00080071 (2)OFFICE
BUILDING DIVISION PERMIT
%-VIN J. KAG I VK''11Vr'VK1V1A'P1V1V':
BUILDING ADDRESS:
SANITARYNO, AI'PLICATIONSUBMI'ITALDAR
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0 080071
OWNER'S NAME:
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'OLDING PERMH' INFO 11 77
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ARCHITECT/ENGINEER
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LICENSED CONTRACTOR'S DECLARATION
1 thereby aRrm that 1 licensed under pmviuone of Chapter, 9 (commencing
w
Job Description
F=r�
with Section 7000)of Division 3oldte Bomeave and Profadow CCode. my been. is
�y°K<
in Nil far. r.... Class acB«v� Lic.g rIq%51+0
Yom"
RDD WINDOWSy DOORS DEMO AND REBUILT
3LL
ate—�—�A—Cnnwc tsI
f'_"YRCHI=SDECIARATION Gahs•r•
BEARING WALLS/MASTERBEDRM RMDI_
to
1 undersu,A my plans Nati W mud as public reeds
s.s. o°
Licansbo PmeseiorW
OWNER -R- fr DECLARATION
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1 thereby dRdeal et 1 exempt exempt from the Contractors Licence Use for the
5 m O
following re+ron. (Section 7031.5. Boincss and Prefrssiom Code: Any city or county
Ft. Floor Area
Valuation
which requires a permit to crostion" alter, improve, demolish, as repair any ...
prior to its issuance, also rqumsthe applicant for such permit ofile asigned statement
that he is licerved pursuant to the provisions of the Contractors Licema law (Ceq.9
(commencing with Section 7000) of Division 3 of the Basun. and Professiom Calm or
Number
pN Nb
Occupancy
Pane Y Type
tet he is exempt therefrom and me basis for the alleged exemption. Any violation of
Section 7031-S by any applicant f.. permit rob*,, the appliunuo a civil penalty of
$80000
net mor, man live hundred dollen ($500).
[] I, as Owner of the property. ormyemployees with wages astheir sole compenauesm,
�O Required Inspections
for We. 7. Buuass
t imced motional (Sa000
wdldothcwark and rheonscome is roM
s era apply tm an own. of
eCode: e Contracror's License Law data35708022.00
and Profeaiom Th
win, bu
Papery wilds or improves Nemmt.W who doea such wads, himself or through
its
his we employe., provided dust such impro xmemta art not inaMM or oResed f.
sale If, however, the Wilding or improvement is sold within one yearo(completion, the
101 — FOUNDATION
will have e Wase of proving that M did nm build or improve Nr pur-
th
pwbuilder
ou.rofsata.y
102 — PIERS
1, n owner of the Property am exclusively contracdne with licensed contractors to
the project (See 7060. Bashers arW Profeaaiom Code:) 7Ne Conereetm'e Li.
103 — OF E R
omnmad
cess law does and apply roan owns of papeny wW Wilds o immw. connote. and
1. Qi4 — REHRR
who contracts for such projects with a connactor(s) licenard pursuant Ne Contractor's
u"n"'ave
105 — ANCHOR BOLTS
I am esemptuttder Sec, . B a P C for this sawn
106 — SEWER R WATER
owar
202 — UNDERFLOOR PLUMBING
WORRER'SCOMPENSATIONDECLARATION
1 barely alum order penalty of perjury one of the following decl.atima:
— UNDERFLOOR MECHANICAL
p leve.m wdl m.int,;r.c.,Reade arena.rim aB.inaurt rat wnhera cumpen.
203
sad ion. as provided for by Section 37W of the Labor Code, for the perfomurre of the
204 — UNDERFLOOR FRAME
pok fee which this permit is issact.
lhave.tdwillmeamainWorke.sCompensationmrondox.inasnhmbySection
205 — UNDERFLOOR INSULATION
3700oftheLqbm for the K ce ofde woh for which this permit isl..wed.
My Woher�C,� curs. man Policy number a2:
301 — ROUGH PLUMBING
catKer:�'^l`—CERU EMPTIONMOOMWORia3Rs'
302 — TUB & OR SHOWER
COMPENSATION INSURANCE
�p3 — ROUGH MECHANICAL
(Ibis sectimansuin. he Completed ifthe Perot is foromhu baddollars(SI00)
. Iess.)
304 — ROUGH ELECTRICAL
1unify that in the which Nis sawed,)awl
oas
trookTor
the
no employ any Canon in any manner so as w beurme subject ro Ne wmhen Compeer-
my
305 — FRAME
cation ewe of California. Date
306 — H01_DOWNS
NOApplicant
NOCETICE TO APP LIC ANT: If, after making this Centric.. on,youaeuls,
307 — INSULATION.
the Lidoir
becosa subjects. Ne Wahcra Compemarion provisions of Ne Labor Cade. you muss
forthwith comply with such provisions in this permit shall W doemed revoked.
308 — SHEETROCK
Z
0
CONSTRUCTION LENDING AGENCY
for dice 6.
309 — EXTERIOR LATH
0
Z
eby arm door is. comoss,don lending agency rce of
Ih.affirmor V
the w.it for which this pmatitisissued Scc.3097,Cis. C.)
310 — INTERIOR LATH
h
E"
G(,
Ledder's Name
311 — SCRATCH COAT
UndelAddna
1 certify this 1 have read this application and attic died the aW,c infomaaon is
Lr7
313 — ROOF NAIL
a
D Z
cartct.l.gra to comely with VI city ern county otdinsteea ab ata lawa elating m
building construction, and hereby suNonu represcnatives, ofmis city to emeruped the
501 — FINAL ELECTRICAL ENERGY
0
U. F,
abuvemcrumned romped, for inspection purynas.
(We) agree to ave, indemnify and kap hstmless the City of Caper irw against
502 — FINAL PLUMB1NG ENERGY
C V
Iiabihues.judgments. casts and expenses which may in any way seems against said Cay
503 — FINAL MECHANICAL ENERGY
y W
0.
F- V)Sou
inconatiu,oceofNegranungofthis period.
APPLIC INUF.RST'ANDS„DWII.I,COhtl-LYWITHAI,I,NON.illyl'
504 — FINAL BUILDING ENERGY
�z
—
.iitl ATIONS.
-fjL� �•/d•l�ai
505 — FINAL ELECTRICAL
sig namt/c ntr err Date
506 — GAS TEST
RDOUS MATERIALS DISCLOSURE
J appli dor fumeWilding ..'orsmaabandlehavNmismaanal
Re -roofs 507 — FINAL PLUMBING
asddey he C1�?uno Municipal Cade, Chapter 9.12, and Nr, Health and Safety
Type of Roof 508 — FINAL MECHANICAL
erSecdi
❑Yes [I No
Williydre applicant or [INo. Wilding.cupwt me equipmem or devices which
All roofs shall beMezd2fi r tHPWFroQpf'ing material being •
conterm dsas dented by to Be, Ana Air Quality Management
,mit hens
installed. If a rociAMinngtafE �ith5tl IN kiEtaming an inspection
ausait
I agree to removeFalPmew �rI>ttLPitiall� iil�pd�flBiSSApplicant
non source regulations.
1 harardousnuadatargoirtnenuunhrChapter 695ofdeCash-
understands and will comply with all point
forma IN d Safe Code, Sectiom 15505. 25533 and 25530. I uMerM that if the
Wild' Bd.sera cu nrly M1aveenn ,Own it is my responsibility in notify the occupant
or mryirtnenu 'eh masted prig to lauance of a Cenifrcate of Occupancy
n/1-- f • O J
Signature of Applicant Date
.gen Dau
All roof coverings to be Class "B" or better
OFFICE
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