02110027 (2) CITY OF CUPEWHNO
BUILDING DIVItiIONPERMIT CQNTRACTOR,INFORMATION
BUILp14(D3DRIP,RIMROSE WY CITYWIDE ELECTRIC rRMrrnf02110027
Dw RR+ARIO ANGELO C 4686 MERCURY ST. #A APPLICAEIt9_NJ1VR9 r2002
ML
ZONE: (800) 797-8677 SANITARY NO. / CONTROL NO.
ARCIIITECTIENGINEER: BUILDING PERMIT INFO
BUIL ELECT PLUMB MECII
Gci
Ito, LICENSEDCONTRACTOR'S DECLARATION
%-;: crash7 (XPoInnhallamtthelo i.cotudfiiuonsofChaplcrnlcommendng ELCT SERVICE L�E �ftKLS�tlon
withsn9ion'Lkp)ec Division 3ol hr Businessand Pndcsxinns Calc.and mylicenseis
FDm Licen font and dfn't.
a Z;- I.icensr Glass I.iti.a FIIiiALED
O Z_p Dmc Cuntmehtr
F�tw , ARCHITECTS DECLARATION
yYi y< I understand my plans shall M used as public records
X36 L"umdPrulessts.1 APR 0 8 2003
F-LLto OWNER-BUILDER DECLARATION it nn
aP 1 hereby affirm that l am esempl from the Cuntranor's License Lwl for the BUIL
o n $ fnllnwing reason.(Stolon]1131.5,Business and Prnfessinnx Calc:Any city'I county a 1•V
which requires a permit to construct,alter,improve,demolish,or repair any Mructure O'Y
FZyIprior m its issuance.also requires me applicant for such permit file a signed stuentern
a 'that he is licensed pumaanLln the previsions of the Contractor's License Law(Chapter 9 vy.6h1.'? oOArOO I Valuation
(commend ng is in Section Igkq of Division 3 of the Business and Prol'essinna Cock)or
i mat he is exempt rhemfrom end he basis for the alleged exemption.Any violation of
Smile.703 L5 by any applicant for a permit subjects Be applicant a civil penalty of Ppl-N Oeeupancy Type
not more than five hundred dollars(S5IXp. 11 501 - FINAL ELECT ICAL ENERGY
❑IJS owner of the pmpedY,or my employers with wages ae Their sole compensation,
will do he work.and be atruerme is not intended tk offered for cote(Sec.704d.Business 585
and Professions Code:The Convector's License Lw does not apply to as owner of egmre nspecttons
properly who builds or improves thereon,and who does such work hlmsclf or through his
Own employees.provided Out such improvements am not intended eroffeed for sale.IL
however,the building or improvement is cold within one year of completion.the owner
builderwill have the burden of proving mat he did not build or improve for Purpose Of
sola.)
.as owner of on,pm,bsi am exclusively contracting with licensed contractors to
consumer the project(Sec.7044,Business and Professions Code:)The Convenor's Li-
cense Lw hes not apply tit an owner of property who builds nr improves therein,and,
who contracts for such projects with a ctmtractorts)licensed pursuanuu the Contraalors
License Law.
❑ 1 am esempl under Sec. .B&P C for this..an
a/11/
KR'SC MPENS TION LARA
1 hereby affirm under penalty of perjury one of the following declarations.
I have and will maintain a Condition,of Consent to eff-insure for WorkerCumpen-
sation,as provided for by Sectio 3700 of the labor Code,for the performance of the
wort for which his prrmit is issued. r
I have and will maintain Worker's Compensation Inamor ,as required byl
krScmion
3700 of the Labor Code,for the performance of the work(or which this permit is
issued, i
My Worker's Com Evosarion Insumnee carrier and Policy number are:
Cather: Polley No.:
CERTIFICATE OF EX EM PTION FROM WORKERS'
COMPENSATION INSURANCE
(Tris section aced nut be completed if tM profit is foronc handed Jolles(S 100)
nrLess.) _ i
I cenify that in the peyfnr ace nl the work for which this permit is issued,l small net
employ any person dna mer so as set become subject it)the'Liv iCompination
Laws of Califumi4.� e "
been j A e L a(mr making n provisions
Of
Excntprioa,you should
Mm s jmp y the Worker's Comp or this provisions of me LMu Cale,Sim must
O z forthwith comply with such provision or this permit shall be deemed revoked.!
zo
CONSTRUCTION LENDING AGENCY
C4 > Ifrr.hick rm thahereissued( ec.30 lending agency for the performance of
W 7 the work far which this prior it is issued(Sec.JIB),Crv.CJ
Wa Q Lnder's name
I<ilder'sing Address V
V 0 1 unify hat I have read this application and state that the alcove inlmnmiun is
L[. (•-' coned.1 agree to comply with all city and county ordinances and scam laws relating to
�U show-geolionul ionand herehyamboriacrcpreumativcs of this ciry to enter seism the
U abnvr ole)agree
property fm embiftian keep:l.
ha
C (We)agree m cove,indemnify and keep harmless me City of Cupcnito against T
N in
judgments. this Permit.
APPLICANT
may in anyway acrrvc against coitl City
U z APLICANT of the granting of thts permit. C/
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
-O Re-roofs
na rAppb iIAZANDOUSMATERIAISDISCLOSURE II Type of Roof
Will the applicant or future building Occupant store or handle hvarduus brouial
as defined by the Cupenino Municipal Cork,Chapter 9,12.and the Ilcalth and Safety
CodoSrrcon 5532nd? All roofs shall be inspected prior to any ooffng material being installed.
[Dyes No r
wJI err applicant future huildln tea tasee corm er devices whim If a roof is installed without first obtaining an inspection, 1 agree to remove
pp gr pan quip
emit bvmdnus air contami`nants/saas dclined by the Bay Area Air Quality Management all new materials for inspection.
Districl'r
❑Yes YAr
1 have mad the hamrdaus mamrids mquirrments under Chapter 1.95 of the Califon
niaflealm&Sgcty Cork.Station25M)5,25533and255U.Iun&m crowd -building
does not currently haw a tenant.Out it is my neponibility as nobly tM occupant of drc
equimments
which as(he mer poor or iluaace,(a cenir amof aneupancy. Signature Of Applicant Date
OwiCfks/authnr¢etlagenr �`
Datet- —� All roof coverings to be Class "B'.' or better