01010061 crBU BUILDING CU IVISIO N0 CONTRACTOR INFORMATION:
nmt.utrvc Drvtsloly PERMIT
BUILDING ADDRINS: PERMIT NO.
'f218:3F, WOOD1EAARY Dft 01.O .0061.
OWNER'S NAME. APPLICATION SUI3 DAPI.
CI-0D l F-AI•1111._ C.; AIdI) 'n IF.:IRESA
PHONE: SANITARY Na. CONTROL NO.
ING PERMIT INP((
rct nRC111TF.CT/ENGINEER: Iil11LD
t9i O O PLLCI' PLUMB MECH
W
U
LICENL L
S N 6 H"n1SIiD CONTR,.Cnde, S UECLAIiATION Job DCSCrI ion
I hcrcny uftinn mm I an,offlue li under Provisions nt Chapter'.(conn license
y F tOJi with full for a and C'd Uivixinn i of me Ou,inc.,and 1'nder.ions Gtic,nnJ n,y license
is in mu force am fill«t. Fd79_AC;E WI:I+iT)(:IWS� (3)
z e m a Liaise Class Lie.p
O�U )a,_ Corderenn'
'v,33 aARCIInECr S DECLARATION
I understand my plans shall be used as public record,Wtu 6 O Liccmcd Pmfcneinnul
OWNER-RUILDER DECLARATION
m 1 hcrcby udinn ihw Inn,ex,n r Inns he Cmntnctnrn license Law Wthe
F z f following reawn(Section 7031.5.Business and IIn4ev inn,Calc:Any city or roomy
` O which rex,mo.a pennit to construct,alter improve,demolish,or repair any stmemre '
a, Pdnno its i"morce.also requires the applicant fm such pcntdt to file a signed statement
a. that he i.licensed Pursuant mthe provisions nthe Contractors License Law(charver9 Sq. Ft. Floor Area Valuation
(commencing with Section 70001 of Division 3 of the Business and Professions GNe) tL.12M,
or that he is exempt therefrom and the basis fit the alleged exemption.Any oulmim,
of Section](UIS by any applicant for It permit othJecu the applicant on a civil penalty
Ill on,more It....five hundred dollar,($501). APN Number Occupancy Type
DI.:,,owner ornue proper:y.n.ny entpinyce,will wase.us then..ole.......va'tion,
will do the 'k d he met n,I inord,d uttered In, (See 7PW3
Business oil Profession,CtIThe C ron, License
'I,w J t an
R
equired Inspections
ow0e f property Who ,,i ires, here t d vilit,a s such ork ani,elf 1.01. FOIJhDAfIOI
nr though h- o e mil yeprovided th t. h ini n I e not intended or
oaered fee sale.It naw
'he hudildingor unponscricut is wild within one year or 1.02 - P1 F163
completion.the ownerholder will have the harden of proving that he did not build or
inecu a for parlw.n nl smu.l. ].f.2 - LIFER J
01,a, owner df the popery,an,c.do,lnely cn�na,rms with licensed eonrmmt`In .,! - Fd_13AR - 9/
nstoct the maim(Sees 7044,basin- of Pmlesonns Corea'nte Coonmmr', ].I:)+
License Law does not apply to an owner of property wan hoild,or in I. nuroor. 1.W.; — AhII:a-IOIr< B0. F3)
and who contracw rte such projecµwill,a c(lracnrfsl licensed pnnuam to the /
Contractors Lieenu Law. 106 .._ SI-:::W_R & III ER
Cl I am exempt under Sec. .B&P C for this=son
E)02 — uNDEFzFL.aaR r'LurIBINc
Owner Date
WORKER'S COn1P1iNSAT1ON DECLARATION 203 Uh1DF..T{Fl._GGR 1•IF C;F'IAN:CON-
I hereby afhnn under penalty otperjt,,y an of dm following Iceland!.....: 11.04 '- UIDERFL_OOR FRAI'IE
D I have Itn1 will nannnin a anireate of Cma.eln 11,wp-insure m Worker:, 205 -- (31,11)111:41 00R :I:DISl.l1...ATIC.)'I
Compensation, as PoMded sur by Section 97011 0l' the Labor Cattle, for the
performance,nfine work An,which mi.pernil i,_...ed. 3(81 - ROUCH r'L.LA'D11,113i
D 1 have and will maintain Worker'.Compeoutinn Insurance.as required by Senium 3L8i2 -- TIJD & OR 9-10WER
TIID of the Ivnur Code,res,the perforonneu of the wad for which his III i,
i..am.My Wnaer,Compen.adon mmnne carder soil Policy nmnm,me: 3183 " ROUGH tIECHANICN_
Carrier: Policy No 304 R JIGH 1:1 E'CTRCCAI...
CIiR'I'1P1CANPR
'I'ION OF I?XEMIH IOOM W ORKIIRY
COMPENSATION INSURANCE Liles "" F1:l l•IF...
This sectio,need n I be completed it the Iv reit is for one hundred dollar. 3124 — FIC11.DOW1,113
($uaBmle,^.1 307 - 111iL11.ATI011
I certify that in he perfnm,ance ohne wank for which his pendit i,I...ed,1 308 — SI•EXTROClC
shall not employ any person in any manner.o a.,to hecome subject to the Workers'
Compensation Laws of California.Dae 309 - F_XTE.FIOR LATH
Applicant
NUI ICF.TO APPLICANT:If atc,making this Ceailic:ne of Exemption•you.mmIJ 310 II+fTF.:140.01:< I._A)I—1
h,ssreobjcn m the W..kcr'.Cninpm,atioupro n.of the Lubar Cole.yo: tela
vldu
p O Lolovith comply with such provi.inn.ter this pctnit.halt be
aeenad revokes, t 3].1 ... Srfx'iY-1'f[:�"I COFI'T
Fr_ CONSTRUCTION LI NDINC AGENCY ,313 RUN:'OF HnIL
' 1 hereby arann that them is a comwetimt lending agency for the perfarru antt
I the work for whom nd.peons k,issued Ince.3(N7.Cm.C.7 501 '' FIIvIAI._ F_.I_ECT'fiICN- FIAT ly
yp Lender's Name
z I<nJcr'sAJJrn. 502 - FINN... f-4_u11r<Ildn EIEW)y
U O 1 amly that Iha,c rens hk.npplicaam,and made mt me abo,c inlLmmmm is 5[4).3 F'TNAL.. I•IECHANT.CN_ E1WM''C')Y
W I agree u,cwuply will,all coy and"nohoy...dmerand d.tate lows elating
O U obuild ,a, a maolt.xml hercby I pori, pte..mati,c.of his city ,,,let alnm 504 - F111-11- Cft.11a_.I71:Id(ii fi7alfil�'GY
rk7 ins:all e.mendaned propctty Ill'in,Noi purine.. _ e'
y (We)gree tolace.itmcnliryand kect,[tamdessthe CilyorC.N.Huragmn.t .10`.'4 " FINN._ FJ-IlIM ICA
.F. m liabilities.judgment'.cn.n.and c,pcn,es which ,Icy in any why acerae against said r _ GR53 TEST
U Z City..comvynene ohne gt-.hang or mi.pc sir .10E
APPL.CAN! "11RSTANDS AND WILT OMPLY WrrH ALL NON-POINT IsSUCd ) Date
UR. LATIn'S.
sisnat - anttuon m Rc-roof`i0(3 -- FINN._ Pi_CI-IAh1.T.0 . f—
IEL,
US MN'I[RL11 ti UISCLO$URL
wPl d,cal,laiedtm or snore nunhn:,g:,a,q,:n,t.mmmnannla na,mam�.mmednl Type of Wdf—• f`:I:hIAL. f}TRADE '.
a,derncJ ny mo C.npenntn Maniein•a cnae,chapter v.¢.and me Hcnldh:ow Surety ci].L%) .._ 1'-'1:hlfiL.. f9..Ilhlhla:ly :')
Code.13 i,m zs532(al'r D No w
All W19F9c_xifing material being installed.
Will the apphcanorfuture building occulter.^tuse equihmemmdevices which If a roof is installed without first obtaining an inspection, 1 agree to remove
chit ha,urdous air contmninams a,defined by the[lay Area Air Quality Management
�1 District, all new materials for inspection. Applicant understands and will comply with
DYes DNo all non-point source regulations.
I face rend the hvunlous...uarial.I..p:..rr cal,and,,C,hapw,6.95 of the '
Culitmnia Hculth&S;fI y Code,See, 2550.5.15533:md 25531 1 und...unW mut
if the building d¢.Illi currently have a tenant,that II I.my re,pan,ibllity to loll the
ce Lm of tnc mmm�t,wiot m is.uvncc m u Ccnilirntc nt
'cup=^ Signature of Applicant Date
nuo
In
/ —/ 7 0
Dwncr or mrircJ agvmt nate All roof coverings to be Class`B"or better
OFFICE ,