWOOD' NA II_
Conlracutt5 Llcoos:Law.
❑1 an,eamnnt order Sea. .B&P C u,r nni,lwsnn 603 — ROOF BATTENS
Owner Data 604 — ROOF TN—PROGRESS
WORKER'S COMPENSATION DECLARATION
1 hereby affil under penalty of perjnry line of the following declannion.r. -
❑ 1 have and will msintain u Certificate of Consent to sxif ii-mm for Worker's
Compensation, o provided for by Section 3700 of the Labor Code, for the -
performance of the work for which this Isonal is mut.
❑1 have and will maintain W'orker's Comirsamm on Insurance,m required by Section
3700 of the Labor C Int the perinnnnmce of the work for which this permit is
issued.My W'rk 's_ N anion Invurenee tamer nnJ Pollcy�number rc:f'n
v cr Iblicy No.: _ S 1 A 6
GIiRIIPICATIONoP S!iONIINS FROM WORKERS' O/
CDON01:SA'rION INSURANCE
Crhis section is ud not be connplened if the Nnnit is for one hundred dollars
(Y101p or less.) v
I cenity that in the Nrformatwe of the week for which thi.v Permit is issued.1 O
shall not employ any person in any manner so as to become subject to the Workers' lO
Connpeo,lion La—of California.oma -
Anpllcanl
NOTICE 10 APPLICAN'n Ih after making this Canitwar or Hsemrli m.yon should
became subject to the Worker's Compensation provisions of the Labor Code,you must
7Q7 O forthwith comply with such previsions lir this permit shall W Deemed revoked
q l� CON S'I1ItUC'r1UN LENDING AGENCY
a , 1 hereby affirm that there is a amgruction Inuring agency nm the performance _
of the work for which this permit is issued(Sec 3097.Cir.C.)
G Q Lender's Name
-
Lcnacr's Address
V I certify that I hove read this application and slate that the above infonaallmi is
La. sem. correct.I agree to comply with all city and county ordimancn and stem laws aiming
Q r..7 rebuilding constmction.and hereby iuthorin mprtxnmti,e,of this city to enter ulam
%• the nnn(Wit)a ioaed-ve.adfonots Ikis
erpurptnes.
to Ln e,judginemeevc.madexpense kcanhurnly intheCayrrow not orm,said V”
W City ilio.sequadnts,cuss and expenses which only in nnY way:mcmutgnlna sail V
V Z City in CANT U D of the granting of this Lenoir.
APPLICANT UNDP ST SAND ILL COMPLY WITH ALL NO INT Issued by: Date
Ce REGUI. IQt
h,momaof nppfi vno 6,aranar Dre Re-roofs
HA7ARDOUS MATFR1AI S DISCLOSURE
Will the applicant lir future Wilding occupant store or handle baziNous anile al Type of Roof
ns defined by rhe CuNni no Municipal Cod,Chapter 9.12,and the Health and Safety
Code,Seetlon 25111(al!
0Yas 0 N All roofs shall be inspected prior to any roofing material being installed.
Will he applicant a,future Wadingoccupaotuxequithnentwdm;ceswhich If a roof is installed without first obtaining an inspection. I agree to remove
isemit huearJous air cummnmanta av defined by the 11ay Are,Air Quality Minutemen,
nienin7 all new materials for inspection. Applicant understands and will comply with
Cl Ya, C1 No all non-point source regulations.
1 have hard he Weallous materials rtquimnems under Chapter fi 95 of be
California Ilcahh d Safety Coate.Sections 25505,35533 and 25534.1 understand that
if the building docs our cuncnlly hrvea tcnan6 that it is my rcepansibilitym notify r 10&
cupom of the requian lral,which Inns IN incl Pn for m Ixsulmee of a Ca11i0cwc
Oceuwtney. Signature of Applicant
Date
ownnrm a nrnen ager/—�"'� � 61L�a All roof coverings to be Class"B" or better
OFFICE