00070153 (2) C7DIN1
PERTINO - - -
DIVISION '•', `MI MITC CONTRACTOR INFORMATION".
BUS. ,F"c PERMITNO...
• - :L
'O V03 CANYON 'VISTA .DR ROYAL•,ROOFING ;.' APELIcnTioO,t tr 153 '
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.ANT 'KAY D. ;.x• .1345 .VANDER WAY. ,, SANITARY NIb7/L4y !8WP.
Opp ARCHITCCUENGINIfR. r' a (406,.)'279-2^3.^3+2 BUILDING PERMIT INFO
1^ ry BLIIC ELECT, 'PLUMB MECH,
W
a
Z b'0 2 LICENSED CONTRACTORS DEGLAItAI ION Job Description
IA r, ff that I'' d d p 1CI pt J( g
inS f 7000)1fO 3 f1heB dP f'' sCC�vil.aru�license L' it • y -
0�.� nfll force tf t6/s�!•V •t .,
xx� Lic t,c Clas f k '
W 3 LL y Do,, "Cnntlleml •• , Y - - 1.
ARCHITECT'S DECLARATION HOT MOP TO SAME
C O.� I understand my plans h dI be need us public"Imid - - - - 1'y ]
Licensed Poppli'mal
OWNER BUILDER DECLARATION
m=y I hereby IT n that 1 a pt f theContractor L Law for o the '„v
C 7,�Q toll B� (SU ]Oi15 B .' dP f..' :Cd .AY O coolly • 3. -
`F.�xp winch 91m._ap fou :t t It p e Ihtrep.irniystnette - if -
�'3_ pn t t :'u nee J aspiresthe pnc tin hp into fl signed t mnent
mato licensed ere tin he p : I be c of t .Len. L (Chapmr9 Sq"FfsFloor`Area Valuation
a,m none afg wiln sun tnlom)ert Dvl. n3 ul me ausne.. fe Prartss one coca) ., .*{ - .
ur tlml he is oxempt thuml'rom hid the M1abs for flat alleged exemption.Any...Imi'm - N -
ofSectinnVB3L5iv ueadodicnm for$Permit subjmts the applirain mvcivil penolty• `� "
or nefl mom dfan fine bpwmd done',(�sSnI I ':' "APN°Number% Occtgll rg�oe -
❑I of the P'P tY Y PI Y withwages theirI P 'ton `s. •�'
will d= k and 1h t t tintended ff 1 f I S ]lD4 'G 6L1 p
Bu facts and ProfessionsCode The Contractor's L n. Lu d 1 apply f f , 35626007. 00-tlulred Inspections ' -
w fp mit Whoh 'Id' pr 'm and h d lwork Hansel f
nr through r,own employees,provided J' h p em r re tintended or ,� ��� •; :'
or
utteredcompletion,toowner-boulder rue
wilila�halibut,
fof pmving thatn didno,nile f " "' 31x,5 — FRAME �•
imp f purpose of sale),
- a,
307 — INSULATION
❑pc, wnm fmtpeceny eeha y t fgwt ll . 1craftsmen,t '501• '— ROOF .TEAR' OFF
constrict the p,.j.t(See ]044'Bt-sine-' and P f.-„inns C de'J The Contracmrs. - r S
License1 d t apply to Wier or property as no build' improses thereof
and n contracts for h projects nw th a eonmmctoul licensed p sant to me 602 •— ROOF PLYWOOD NAIL
L
Contractors Ueert,e L.w. - .a. ij3;= ROOF 'BATTENS
❑I am wand under Sac .B&PC lot roti. n
Owner .., Dule 604ROOF `•IN=F'ROG.RESS
WORKER'S COMPENSATION Ut CI ARAi ION - - ''
Ila by ff Ip lry fpJY Ill ill gin �brl :,
f
I la d 'IL t ' C ff t I Consent i II f Winkel
Co p i . p red fin byS 1 3900 fila I1 Cd f tin _
pef ”' f11 kf which this p t I. -
❑Ila d II t ed kr, C p f I : e q dby5 f
3700 f 1h Lane Code,for 1h pef es f me work for which I', p it 1s
issued.My W rkera C mp rat n Insure a e , d P mh/11 ury p e' r
Caner Poly Na.�� �f��p tu
CERTIFICATION OF EXEMPTION FROM WORKERS'
CO ENSAI'ION INSURANCE 1
(This section feed not ne completednn•permit's for one hundred Boll - - -
($100)orless) -
1 ecrtif,that in the performance(if the work for which this permit is is,m eL I' - v ' -
shnll net employ any p Y a,m becomemnectm the Worker., '�a
Compefsatmn Laws of California.Data � � a '
Applicant - - 1- C
tit
NOTICETOAPPIACANTIfaftcrmuk' gth:'Cn'f t flxenptan lou,hould
become subject to theWorker's C p 1 p sons of 08 Labor Code you rroo
.Q forthwith comply win such p'ov s ons or permit shall be deemed revoked -t y
H ; CONSTRUCTION LENDING AGENCY
ai I la IsY R that mere t lending agency f t performance _ -
W ofm kf hhth permit'. issued(See.309] C' CI I -
A Lender.Name a.
"Led Add v • ,�� '1'
fly flue lh dol . ppI t dstore Ilsllb h information
gT+ [�.1 cor I.1 6 1 pIY with II p d re do e, t l .ill n
(6w6.1 mb Il. b 't t Ila ] a representatives Ithis lye t pit
.the h mentioned p p ny f p t p p .. r '
1 Fa' led)aB t d fY Jk PI I ,.theCryfCpi gist I
llublde Judgm m t doexpenses h h y any y against. id
l',f V City wapa uetf the grnmifg of the permt.
:APP SITUNDF TAN SAND//////WWWWWWyyyyyyLLC((((((JJ��IIGGI1��LY WIT ALL NON )INT Issued b * Dale
t; SO;Be REDUE '1.5.� f 7 �"� e'
Signature_ of Apphcn 10mu afcmr - side ' Re-root's •^ ,
HAZARDOUS MAI ERIALS'DISCLOSURE r
r- w'nme pplpa t r t n ld gnccupnnlsmrenrh dl h_ I nut-id „ Type of R
r' asednee M1y the Clp foo Munlc pal COJG CM1apler 9.12 .nd the Healm atJ Safety _ ,
Cad Section 25512(0)1 - ) •- ^
❑vee ❑Nt All roofs shall-be ins ected prior to im 'roofin material being installed. `
I P D Y g , g`
Will 1n applicant t future building occupant use egf.l t- a winch If a roof is installed without first-obtaining an inspectiol agree_tosr .,remove
.'I m10- . I 'cent nt.it,defned by ma Ba>Am.f Air Qnm credit,Mafegt nom -
.a e' - r`0 . all n,ew;materials for inspection: Applicant understands,and,will comply';with:
❑Y" ❑Nn ' . all_'non=' int source re` la ions. . _
1 h ad'the hevand w.' at I' 1 h'under Chtple 695 of the
Caldi n H hh&Safety C la Sections 25505 25533 d 25594.1 and r land mat
5 if the building d t coir,my helve aten n moll'. yresponsibility' t n tfy the
r occupant oC 1he atqu'I01
emems wKch must be ct prior m issuance of]CerfCe'a1e of
°"Fpan`r' - Signu[u_r_e of A p!ican[ "aliv
Owner re auWorrul agent Dam `'All roof coverings to be Clas's B or better '
OFFICE