01050095 (2) CITBUILDING
NG DIVISION
IISIONNO
IL PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22047 MC CLELLAN RD GB GROUP 01050095
OWNI!R'S NAME APPLICATION SUB DATE
BROWN .JOHN D 8921 MURRAY AVE 05/09/2001
• PHONE: SANHARY NO. CONI ROE.NII.
(800) 653-7172
O z Z ARCHITECfB3,NGINEVIL BUILDING PERMIT INFO
(u O O BLDG ME= PLUMB NaCH
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IntF�>`b I.ICBNSIin CONTRACTOR'S DHCI.ARA11ON Job Description
Z O , 1 herrn ff,caro dal I ant kenad under )'Che ler 9(cmn,nenaln
Evil Pmni.sionso p 8
mC out :1 in Suction 71XXB nl Divi I,hn 13usincsv and 1'pfpye6vly$. Ie,y'J mY)¢'cmc
Z. '.sefull r', 1E..e°ndencl. [V�j`(°Lf9/Yt�/� REROOF/SIDING AND TRIM -
0 a Lirc,,.e ala x _ sec.a
3 i V Dane Commcmr
ARCHII'ECr'S DECLAHAnoN
1 understand my plan,shall M1e used as public lecorJ,
se
is.Mz C O Li.ire l Professional
co OWNI-R-BUILDER DECLARATION
¢1 1 hereby.1fim,Inas I am exempt from the Contractor's License Law for the
following ,.,an.(Section 7031.5.Bmtine,a and Pmfes,inn'Cade:Any lily or counll
Fp wn y ' ps,mor I or 'I her.it I. tell Intl pai,any um,lauc
at a(orI I L 1 the 111. or suchI ill life it soaredsi moon
hod he is fircustalper,attomepa a, f hn c nn I La (Cn,pnr9 Sq. Ft. Floor Area Valuation
(cumm,min,x'ilh Section 7(XXR of Division 3 of IM1e 11 sinev,and Pmdesfon,Cmle)
or that he is exempt dercfrum and the basis for the.allegnl exen,fron.Any sill $1 VJP94
of Section 7031.5 by any applicant for a permit wbjects the applicant o a civil penalty APN Nber OCCU ane Type
of nnore,mthan five hundred duaart(S($500). um
O. P y yP
01,as owner of the progeny lir my monsoyeex with wages as thei, on,rompenvtion. ='
will Jo the wok,and the stmnarc ie not intended or otlered for .In(Sea 701 1.
Business and pndusxlons Code:The Clinical I.iucnw Law dose,not apply to an Required Inspections
r lir property ,Who builds lir in,prnvno thereon.nmol woo dna,turn work hin,ulf
oil(I..u..I his n ill emp.nym,.provided that such ltnprnvcrunu are 1ml intended lir 305 FRAME'
nle,al rnr tore.u:huweve,,the nn0dirg lir impm.emeln'1, ,,It wi llin tate your lir '07 — INSULATION
tapir, u the uwno"n°Jd",w',R have In,harden of pen firs,that he did m"I bund"e
nnuavefor gmmmenl,ale.). 601 — ROOF TEAR OFF
01.as Acaempuder
pmI an,exd contracting will,Bcensed contmcto"1O 60=' — ROOF PLYWOOD NAZI_
nzlm ,(Sec.7DW, and Profrx,ion,CAc:)The cormacmr'. I_
I'iccmeno pl nttx rpropcnY who builJa or impmvca mcrtnn.
and whcar eM1 t a contractor(.) Bran,d morstem m Ile 603 — ROOF BATTENS
Cnnoacw
❑tators. .n,C Pc r sre , ROOF IN—PROGRESS
lineOtK fH'S CUM BNSATION DI_c LAI<ATION
1 hereby ailuro under penalty of peo, ry nnc of the fol.nwing dcelaralinm: ,
0 1 have and will n,inulin a CeniOcate of Conan, u, o II-insum for Worker's
Cmngenv,im, as provided for, by Sec,i"n 37W of ,he Lum, Code, for the
performance of he work fur is hich mis permit is issued.
01 have and will maintain 4Vmkcr',Compensation Inxserance.as required by Section FI M A LE D
3]00 of the Labor,Cole,fur,M1e performance of the work fiir which this pem,it i,
iesue<L MY B' k Cnmpn�rvf,r����Incumnce carr''.unA I/'nyll�ey not her
Carrirr:_ N�...icy N...: /L1a� _ NOV 0 8 2001
C: 7 PI A'lTo UP EXE NI P'I'ION,I,tOMWOIt KERS'
COMI'.?NSATION INSURANCH ,
(This,ectinn nerd not be completed if,M1e permit is for one hundred dollars BUILDING
IS I WE m less.)
1 certify that in the performance of,he work for which this permit is issued.1
shall not employ any pemnn in any manner so as to ben,me subject to the sol"Acri
Compenmtion Laws of Cnlifnmia.Date
A,fiwanl
NuricH 10 APPLICANT:IL afar making this Corllticaln of lixcmplinn,you should
be,o nc,uhlmm th
r e Worker's Compeer-1 (........inns a he ,al rCold,,you inns,
Q O limhw'uh comp.y wilh such P.nvi,inm III'lot'perm.hall he devned revoked
i
F' CONSTRUCTION LENULFG AGENCY
W I hero.affirm(his(hem,I a nmsvuS e. lending07. agency her rhe performance
If IM1e work fur which,his pennil is issued(Sec.3119].Civ.Cd
S Q I<ndcr't Name
D Isnder's Address
U Q I unify thio hove read Infix agplicmin lid . .that Inc above infmmatiun i,
R.1 (.. n,rcO,Ir,pv,mronply hhall 'Iv: J an maniacand'none lawxminting _
Q U Inn ld g a 'efi 11 'u 1 ,'111vv fm' ly. c'man
01 m r mil ,per , e. p /•\
W (Wellston, A 'Ian war Winnagslid
Vi Cry
J Jg a l: xc lt 'Y :ny y c gai n.sad
U Z C,y y rest kI I f,h 1
APPLICANT .DEH A I' D COMPLYH ON INT Issued by: /v7 C' Date
SOURCE RF ,ULA
Signature t , RcaMcumamm tar Re-roofs
IWARDOUS MATERIALS DISCLOSUH
Will the upplicnnt lir flaunt M1ulldmg ca m smm m hon a ha,ardna,m,me,ial Type of Roof
n'Actined by
6lgcnino,tur itoI c.Chupnr 9.12,and rhe Health and sutiIy
Code,Sr,lsm 25532("''!
E3 Yes All roofs shall be inspecWons.
erial being installed.
Will d,r appfeuntmmm.e nmmm rapdnt ey, .n 1„�„demce.worm If a roof is installed w' clion, 1 agree to re xrve
emit hmallont air cnn,:nninan,t as Je cd h)'the l Arc: it QualilY Managen¢m
c it hu all new materials for ns 'ds and wi col ply with
OYe, •.Na all non-point sourc reg
1 have read,he h: lose, q, em• sunder Cha r b 5 o he
California Health&S° yC v 511 25 um125 and ,tan mat
fuchuildru d,.cxn moll m. pumibilily not 5'Ihc
'et"Int al'he can uemen, In be ,d , In ixnnance of v •nlli ¢ ,1'
Occupancy alt
Signature of Applicant
` V All roof coverings to be Class"B” or better
110/
OFFICE