00020202 (2) CITY OF CUPESION 0
BUILDING' Q O ^ Nn
etnLnc vision PERMIT CONTRACTOR INFORMATION: L. .G_.
BUILDINGADDRk O 2
SANITARY NO. APPMCATION5UBMnTALDAn
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Job Description
wish1ofDivd'3otitic BuummRof ' Code.ad myliaeu
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Eap Dm,_CLu Lie.• 'J / I �
Y3j av a, n... ARCNI'O=DECLARATION
f�,j,5, lundvmad my P✓m JWl be u.cdo public toad!
y�y o O LcmtN PrnlcutarW
OA'NMBUDDER DECLARATION
{_Z 1 bueby.1Brm Ihtt I w comp from the Comnetol.Lieu Iry for me
F❑ follwin,tum.(seal'MH .Bminu and PRfeW't Cade Any city'nmay
s width"«'i'a.Penrod wcatvRw0..Rn,i'n" .demai.b,oeopml Y tonmYe S F[. Floor Area Valuation
Prow W ftz; tuR tlao le9niRt rh applicant for mob Pewit m rde a aipnl mvtvn (I'
dw he i.Ike pintoid wtbe proviuomatl:ccnwr Y.I3curte U. (chvbnq C9G
(canwtcum,with Sewn1000)a MAkion3oft Bam.m Rafe i Cadc)on -
tbid M h eu tbeeft«n me ft bui.fm tho"kpd e n moo.My violu.Ue of APN Number - Occupancy Type
SctTon M15 by my Np1I Inc ap«wit mbjeeb the sWicmI to.civil p®c,a
m tnoae tlw BK hwmeE dWlra(5300). e.� 7 -C�
❑1•,.,wmanenl•w«Ir,«mrm'por��widlw'.w�a<ir.aee«rmemw«�. Required Inspections
ww do wew«k..mmn.oYcoYe iaminteododaortecloto.vpty raa,eui a
uq tiaetdou Cock:lbe C'trcua'.I.iRn.e lad dou m apply to m awoer a
Ithi..win build.',clod t ach t rod who don mch win Nmrolf'thwu,h
hie owo etnplq, pwvWN dun urh roma 6iomu a m in odrd a okve,for
�n.If,bawerv,0 heoe tbnjaimp proe LwM viid nane)aa lbe
-baldn will haK Ne budeo a r.ovwr thu b did not hold a iplPwK t«pw
❑1,u ownv of dR property,am Inc. d eaarrliy with 14®ado intim w
mwcl d P jos Iso.tach,Bu.lm..m Who bi.coactme ca th c lu-
temlawdu«c tocb cjomowmofpropely who hYiWtaimprnv«dtveao,and
wha c'trrtt t«.uch pquu wiW.cw�rrla(a)IkaeM purmw b Ae Cwwrwlt
Vcrnk law. '�`
❑1 e.emµ9Me5a. .BlPCf«thitRmt V
Owner - Da� 0
W00. COMPPI:SATION DPlIARAnO
miva
Caifa
=Y alarm pmalry ofpr jury ws Mde ralw1y decWubm:
1h. vtd will vYie a corn'to wlf.inw far Wohelt Coo
a a the
work for whiby
ich Nle pe 331W tabor Codc,f«Inc f
peamuaz Ne
(]I love"will nt outin Worker.Cco ontmon I....n re'iwrod by Seco'
3100 conc Lab'Code,fa the perfmwRe attic wort fa Wdch!lis roil u i.uad.
MY Wahnl CotrWenudan IwYr.ac tuna W Pa4y vumbe K:
Cartier Policy No.: /� 1
CEItrfFlCATI3OF SATIOTION FLAN WORKERS'
CVMP61i5ATI i(tho afo FEg 2 9 2000 u
(nws aeeti'and m m aenPl.tm irwn Pe„mt i.r«oa htwAed ddm.tsloo)
a al
1 cenify Om in the perlwuueortbewak fawhich Chit perrwl it ImN,I•`• -
rot nrtplvy mY f<R'm uY mmrcr n u w be«ne abjut to Nc w«tc!Cowpen.
won law+a California.D..e
Appl
a
NOTHOMETOAPPLICANT:If.coow Iix Nla CWinl a of P.ubc,coo Ya.houW _ 8V
heearc co.,y the WictnMCowpm thnt aontd athelataco Yau ttuu J
t«Ihwllh LWtplr w11h.YCh PNYIYIpt a Ihl.PC11111.IYR be dKi«d rtvaRQ
z CONMUC ION LENDING AGENCY
O O Ihecby Witn,t t u.c'atruN'k+d'nZ Vwy for the pori m ca
z do w'tf«which Chit penia u iv 1(S 3091,Co,.C.)
1<Mc/a Note
LeMefI Addrtra
=W 0 1 w trod I hay tad t1 city mdcoun and tau ct d.hove In mbmon i.
z eoUdinj,co we and with01city utl t, «ori .of W.•..Mrn rtWo,ro
. ...�e00NLYk11.Yid fac moron R lae.tOWiv«Of MitCITYwenlGYPW nIC
U 0 .hove-muni'1Pope .f«i ooify pupme..
OU (We)yrtew uwwdlc ily aidkap yIn m Ne Chy of Cupenlm.{.au
U IiabOttin,judgmml.,me mdetpeun utich rtuy In my w.r.u'rne.9.iott aid City
y 0- A PICA 'T NDrmsTAN,ofN pavde
f' y SOURCE RE UTATIOTANDSAND WIIJ.COMPLY WITH All NON IOINT
U z SOURCE RP_(:UTATIUNS.
Si aAPP m tr.cw' Due rl • yi1�V �f
FLVARDOUs MATIAIAIS DISCLOSURE
W0l theappliuw«fwwe buiWin,tmpmtuae«hadkhundw.muei.l Re-roofs
Code.
collood
by usCupto to MYnicipw corn,chapter 9.12 urd the Hc•th and safer Type Of Roof
[I Y. ❑N
Vr3111h[,PP,;I'e,IrP//B,�bY�,,,,,ea�„s en;panm,«,e„«t wti� All roofs shall be inspected prior to any roofing material being '
emitb to,sur coo omo,adcHoodbyInc NYAr AOQvnryMm.,e+teat installed. If a roof is installed without first obtaining an inspection
" ' I a ree to remove all new materials for inspection. Applicant
❑Yn a g
Ih.y Rad dr m,reaw.RN'd���.aim GEye�695 chine G.R- understands and will comply with all non point source regulations.
forma ffulN&WnY code,Smiorn 25505,25533 and 25530.I vndvgW thu J de
bulWiry da«m m+e+y haK.tmmt.that h it on,oc"oncNIRY to notify d.a«,rPwt a`1��79�0700/1
which tM wmuerc a. m a
o.,te'.Ynu,e ,m faro ignature of 4plicant Date r
All roof coverings to be Class"B"or better
OFFICE