00030077CITY OF CUPE
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BUING DIWSION SION r -PERMIT
CONTRACTOR INFORMATION: PERMIT No.
roo O 300 7
BUILUINO ADIJRCSS:
5315 ca �t«
l ^ O f , SANI'LARYNO. APPLICATION SUBMITTAL DATI
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( ER'S NAME:
NIC CONTROLM
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BULDINO PERMIT INFO
RCHITECrfENGINEER
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LICENSED CONTRACTOR'S DECLARATION
Ihcmbyaffirm inn l un BcemN uMv povisiwu of Claimer 9(cammeming
Job Description
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wiNScetion0f)(KH. Division3 fNe Business and Professions Code, license is
in Nil force eRace 7 �'D '6
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ARCHITECTS DECLARATION
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1 undenund my plans shall be, mud as public rocceda
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dsm Ism exempt to . Me ComTmary
1 hereby aRnm hers I un exempt from Ne Conuacmrs License law fan Ne
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following reason (Se Wan 0031.5. Business and profwiau Cod=: My city w county
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W eller, improve, demolish, or repair any struclwo
which recisions a permit construct,
Sq. Ft. Floor Area
V• ytion
'norm it. issuana.alsorryare.Mesp hosetfor•uchpeaman le."S d•umment
IMI he is licensed pound to the provisions of Ne Conmctors License law (Chap er 9
(commencing with Section 7") of Division 3 ofebe Business and Professions Cosm in
Wt he is exempt donations Ne basis for Ne alleged exemption. Any vrolmon of
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Section 7031.5 by any applicant for a permit subject, she applicant me civil partially of
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porew mNan five l undrM dollars (S500).
Required lnspeclions
will do the wank• and vee swcmrc is not intended or offered facade (Sec. 7W, B udmas
Co: The Contractor's License law does norapply to an owner a
and Prof nsiom de
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Property who builds as inlpnovas Thereon, and who Miss such wart N.H. through
his employees, provided Nat such improvements an not intended m offered for
We. If.however,wthe Wildinguren of,rmen is toldwithin one ywr improve far vee
r -W idm will have she burden ofproving that d did nw Wild oimprove fan pun
you of sale.).
I, u owner of the property. am exclusively cooaacting wish licensed conmcwn to
construct the project (Sec. 7066. Business and Professions Cade:) The Contractors U.
apse law does Iytoa or pmpmy, wed Welds or imptovea Motion, and
applyje ts ofprolot(s)heented othe
Cerman. M•u
with pursuantto
wives
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no contracts. ranch
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e �pder5ec. .BAPCfwvelareason
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WORKER'S COMPENSATION DECLARATION
1 hereby alarm under Penalty of perjury Own of Ne following (Imbio tions
j 1 have and will maintain a Certificate of comenuo sel0tnsum for Workers Camper -
anon, as provided Ian by Section 7'/00 of she Labor Cade, for Ne perfortn.wc of Mm
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ork for which Nis permit is issued.
1 have and will mamosin Worker's Compensation Insurance. as mquired by Salton
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yWorker's Compensation Insurance carrier and Policy numbsars:a:arrier:
Policy No.:
CERTIFICATE OF EKEMPfION FROM WORKERS'
COMPENSATION INSURANCE
(This satin reed not be,cwnpined uNe pemm is fwow hundred dollars (SIM)
or leu.)
I,mry shnin the Nl. Wis iss'
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Coneshill
my comm,an as bamoewhich
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raw employ any perwn in any manner w as o become subjut ro she wanks=' Compete
s lion Laos of California. DauApplicants
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NOTICE TO APPLICANT: If. aft. making this Cenifcam of E.aamlrtion, yw should
hecome subject In Ne Workers Compensation provisions of Ne Lmor Code, you must
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fwmunin comply wish such provisions or this permit .ball ba deemed revoked.
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CONSTRUCTION LENDING AGENCY
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I bonny aRusn that then is a common.. lcnding•genry, fan vee purormana of
Ne work fm which this permit is issand (Sm. 3097, Civ. C.)
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Lenders Name
lander. Address
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emir, that 1 have read vets applicadim and stun Mut the above inframauon is
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whom. l ague no comply wish ill city eM coumy i dimme. and sum laws elating m
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building contractor, and hereby auNonn nprannsivm of this city to enmrupon
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above-mentioned napery for inspection purposes.
(W.).gtce m save, indemnify .rad keep Mnnleas the City of Cupenina agairul
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Mbilids,jud u.ndeapems which may in any way.moe.gaml said City
in consdqu t e of N --amil of this permit.
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N'PL1 U, ANDS RANDS AND WILLCUMPLY WITH ALLNUNPOINT
'IONS.
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HAZARDOUS MATERIALS DISCLOSURE
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Re -roofs
Win Ne applicant or future Wilding acapnr son of haMlehvudom manna
as defined by the Coltman. Munlawl Code. Chapter 9.12. and Ne Health and Safety
section 2553240^
Type of Roof
Cade,
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Will Ne applicant or future Wilding occupant ae equipment w devices which
All roofs shall be inspected prior to any roofing material being
install If is without first obtaining an inspection
Contaminants as dinned by Ne Bay Am. An Quality Managamem
, a roof Installed
strict?
I a e t emove all new materials for inspection. Applicant
TKO
un rs sand will comply with all non point source r///egul��sations.
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Mc h.zu/y m.�;•I,�,minmenl, mer Chapter 6.95 of Ne oat.
my Cod=, eavwu t, Met i 253JJ sed 25536.1 uMuxurM Nn if Ind
myhaveamna responsibility to notify she waupant
rican.ism
hichmulbemetnwtoisaue.'ofaeenifina
u e of Applicant Date
ed.genl Dam
All roof coverings to be Class "B" or better
OFFICE