02050057 (2) CITY
ofcDPEONt SSIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10690 N DE ANZA BLVD TERRA NOVA INDUSTRIES 02050057
°nyCAnO PIZZA & BREWERY 1607 TICE VALLEY BLV AggC f(bD�YW_2
PHONE: (925) 934-6133 SANITARY NO. CON ROL NO.
Q00 ARCHITLC'1'/GNGINFER: BUILDING PERMIT INFO
— BLDG ELECT PLUMB MECH
yz
LICENSED CONTRACTOR'S DECLARATION
"5 v 0 1 hereby afhnn that 1 am rased ander f Copier 9(,mora ein DEMO Job Description
i z o s pram:ion:o pt g
mFm with ction]0)o1 of Div�'iion3 of the Business and ProfessionsCode. dmylicense
t ticCa.f u11 forte ane effcfl\
;O i C ansa Clazs /� Lica a
r S u. sate< customer
a ARCHITECTS DECLARA N 10 601
v, 1 understand my plans shall he used as public records
nc C Licensed Professional
" OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for the /��
i a following no son.(Section 70315.Business and Professions Cade Any city or county ��—.../// $50000
P F o which requires a pcmrit to constrain.alae,imprnJe,demolish,or rtpav any structure
prior to its issuance, requires the applicant for such Permit file a signed statement
rhat�.r that he is exam ttW� td m<proslsi.ns.rme c.nr,«tws u«nse law(cnapter9 35�.(Y^2.3DL*rAOa..e, �„ Valuation
mis IittnsW
( enang with Scnioni]I1f10)of Division3ofth Business antl Professions Code) I\:s1 f s . i t( ;;
p' nufruni'and the basis for the alleged exemption.Any violation
of Section 7031.5 by a1.11hri m for a permit subjects the applie=s,m e civil penalty
of not more than five hundred dollars(S500, NO &MNONRD INSPECT ONS ': . • Occupancy Type
D 1,as owner of the property,or my employees with wages as their sol=compensation,
'will do the work,and the structure is ma intended-or'of,,d f.rsale'(See:7043,' -
Business and Professions Code:The Contractor's License law does not apply to an Required Inspections '
owner of property Who Wilds or improves thereon,and who docs s«h work himself
or through his own employees,provided that ro improvements tintended or
..ffcrcd fnr sale If.bo 'the building- '.one ywr of --. - _...... -..... __. _..._._.. _._. ...... _ .___.. . .. . .._ _ . .
improvement fold a di
completion,for the owner-builder will have the Wrden of proving that he did not Wild or
impose for purpose of sale.).
DL towner ofthe propc.7 am Bannersacomrxting withode,)Thcommnorsrs - "----
conswa the project(Sec]043.Business and Professions Code,The Contractor
License law does not apply man owner of property who builds or improves thereon. •'
.and who mnvanse L such projau wide a.commcsor(s)liaitud.pursavm m theComm .
01 sin
License law.
❑lent exempt under Sec - ,B&PCfor this reason
Owner,' Data '
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty_.(perjury orr the following declarations:
❑ 1 hiv am will rmaintnin a Certificate of Consent m•self-insure for Worker's
Compensation, as'pmvided for by Section 3700 of the Labor Cod1 for the
perforiance of tie work for which this permit is i...ad. .
D 1 have and will andamin Worker's Comionostioo Insurance,-art inquired by Section
— _ 37f he Labor Code,fnr abe perfofoance of the work for which this .it is
uedl My Workers Coanpensaaion lnsuraric,a carrier enJ Polcy n
iumber arc:
.. - i' sJ Pol'cYN
EXFRO :.. .
CariSe CERTIFICATION OF EMPTION M WPRKERS'� , 14
t. .' a
COMPENSATION INSURANCE-
'v Cr ssccuun need not h eompleted'f he port is for ane hundred dollars - - —�-- -
1S100)at less.) -
.
I c n fy arta in the perfoarource af the ark for h h this permit is issued I d'. ,
shall
n of. pl Y say M any ..n t bccoine b]ect t the,W rkers •. .'
pe "s If t
Applicant
NOTICE TO APPL CAhT ❑ mkng sCertificate ofExemption,you mould "-'
Z hem object the W A .C pe set v s ons of theL W Cod you must "
O fonhw th comply with such provisions ons or rh' permit shall be deemed voked.
r, - .._. .. _ . ... _ _. ... _ ..._ .... _
- _.......... _. ..... ..._ . . . 1 __._ _.. ._..
fn
CONSTRUCTION LENDING AGENCY
I harebi affirm that there ass construction lending age«)f the'perfoitnan<e
W ... Lad mo kme which Na iv.C.) r "'
farpe t sissucn(Sec 31197 C
Lanae naarrs!0
C,1 I cenify that I have read this application and nam that the above information i-a "
coved 1 spree is comply with all city and county oMi...ses and state laws relating
r V to Wilding construction.and h6eby autnodu representatives of this city to enter upon
-rW the above-ramioned pmpeny for inspection parpioa,
F L (W)agree ao sava.mdarmify and k<p hamdess the City of CLpeiu o egamst
O Z City t j J tx L d pea. rom
h M1 y in ny y against said
AP Y IC TI ANDS rumm hIL�C hsM1t RHALy�L3 rom ' Issued b r G L----
L of,Ns ( J 2fJ_ y' Date
gnam prcant/contmnorDam Re-roofs /
HAZARDOUS MATERIALS DIS OSURE -
.:r wBtn<ap�li2am rl b laing«a br nanme hatareoaa natenzl
Type of-Roof. .. _
az def San d by.the Copao M im1I CChart 9 13,and the Health and Safety
i Code to 255321.) M ad _, . . - .. . .. �.. ... .
❑Yea FJ h'�L.t r,ti; r 4 1 _ s .r �•' <q r ' s s
t All roofs shall be Inspected nor to any roofing material being installed.-
Will ths,applicant future Wilding occupant equipment devices which If a roof is installed without first obtaining an inspection; I agreetoremove
I a h ardo Management - ....
m 1 p d f d by tie Bey A A Quality '
�{ °isinC ,�(dN all new materials for inspection.,Applicant understands and will cam 1 with
oYP_Y.. .. :. ..
all non-point source regulations..
1 ria a rend 'irso.ofmas materials regchiman 'ander Chapter 6.95 cf'the
Calf is Heal Sr tyCede,Sections 25505,25533 and 25534..I madmidandthat
it ui 'a oes Immntl a"m ,that itismyrespnnsibility m notify,the
t o! 'e r moment crintax,his a pdo,1.issuance of a Cenlficam of "
anct�/..
Signature of Applicant Date
nerOraath«laedag=tit Date All roof coverings to be Class "B" or better
'' `= OFFICE . . ._ .