02050007 (4) CIBUILDING DPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10203 MINER PL NU-DESIGN MANUFACTURED 02050007
"WNER'S NAME: APPLICA ION SI R DATE
GOLAN SAUL AND LINDA 1566 LA PRADERA DR #3 O5 02 2002
'HONE-: SANITARY NO. CONTROL NO.
(406) 374-4362
O-OZ ARCHITECTIENGINEER: BUILDING PERMIT INFO
kC - BLDG ELECT PLUMB MECH
'z LICENSED CONTRACTOR dunderSDECLARATION J bDescription
i z C I hereby affirm hal 1 am licensed under provisions of Chapter 9(commencing SUN ROOM (14 X 18)
:ml_; with Seainn 7(NIO)n(Division3nfihe Bins and Professions Caie,xpdadyh,opo,
in ma�fccind< La Liceme Lc _:odu rt e Contracto3 3 ts In ARCHITECT'S DEC A I N1=-o tand Y plans thud be used as pnhlic mrnNs
' JUNi re o Llrenmd Pmfess;onA f� qq
1 hereby affirm that 1 am OWNER-BUILDER
CfmmEh Conmalccttor's License Law for the � " `170
following rcmon.(Section 7031.5.Busines and Professions Code:Any city or county $15000
f F o which requires a permit to construct.alum improve,demolish,or repair any structure
u3- prior to its issuance.also require&dicpplicant for such permt to file a signed statement. --2`•^
haa - - - -- - -
thasl sed phimon1 the Pm nsofine Contractors License Low - g'VIUation
(core g 'hSonim7000) fD' sion3ofheBusnt adProkcstonsCode)
m { I ;s\ ; ±'3 � 5.t�',��'. TFP�fltst`f:.J
or that he is exept therefrom and he bass for the alleged exa ignini.Any violation _ - -
-of Section 703P.5 by any applicant for a permit subjects he applicant to a civil Penalty
.
of not mme than five hundred dollars(SIM). 10 14 PN lxfc DATION Occupancy Type
01,as owner ofthe property,or my employees with wages as their sole compensation. 102 PIERS
will do the work.and the storm re is not intended or offered for sale(Sec.70x4,
Business and Professions Code:The Contractor's License law does not apply to an 103 - UFER Required Inspections ^
owner of propeny Who Wilds or improves hereon.and who dors such work himself 104 — REBAR
or through his own employeesprovided hat such improvements is sold are not;mended or ----ANCHOR
_
-compile ion,the.B,howevere the Wilding t or improvement of
r,old within not year or - 105 - ANCHOR BOLTS
icompletion,the me tifnrin.).will have the harden of proving that he did not build or 10 6 - SEWER & WATER
mprove p rpou o
01.�od•ner of the property,am exelosidey contracting with BcenseAoomaito . . 202..-- UNDERFLOOR PLUMBING _ ..
conawe,he pmjrct sec.70a4.Business aad Profession,code:)The Contractors 203 - UNDERFLOOR MECHANICAL .
License Law does not apply man owner of property who builds or improves hereon.
ane who contracts for such Projects with a enotmctmt,)licensed pursuantto die -204 — UNDERFLOOR FRAME
Ctionn0 l amcexemptcurder, s«. :B&PC for this reason 205 — UNDERFLOOR"INSULATION
_ OwnerOnto 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ihereby ammtunder Penalty ofkrjj yeneothe following declarations: 303 — ROUGH MECHANICAL
Ij 0 1 have aad will immolat®r a Ceinrratc of Convent to oaf-hxurc for Workers 3 04 — ROUGH ELECTRICAL
0` Compensation, ® provided for by section 3700 of the Libor Code, for the
pcHormw
ance onb< ok rod which his permit n issued. 3 05 - FRAME
- 01 have,and will maintain Worker's Ce,mpmmmion Insurance,as required by Section 3 06 — HOLDOWNS
37W^ffthe
a-Labor Code,for he performance of the work for which this Permit is 3 07 — INSULATION
r�//1`� /F PoI.it carter and Policy number are:'
issued.My Worker''sompensati�nsuran, 'q - ., . .. _ .... 308';'. SHEETROCK-:•_.. .- --- --
or{- "'Del' /�OY1'o/. .,a",-
CLRTIFlCATIONOEEXE ION FROM WORKER- g ". f3'09 ••-t;RTERIOR' LATH'
-- - COMPENSATION INSURANCE t' '
�,.._ --310—'----I-NTERIOR--LATH-- ..__. -
^ " 'Thin'4e8idddecd not IN,completed if the permit is for one hundred dollars 311 — SCRATCH COAT - -
(SIOo)orlas.) „
i'smfy in.,in the PeAopmmme or he work for whleh this p<rium;s;sued,l 313 — -ROOF NAIL: .• -•- - - ...- .• . . ._ . ..-
shall not employ any Person in any manner so as to become subject to the Workers' 501 - FINAL ELECTRI CAL`ENERGY
Comlicapt mnLow,orcaummip:Dam
Applicant 502 ..— FINAL PLUMBING ENERGY
- ..
NOTICE 10 APPLICANT If,after making this Cemfiram of Exemption,you should 503 - FINAL MECHANICAL ENERGY
become subject to die Worker's Compensation provisions of the Labor Code,you must
Zforthwith comply with such provisions orthis permit,hanIN,deemed revoked. 504 FINAL BUILDING ENERGY
V1 •"' CONSTRUCTION LENDING AGENCY ' SOS - FINAL ELECTRICAL
I nerehy affirm that here is n e imurni tion lending agency fur,heperfm nance
?, of me workforwhichthisPemihisissued(Sec.3ov7,Ch,C.) 506 - GAS TEST -
'i p acct°raName ` 507 FINAL PLUMBING -
7 Z tinder's Address - - '
U O lready hacomplyread ith.;I ityanddmiand,tatehn., adsvtelawsotionn 508 - FINAL MECHANICAL
�TwE.a correct.1 ague m comply with eb any and cony ordimamms end auu laws relining 509 — FINAL GRADE
(� mhui ,,menstmetion,,nherchyaohoizcrrrotenm,iv<s of tits city uenur upon 510 - FINAL PLANNING
the ebo(We) gree tm,mde,nyfor inspection purposes.
f}' y (Lac)agree m save,indemnify and keep hartNcss the City of Capeniao against 514 — FINAL PUB I C WORKS
Zi liabilities,jadgmam.,costs and expenses whah may in any way accrue against said 1
U Z City in cmnaequcnec of the grming mfur permit
API'i. . NT UNDERSTANDSAND LL COMP WITH AL - INT Issued b n Date
S 'REGULAT Y'
S arrom.mf ApphranUC.mommr )ate Re-roofs '
HAZARDOUt MATERIAIS DISCLOSURE '
.
Will thea ppI cum or futureilding occupantstore or handle hazardous material Type Of Roof.-
as defined by hno e Cupcn M roc WI Code Ch pie 9.12.end the Health and Safety -
Code Sect m 25533(x)+ - x
. _ t f ,, t
'0Y t
All roofs shall be respected poor Co any roofing material being installed.
will fin, pplm t I r h 'lding p t...egwp t d rc,which If a roof is installed without first obtaining an inspection, 1 agree to remove
nit homplions air contaminanZ!firav
itsb3 he Bay A.Air crudity Management
Disci, all new materials for inspection. Aplicant understands and will comply with
'a ❑Yes _ all rich point source regulations., ,_ ..._ -
:.1 have read the hamrtl requirements under Chapter 6.95 of the
California Hwlh&Safely Code,Sections 25505,25533 and 25534.1 understand that
irihewildingdoesnm cumcn I have ,hat it is my responsihilitymnntify the
occupant fine rcquiremcros which mu, ren prior romance of
a Ccnificem of
°ccup j r' Signature of Applicant Date
-' ow rnrauhmnzedageni ate All roof coverings to be Class "B"or better
. . . -.. OFFICE.