NO PERMIT NUMBER (2) C
nut of cv sioNNO CONTRACTOR INFORMATION: PERM rNo.
PERMIT
BUILDING ADDRESS:
8S'8 HYDE AV BUDGET' PLUMBING sANn'ARYNo?D �uBMITfAL DATF
OWNER'S NAME: NEAL THOMAS S ^28695 ROANOKE ST We 00
PITON': ❑
ARCHITECTIENGINEER 1510)303-7847 BULDING PERMIT INFO
nU�
S
>Z
LICENSED CONTRACTORS DECLARATION
Z O vmi—
I herebyeArmDNet 1 em licensed under provisions of Chapter 9(commencing
Job Description
NSecion7
or anrrce and effect. REPLACE WRTERHER
TER
y ou '
Linn¢Clan lit ia _
Date
Conwcmr
tty tai.O gARCHITECTS DECLARATION
C < I understand my plana shell Mused as public rccoNs
d
IRK LicrosM Peofesioral
OWNER-BUE.DER DECLARATION
{=z< I bereby afro Nei 1 ern cumin from the Convector's License law,rue she
Eo fallowing aamn.(Section 703 1.5,Busir ss W Professions Code:Any airy m county
L 3.$ which require is permit be tons.,alter,improve,demolish,or repair any stns.
pri rcquiresNeapplicantforsuchp NOW on file a signed S Ft. Floor Area Valuation
m to ha issuance,dm q
that licensed punumnONepmvivions sion 3 of es Bell .card
Lew(Chapter 9
e)Or 600
(co he is ingwiNSmdoin and thetif ivisionr ofrheegedeuentlon.Any,
Code)Or APN Number Occupancy Type
io is tempt therefrom W the bars for Ne alleged Gumption.AnY l persaon of
Settlor)Ode by five
reddmtfmaparotinmbjecvNeapplicantmncivilpctWryof 3 539014. 00
NO more Nan five humid dollen(temp.
p I,aanwmtarNepropcTy,mmramploym.withw.guaNeh.aleaaTpensatbn. Required Inspections
will Bothe work,sed Ne ewewre is im imWedre offend(.. ply )oea,Budueaa
and property
w oro Code:The Conroe mo License taw esus nm apply m lf ower of 106 SEWER Ar WATER
his o ny wW builds or improves Neeon,W who Daa such intended
deOhimself m through
Wawnempmyetheprovided theportiTpmvemewarototintendedmahum.for 202 — UNDERFLOOR PLIIMRING
witrenoverwillhvethebding menofprmengNethsold didnomyeearcomso,for e. 301 — ROUGH PLUMBING
owoer.Wildrr will have Nc burden of proving Net he did net Wild m improvx for pm.
prose
Of me.). 302 — TUB & OR SHOWER
❑1,a owner of the property,rue melueively convecting with licensed convaeoa to
Frovenct No prow(See.7W,Business and Profession.Code:)The Camrecmr'a U. 502 — FINAL PLUMBING ENERGY
came law does net apply to an owner of property who Wilds m improves thereon.and
who convects for such pmjeca with a cunvectm(s)licensed puaumt in NO Coovmmrs 506 — GAS TEST
License law.
❑l me exempt under Sec. ,B A P C fee this reason 50/— IN,AL PLUMBING
ownerOe,
WORKER'S COMPENSATION DECLARATION1herebyll mai under penaltyof perjuryoneof Nerollme,ior declear.o:❑have andwilllfor by •Cion efte370 ofGamanlmCode,fee fm Waosoma Cornier..ion, r provided tof by Section J]OO o(the 4bw Cade,(m the periomurce of rkwork ate which Nis Comm is ivued
1 have and will maintainkonWorkers Compensation work
fi nnca,h required by Section
My0of the U Wr Cede fm In,. .canoe r(d work rorwhicmhiv permit LL issued. 00
,
Ce Workers Compensation Inaurame terrier and Polley number arc:
Carrier. Policy No
CERTIFICATE OF EXEMPTION MOM
M W00.KERS'
COMPENSATION INSURANCE
(Tris rectum need net becmnplered ifdrc pcmdt is farom hundred dollen(3100)
m Ine.)
toy my that in the performance ofthe wok for which Niepermit is ntr Co shall
rte employ any Canon in any manor a n to become subjecno Ne Wottrn'Compen-
.ion lawn of Celifomia.Dow
Appheml
NOTICE -
CETOAPPWCANT:Ir,after Ci.ion.of N Lamptioayoushould
Incentive:ecomplyrt i W such
ism Compenr this pmrot shu of No Labor Code,you
forthwith comply with such provhiom or this Corrin shell nd domed rtvoknd.
CONSTRUCTION LENDING AGENCY
0 Q I hereby aR�mr dust Vert is•comt=Nm lending agency for the performance of
Z the work for which Nu permit is issued(Sm.1097,Co.C.)
[: 2 -
w Lenders Name
Under.Address
Qs Q I caNfy Net 1 have reed this application and seem
w Nae No move information is
.ZILCo."14.m comply with ill city W county ordinances W one lows relating to'
z building convrmtion,mull hereby annuitiu mpreun.ivn of ddscinym enser,upon the
V 0
move-eemianed property roc inspection purposes.
tz F.
(We)agene be save,indemnify W lusep harweas the City of Cuprous against
V tiabihuhn,judgments,toadstool eapensea which my in my way same against aid City
} tgl in consequence of the granting of this lemtit.
y z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONd01N'1'
f..) SOURCE REG ULATIONS.
Sill.of ApplicmUConuaem Data
HAZARDOUS MATERIALS DISCLOSURE
Will the aliplicane or future Wilding ocupmt store or handle hemodour material Re-roofs
az defined by the Cupmino Municipal Code.Cluipat 9.12.W the Health W Safety
cede,Section z522N)? Type of Roof
❑Yes C1 No
""IN
mt ae"Feen Or future Wilding occupuse equipment or devices which All roofs shall be inspected prior to any roofing material being
men ti.edaaIair emounitananadefinedbythe Bay Ares Air QuaityManagmant installed. If a roof is Installed without Iirst obtaining an inspection
❑Yes No
"y I agree to remove all new materials for inspection. Applicant
❑
I NWcound the hn.dwa m.tmal,mgairemena ender Chapter 6,95 of the Can. un erstands and will comply with all non point source regulations.
renis"Won A Safely Code.Semiom 25505,25555 W ss53a.1 undated that if the
building dos mat ci ndNy have•time .Nm it is my iespomibiliry in notify the occupene �_
of the rtpermisnu wNch most W met priw m haueoe ofa Certificate of Oomiq .
Signature of Applicant Date
Ower or euNorized agent paw
All roof coverings to be Class"B"or better
OFFICE