00060186 (2) ,t CITY OF CUPF,RTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUILDINI,ADpB4:N$:11 WESTMINISTER CT AA G., PER>B f N'.00060186
owueR's SAp1.bO1 I� JAMIE AppIACAIH)NJ I(_I) b/2000
ZONE: IO SANITARY NO.�6y/ CON IROLNO.
40
CsgARCH]UICT/ENGINI'liR: //� p7 BUILDING PERMIT INTO
U 6 !/ F 3 1/ 71 7 HhI)G Ii[.li(.T / PLUNII A,1✓
!�
N= fi.;1ad I a CONnsed al IR'S DECLARATION lob Description
z p 1 herby 00irm thin I Una licensed Ill,I under pmvieiole,f ChOpmr,t(commencing p
�vi 1�-W is"Itin full Ion]OINII of llivininn 3 uf.M1a❑Irina,ural Yr,leaion,Cale,nnJ my liccn,c
ax is in (rte- 1 �1// ELECTRICRL AND MECHANICAL
z{KyS I side
Class
9 �e LA�_ C`nigmii.ir� ..r,(
y�O L O Dole—�= All
-
WF 4 O ARC II fHTI"S IlIiC1,ARAI I N
Sw S 1 undemand my plane.hall be used as public records
C w> "
w O O Licenud I'ndes omil
a. OWNER-BUILDER DECLARATION
1�= I hereby alum Ihat I an.exenpl In .he C...miloor',Liaowe I.aw fm I,,
IZ a following Mason.(Section 7031.5.9u,ioes.,and Professions Cole:Any city or venry
f 2 O which requires a permit to cnmtrucl,alter,improve,demolish,or repair any,m eture
aGm priorm it,iaxuarrive,annrqula,the uppltrial fornah,erra ,,li le naigned urate,......
it tbar be is licensed pursuant to the provision,of the Contractor's Licence law(Chapter 9
(eommc.aing with Senl,n]gXq of Division 3 cilia,Holmes,and Prid ism Cute) Sy. FL Floor Area Valualior l
nr that he iv exempt land nn I and the hasi,lar the alleged clan,ion.Any violin
of Section]031.5 by any applicant for a peond subjects the applicant to a civil penally
lit not name than rive hundred dollars($500) APN Number Occupancy Type
342221211.2. 00
01,as owner of the prelim,army employees with wages m their sole compensation.
will Jo.he work,and.he Mn.aum is not intended or olicied for vale(Sec.71144, eq �e {{11
Bu ineen naddlInyfes,ion,Code:'Ihe Comm lnr.Llcamc Law does nal apply in.hn 304 — ROURRGpLur LE,C I Rte ns
,caner of n Who builds n improve,thereon.and who d«s such wad himsell
nihnn.gh his own cmployevv.provided rhw each ingmrMerands um of intended ur
aCAL
tlbred lm sale,ILh,wever.hhe building or nnpmvenent is sold villain on,yee of 501 — FINAL ELECTRICAL ENERGY
completion,the ns net hudLdlerwifhave the burden ofprovingthat hedid nor Wima 505 — FINRL ELECTRICAL
inapmva p"mn..o
01.us owner of the property.am cWtisively contracting with licensed contractors In .
msl roma the protea(See.7044,Ruxinevx mal Pmdesnioa%Code o'1he Contractors
License law does nal apply to un owner of It who hu 1,1%oa.lmproves thereon. .
and who contracts for such projects with a mmmcto(g licensed pursuant to the
CoIafi e rt Llcende law.
CEl o o exempt under see .It&I'C fur this rca,tan
Owner Date
WORKER'S COMI'Line ION DECLARATION
I Michy alYrlander)cantlyof p.rjury one of the following declam.ione O O
❑ I have and will maintain er Cri ificam of Consent m self-town fur Worker s
Compaxmim., a, p,waled-lou by Sa:duo 3700 of the labor CuAe, for .be
performance of the work Int which this pe.uit is issued'
r h.ne wad will Lindal.Winker',Cnnt,cr,'eliu.ha,ur nee,nra
, llied by Sactian
Illi of the Labor Ede,for.bs petlnrmemce of the work f r which this proot iu
issued,NI,Wororker',1Cnnnessi niiun Inss/urrAa�nce/coater ad Poli
cy number are:
(-artief_vvrt:l R!1I'°!„(IN o�EfaEM'IN''"ON�kG/O K;R.LA
COMPENSATION INSURANCE
1'this union and not be completed if the permit is for one hundred dollars
IE 100) it lcsv.l '
I exnily.hal in the perlimnnnce of the work for which this plaudit is issued.I
,hall sun simply any pees...in way rammer m as 1,b.cona,sunjem m the Winked
Compensatan law fCarfo it, T e -
npphea.mt
N(H'ICI3 TOA 1'1.CANT. I:clicaaaln,m,a sCcna,,nc of Exc,a,awn,you vI...uld
become subject m the Workil Compncation pM,kimo of the labor Cole,you must
OI'onhwith comply ,,It such pMin,itm,or this imil shall be de.•nned rooked
CONSTRUCT ION'LENDING AGENCY
a > I h tchy aftlnn the there is.h cofi,wain I lending glarey fns the perbmnance
of the.,,,it Ila what,Ibis lermil is iva.d(Sec.3097,Civ.C.)
L ❑ Lender's Name
Z LanJcr'a Alin—
Lal O 1 emify that I have mad thin ididiceion and late the the al„rve infommmion i,
W F., a rant.I agree ,,enmpl,with all it,and county al inane_.and,title lawn rearing
[) to building cmmwnin I.and hereby authnrile,npo,wa.......it this city ,,one,u'r.
Fthe aNn'e-mentioned property for inspection purpour.y tWrl'greet,save,mdeamif,t it keep analle,,,he Cayof Ca,Minoagainn
(n liahilitics,pal,meth.cwt,and expenses which may is any way annus against said
City in consequence of the granting of this permit. r3
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: `/ a� Date V
SOURCE REGULATIONS.
Sign tell AppllcunUCo an.....e Uwe Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
AIR the applicant or futum Building'..ant,mm nr handle hamNnas mmcrid Type of Roof
.,d.riued by Ise Cty,cnlno Mars,pul Cudc.Chapnr 9.12.and the Heul.h and Saba,
Cole,Satin.25532aU
O Yox 0N _ All roofs shall be inspected prior to any roofing material being installed.
Win the applicanturforme buddingoceapant me slLm,ment ardedme,which If a roof is installed without first obtaining an inspection, I agree to remove
emit harardou,air coma numv rte defined by the Bay Arca Air Quality blswgernem
Di"Jai all new materials for inspection. Applicant understands and will comply with
0Ya 0N all non-point source regulations.
I have read the ha'ru,.lom'mnmTialy myu irmmns aide,Chupwr 695 of.he
Cli if,min kleahh R Safety CIA,,Section.25505.25533 and 25534.1 undersmnd rho
if the building Ane,not currently hex a mnanL shut it is my mspomibi lily to notify the
eupom nl the rcyuirc.nenln which oma he oral prim m,inxuunc,nfa Cold'e.ne of
He Signature.y' . Signature.of Applicant Date
d'^"�� 0 All roof coverings to be Class• 13" or better
Owner or awhomed ager I D_e