02292138OFFICE
CITY OF CUPEWHNO
CONTRACTOR INFORMATION:
BUu.mrvc HMsu>N PERMIT
Ii UILDING ADDRESS:
PERM I IF NO.
(OWNER-SNA)I J
APPLTCATION sOMWO 3d
PHONE: SYMHNFFC
SAN] 'I'A RY NO. t= Q
al 7,
ARCHI'rECr/ENGWEIiR:
BUILDING PERMIT INFO
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BLDG ELLC'r PLUMP MECH
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LICENSED CONTRACTOR S DECLARN,oN
_ Job Description
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1 hereby affirm Ihal 1 am licensed under pmvisinns of Chvper 9 fcomincncing
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with Section 7000) of Division 3 ofthe Nosiness and I-ofeasiuns CNe. and my license
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is in lull It and ctlect.
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1,¢cnw Class Lic. N
Date Commcmr
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It NO CONDITION
AIICIII'I'ECI" 5 DECLARATION
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I undervanJ my plans shall be used as'.bill 'eland'
Ci0
o
Licensed Pndessiowl
Ir DECLARATION
that I at e,mm,e limn the Coal s License Low tin,he
I M1ertby all inn that I um.
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...isC city lir county
futures, h,,dc:
alte cu and
whichire reams. mouton 7onIS,
Jcmnlish,
demolish,
h o
t, vet m repair any IWCwrb
which rcyuirca .n pcm,it In construct, alter, improve, pi
prim to ies issuance, else requires the appticam li,nuco rennins lilr., signed stmclnem
Ibathe is licensed put oant to the Ill the Conmacor's Literal Law (Chasm, 9
Sq. Ft. Floor, Area
Valuation
(comalwa ing with Section 7001 of Division 3 of the Buaineas and Professions Code)
Lir that he is esempl th reform and the basic li„ the alleged cxclnption. Any violation
of Section 71131.5 by say :),'plum lina Form, subjecN the,npplimm u, a civil renally
APN Number
Occupalg$'j1gcW
ofmanmrefilm File hundred dollars (S500).
❑ I, as owner tithe noo,ent, lir my cnq,lm,ec.n with wages vs their till m,mrens anon.
e
36901 020RgZlired Inspections
will do the seer, and the .wmure is not intended a, offered lot vale (Sec. 70.14.
Business and 1'mfccions Cal The Contractor's Liccaso Law does alit apply m un
owner of property Who bu ills or improves thereon, and who does such work himself
or through his own employees. pmsidad that .such improvements am not intended or
al a ,l Is sold within sena yea, m
nnbred ler sale. If. hew n,, nm nnldialsormm law
101 — FOUNDATION
e the burden of pving that he did not Intim or
impletion, the ow mr-builder will have ro
mutase fit puriasenfsale.).
102 — PIERS
❑ I, xs owner of the r",crty, .,it exclushely contracting with licensed local 10103
— UFE R
m.amm the project Sec. 71114, Blaine,, and Prafession CW,:)'Ihe Comracnas
License Law dins no, apply it, an usil of pmren, who build,ver imp,o,e, there lin.
104 — REBAR
anti who connects for such projects with v comms).) licensed pmsaanl to the
Conal Liccnm Law,
105 — ANCHOR BOLTS
❑ l an, Latin, under tics. ,B& 1' C for this metro
106 — SEWER 8 WATER
Owner.Date
woRK1:R's cumrENScrvsn'l,ory DrcLnanTR>ry
202 — UNDERFLOOR PLUMBING
I hereby vl3mr under penalty of reju,y one of In. ollowipg dcAarelnn:
203 — UNDERFLOOR MECHANICAL
❑ 1 have and will maintain a Contribute or Consent 1i ,elf-insaw ler Workers
204 — UNDERFLOOR FRAME
Comms ithim. ns provided Poli by Section 3700 it ,Int Libor Code, lin the
,fnrmanmiliii,workto,wiid,h,i,anndisissued.
205 — UNDERFLOOR INSULATION
❑ l have and will maintain Workers Coallminion lnmamce,m inquired by Section
301 — ROUGH PLUMBING
37im ler the Lads cone, far one parfu mnneo of the work for which this permit is
- — TUB & OR SHOWER
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sued, My Worker's Cmnpereell Insum em canter and number arc:
J ,_
Carrier poll,, Olt��pore,NnroPolicy
303 — ROUGH MECHANICAL
�FlCACaIOmNrOcrvF
304 — ROUGH ELECTRICAL
shAI ,ION INSURANCE
1'Ifiis section need not he unnPleted if the permit is fnr one hundred dollars
305 — FRAME
(Man lir mss.)
306 — H01_DOWNS
I certify that in the performance of the work for which This pence is issued' 1
307 — INSULATION
shall sol employ It, pawn an any manse, sn as to heloma whim, to the Workers'
Compensation Laws of Calllbrm.. Da1e
308 — SHEETROCK
Applicant
NOTICE IT, APPLICANT: B.:toe, staking this Cenificam of 17 coalition, yon should309
— EXTERIOR LATH
boom subject n, the W'orkds Compcnsmion provision of the Labor Code, you than
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mrtnwithbimpl,wahsaehpmn;.iinanrmispnni,shauneJeetnedrevoked'
310 — INTERIOR LATH
CONSTRUCTION [.ENDING AGENCY
311 — SCRATCH COAT '
L '
1 hereby affirm the them is a construction lending agency to, the pertnrmano,
lit me work for wa,ish Iris permit is issued (see. 3097. Ch . C.)
—
313 ROOF NAIL
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Under Adifil
501 — FINAL ELECTRICAL_ ENERGY
5
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do
Imrifymnt l havemadtlds pillicationand sue that thenbvve allocation is
502 — FINAL_ PLUMBING ENERGY
F
correct. 1 agree memory with all city and county ordinances and sura laws relating
it, buuding consumed iLand heel, atahorucmpmwn,vavbsofhis city1.care,u,m
503 — FINAL MECHANICAL ENERGY
qu
theal„we-menftonedpropertyforin,sectlonpurposes,
(We).,.I inose, indemnify and keep hall the City of Cnpeninn ugainu
504. — FINAL_ BUILDING ENERGY
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liabilities. judgments, ensu anti expenses which may in any way acme against said
City ioconscquenccofhegramingof this rmcau.
WITH NON
505 — F ELECTRICAL �=,2—%^yy
APPLICANT UNDERSTANDS AND WILL COMPLY ALL -POINT
Issued by: SLIF — ['_S' �T Dante
SOURCE REGULATIONS.
Re -roofs 507 — FINAL PLUMBING
Signature of ApplicanVCn nortur D:tm
HAZARDOUS h1NITRIALS DISCLOSURE
Will the applicant building oc of future b . ,I, score or handle hmarmil a material
Type of Roof 508 — FINAL MECHANICAL
as defined by he Cotentnn Munlalpla cote. Chante, 9.12, and Ice Health vadsarmy
509 — FINAL G RADE
Ciao, Sevilla 255321n)'1
0Ye, L�a
All roofs shall IV jrMecte07WjgigLo tIP7_9gLqP48P.1Gterial being installed.
wiume:mpob-ant it fear building occupant use cyuiPmcnt it devices which
coil hmardous air conmminann as dclincd by the Bay Arca Air Quality Metngemc...
Ifaroof is insta�tJpwitltolFf l'F�l=R.bc�tUb�tRfSR9�Iki:Sl agree to remove
District'
all new materials for inspection. Applicant unlferslands and will comply with
CYbs
all non -point source regulations.
1 have .0 ,tic hnmrJnus mweriuln rcquheanal, tilde, Court v 6.95 of the
Calit'mrnia Health & Safety Coda Sections 25505.25533 and 25534. 1 understand toll
ifthe building does not currently have a tenant, that it is my.1runsiFall, t sadly the
cccupam, of the rcyuiraneno which int' M1 me t poor u, .vsuan.act n C nificaw of
Occur ... cy.
Signature of Applicant Dale
All roof coverings to be Class "B" or betterData '
OFFICE