00100189 cJ BUo NCD I DIVISION
tPERMIT CONTRACTOR INFORMATION:
❑WILDING ADDRESS: PERMIT NO.
OW NEI<'S N D :: .. AVIIIACATION SUR DATE
ONE: 1725 R9D99R9 AYE SANITARY i 0 II C N'IROI NO.
I]CY. ARCHITEC'UENGINEER: — BUILDING PERMIT INFO
µ^t00❑ MAG ELECTPLUMB MF.CH
FEW IJ IJ 1=1 I_I
�y> LICILNSEDCONTRAC'IOR'S DECI.ARA'IION Job Description
I hcmby aoirh firm I am liccowd ander provi,inm or Chapter 9(commencing
�fnL
w with Senior]IXXp of Uivisiomlof the lfusinessanJ l'mIcssions Ctde,and lay license
i,in full form and eff !! II
zptu6 Licetiw Class Lie
y'y�V
X't. ' Dare_,agnf/�°m. Conlraca,r FURNACEFINALED
Q<g �nIA,11R�CHITEQ"S DECLARATION 1 undet,mnd e, —/r be u,ed m public record,� LirrnrdPl
lie s,;omll JUN 0 5 2001
a6pmo
%
OWNER texemBUILDER hour
Ce Centra
RNIJON
1 hereby(Soca Rlal alll exempt fate the Central Ca :A.,e Uric for the
!•Z following,imam.IScct t ]onstr H,alters and 1'n,fn,io li h,or Any rity or county
€c which regains a reran u,rnn,nrva,cher.inipmvc,demolish,or repair maystructure BUILDING
da
Twice to its issuance,all mquims the applicant for such remail m file a signed matemem m that he is licenwtl pursuant to the provisions of the Corrosives Ideeme lud,(Clapter 9 Sy. Ft. Floor Area Valuation
I commencing wish Section 7000)of Division 1 ol'the Business and Prnfesnion,Code)
or that he is exenqu Ihcrd'rena and the hasfs for the alleged com pliun.Any violation
of Steel n 7031,5 by I aprliannt fora permit nuhjeeh the said"Leal to a civil pnhalty
of all latae man live hamhed dolfmrs($51Xf. APN Number Occupancy ype
❑I,as owner of the pro,mil or m)iati cs with wages as their oic compcnahon,
will do the work,and the stmnurc i,not intended or offered for sale see.]IRP. .j ._dl_ .GC.
Ravines and Pmlessions Code:The Contractor,Liccee ww does title:apply to an yUlred Inspections
owner of pmc
pny Who Maild,or improves Thereon,and who docs such work himself
othmugh his own employers,presided that such improvements am not intended of
offered for side.IL however.the building or improvement i,sold within tlnc)car of 204 — UNDERFLOOR FRAME
nnpletion,the ownenhuilder will huve the burden If proving that he did rot build of
nmr..ef'rpmgLwut,dc.). 301 — ROUGH PLUMBING
❑1,mowncrofair poll I,.c-linowlyeunhada,vvimlianedvonoartm,m 303 — ROUGH MECHANICAL
n
esker,the project Isce.nu4,Ba,ine„and Prelr,.ann,Gde:)'1'he Contractor, 304 ROUGH ELECTRICAL
Lienee Law dues non apply eun owner of pmpehy who build,or inaPrtive,them m,
and who learn,for such prtl„cas with it conmcarfs)licensed pursuant to sur 505 — FINAL ELECTRICAL
Cartels license law.
❑l am excmpe under sec. .B&P Cl or this reason 507 — FINAL PLUMBING
°w"" Dat` —
WfIRKlilt'S COMI'full 'ION DECLARATION 508 FINAL MECHANICAL
IILIarcndanun,Npallyrepel,aryllnrmthefollowingdremrffiou, 514 = FINAL PUBLIC WORKS
I have and will maintain a Certificate of Corwin to elf-insure for Worker's
ompenmtion, as pmvided for by Section JIOR of the Labor Cods, for the
performance of she work for which this promil i,issued.
❑1 huve and will maintain Worker's Comae omens Insurance,as required by Section
1]00 of Ile I-ehor C'odc.Ibr the Perarmumr of the work for which this lemhil is
maned.My Wak_ees1 CMb_nu-lpcnalion Imanunre currier and Policy nnmhcr arc:
Cnrricc�fRCBRTII 11,'ION OP Es FiMIe LION FROM WORKERS'4231
COMPENSATION INSURANCE
IThis welior rant hat Be completed if ehe permit is for one hualred dollars
ISl1ut or It,,.)
I cenily that in the perifter ance of the work fin which this ronin i,issued,1
shall sat employ uny Penna a Lilly Luanne, ,,h,W become subject to the world,
Cuntpnumien Lauv-1 Calnin.u..Ilam
Applicant
NOFICE TO APPIICAILL If,after ml 11hi,Ccnifi.olsur Esctmptiun,you should
thermal subject to the Worker,,Compenmlion provisions of she labor C e
dc,you mn
Z Q tonhwidi comply wish such pmvi,inns or Ibis permit shall the m
e deeed reeked.
z tiCONSTRUCTION I.ENOING AGENCY
' heathy uffimh the Ihrre is a cnmwclinL Icnding agency for the perlism,anm
W of the work liter which this permit is issued(Sec..7dN7.Civ.C.)
Q landcr's Nunn
7 Z l,evh,r',Address
e above
fi O amclllI."re I"comply.tl.1)city and countyo ordinancesandstate laws mlatin`
gore comply ran yen g
U m Witdia
,nmamed pro,sedlmreinspecmahuonpur,cwmmeivesof this city minerupon
❑7 ehe above mentioned agree to sal ny for inspection and keep
p harmless
of
Fast
d IWgagmcm,ave,indemnify andAaphaa.,in the wayacum.,,i I,t aid
V1 liabilities judgmcmn,cow,aeJ reading
of t s which nwy in any way uccme aguin.w mid
U Z Cityin CANT NDtil the geeing Lirthis,1_CO. - 1D—���q�.,
AYI'LICANTUNUIiRS'I'ANIISANPWILLCOMI'LYWITH ALLNON-POINT Issued by: Date ` (SCJ
SOURCEREGULATIOt /// 1`/,/00 y'
Signature of Applicant/Cont—nater / Dme Re roofs
IIA%ARDOUS MAI HR1AIS DISCLOSURE
Will Be applicant or future building oecupird wore or Imndlc hvmhms material Type of Roof
u,deoned by the Cupenlno Municipal Code.Chapter 9.12.and the wealth and Safety
Code.Senior 2551200!
0 ye, D&Ne All roofs shall be inspected prior to any roofing material being installed.
will dt.......i,:altmmwm huddne,tl,cu n.e egnipmcdo, levels which 11'a roof is installed without first obtaining an inspection, 1 agree to remove
N IIII did air rtlntatninan,us defined by the Buy Aruh Air Onallty Managcmcm
ela'wrirn all new materials for inspection. Applicant understands and will comply with
°Yvn V21' all non-point source regulations.
I have read the bear—door.material,requirements under Chapter 6.95 of the
California Health&Safety Cale,Sections 25505,25511 and 15514.I undershirt]than
if the building docs not currently have a tenant,that it is my responsibility hh notify the
ripare of the nuluircn¢e, hath must he tilt prior to issuance of a Cr f icmc of
Occupancy' Signature of Applicant Date
/Ofl7
Owner or dilatated.,can Datr All roof coverings to be Class "B" or better
•OFFICE