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00070042 (2) CITY (IFfO[6# I(TINO• - .. BUDDING DIVISION CONTR TION: PERMIT - '/� ' �. 0.. — , PF:RV11'I' BUILDING Ak)DRES': I 66. OWNER'S - E' q" - .\ a •. APPLICATION SUB DATE , :/•NONE: _ — SANITARY N0_ CONTROL NO, r72-S7— 16 n2 , FURNACE Oat, ARCItI'I'ECTIBNGINF:f;R: .,'',! BUILDING PERMIT INFO , O❑O `1 •- .. - BLDG 'EEECT'' PLUMB MECH ZO 8O LICENSED CON'fRAC I ORS DECLARATION•' ` 4G I hereby urrrn that l an Y ed under provisions I Chapter 9(eo no g 'IOII DBSC1-Ipt10D. " rrtoHw with Section 7000)�YfafD.-.. o3nrmaB otdP6f7rW bdC2J3,an2d ry:'l' leL .w lull c I, Firer, ce-= 2� I » cDat �• i - .. C ntmw r ARC CUT'S DECLARATION r O 1 and rvUU�`((—,JIaaI� pl��pprs un d P M1rc records ' r � y . �� ea 4 C Licensed OWNER-BUILDER DECLARATION 369].30S�. IJKr II hY affirm that pal' the Contractor's'I' La,' tor fl,6 , �ZQ folovi.,reason.(S I 70315B : JP f:: Gd'AY rily,crounly Y Z D which requires a pernot to .t' t I, demolish,carrier, y sompure 1.• .. a3an pnorto it, 'alkii re1 ''.anapplicantl h c '1a fl- s. i.lmmenl. . IhaI h d pursuant the p fll C a f L 1 (Cn pt 9 w Sq. F ooCA ' n .Valuation (cnmcenc„gw m Section 9000) fD' 3 fm B dProfession, f s .ce). j. or that he is exempt th rnn and me ha. f (halleged ,npf rAnr s'nII' ..30s —,' ROUGH _'MECiANd CAC. " ,.1 Sovann'AHI5bymyipli air fur,parrot. b)nsmenppl It civilp Iq lir not more than five nandrea enlmrs($SfNp r .AMMunibeiROUGH EL'E T-RICAL Occupancy Type - - ly-eofineprf ro v ply m �. In ' , l p am,, 505 — FINAL :EEE TRICAL" a' If tire aI I I d I' an civil 7B4. tIL 57 FIN{ egEdhse eI r 1 L we p nld. p It. richwork nIr ' — " ' orih through yh h: .cemployee,.P I llntat,ap rot intended .508 FINAL MECHANICAL 'd' r- - offered fIf.he III,b 'Idg Z,improvementis'cli Within",year of _ applel file minnuhaldr,vvillk Ira Introdeforphwin,thath dianchbld or improvi for Parrive,of El II, fth property, exclusively contracting with licensed c l ve :I - - o , t ah p I I(Scc )Ilia B .'nc,.,ad 1 r fc a :C 1)The C a I r . Lincoln Law doe:rol apply I vneror proper)who builds p :thereon, c t and who contracts for such projects w ah u comrecmr(s)licensed pokumot to the - k - Co tractors Licarea,Law 1l,er coar't order B&rcr ,hi,ociomis I Date' WORKER S COMPENSATION DECLARAI[ON. thereby oftirm once,panall,ofp.i Y runt the punitive gd larafon - .t•- ° I have and will maintain ,Certificate r Consent to Self Insure for Worker's Compensation, a. provided f by Section 3700 of,the turner Crelefor the - perf nonce f the ao kf r wniah this p ,I Is'sa W. - � + .. °Iha rnJ will once hit mWI C o,apeidtioo hencrow,a inquired by Seefirc, - -C V . 3700 of the Labor Cnde.for the patlorm irce of the work for which di,s far,ni t i4 isiLeJ My Workers Compensaltionlsslanee carer/f,�ad 11.�llncy r�n9ben��/e )/ .Carie, ePlk�l Polcy Nn. LWI%SL� !_G-/LD'1 CERTIFICAI IO OP EXEMPTION FROM WORKERS' y. - COMPENSATION INSURANCE; `' - (Tirs section m,oil na he completd if lie lwrmit is for I ondral dolly, (11100)1,,less.) 1 con ry,lhat in Ino perlor lienee of the whrk for which Ih p ,a is i,,uctl, k1u11 n [ „plry any person Y marme,so us to become table 1 to the Wo kers - o Chro'catimmin Lows of C I'ronir Data A,mhlrul NOTICE TO APPLICANT Ili afterk g this Cerrificate efEwindion,yo.should z❑ bee I I I Workers C p t p [ie Core,y a forth �ilh comply with -'with : rIh M 11 b c I,tr1 roil asoked. ',. ~ CONS I RUC I'ION TENDING AGENCY, E~ I R"by had there I,a coushorheintlerafi,nbencYI is,the perform c,, f "s, work for which W of lh ,1 Cr,r ❑ Leader,Nz Lender's Addictsame -1 .. 1 Yve 11 111 dal' tya f and.laa athat res, above f ( s W r.) un'- a.1 g t ply with 11 cityand c t} Jnan olid stnm Lwv rel ti g• - Q V ,the rowinto, ...ared and I by a th p Y .of ah s city mpmcr upon �y rW the ah We) I' cop v,ime p a purposes. [y - (We)ag eel av, ndenm lY, Jk keep formless the City [Cupetp against, Vi liab a :' lgn a. sl and c p n . i h may In un,way against 'J U.G Cay n n. qucn<e of In % mi 8otm per .- /p/ c` , - - APPLICANTUNDERSTAN N s OMPLYWITHALLNON-POINT Issued by: `•. G.�•K.. Date SOURCE REGUI 1 _ '/cam p _ y 'isnamre.1 A,pheml/Comowl., / Date Re-roof§ HAZARDOUS MATERIALS DISCLOSURE .. - I% f _ 'Will the PPr a or future building Wenpa n store or hardle haurands I _.. 'Type of Roof.`. _ Is defnul by the Cuperllno Mon...pal Cala naptn 9.12,slid the Hwllh and Surety' s , _ Code S fla, 25532(x)7 - _ - °Y: , CCC333 All roofs shall be mspecied prior to any roofing material being-Installed. ' - Will the ppli lit r famre b 'Id'ng hecheild use equ p tg J which emit hazardous air contamlmunaa l,a define the Bay ryes n,r Quality Management It a roof is installed without first obtaining an inspection, I agree to remove `District, all new materials for inspection. Applicant understands and will com I' ,with ' °Yea - . z,I�, ^'� P PP, - - P Y, all non-point source regulations. 1 hasc and the Incautious an,ae'.111 topprohneol, d 'Clbrqpwr 6.95' f the Caliform.' H Health&S f ay C 1 S u n.25505 2553] d25534 I ,' d ah t - if the million,dT currentlyh ti tenant,that l :onymp T ItYa Tryoc a It clip fin q ' M1hmost n aI f a Certificate f Occupancy' / �.' /-0'„ Signature`of.Applican[ 'Date ' ..All roof coverings to be Class 'B" or-better w authorized agent dI, Date' ' �` � o