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BUILDING DrvIS PERNIIT
C�MIRACI'OOR�INFORM T10NN
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TBD — TO BE DETERMINED
PERMIT NO.
08060012
NER'S NAME:
PERMIT ISSUE DATE
BRADFORD FINANCIAL LLC
06/02/2008
PHONE:
SANITARY NO. CONTROL NO.
AR CHRECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby a1Bm that 1 am licensed under provisions of Chapter 9 (commeming
with section 7004)) of Division 3 ofthe Business and Professions Cade, and my Imme is
ON ROOFTOP REPLC 6(E)CELLPHONE ANTENAS, ADD 1 NEW
u«"Ix �;nd
ANTENNA @GRADE REPLC 1' 'EQUPMNT CABINET
Dam Contractor
RCHTtECI'S DECLA ATION , A4
1 uM Wind my plans shall W used u public morels r C
-5
-
Licensed Professional
OWNER -BUILDER DECLARATION
1 Wmhy affirm that 1 am exempt form the Conuamore License Law for Ne
following mown. (Section 70111.5. Business and Professions Code: Any city or county
which requires a permit in construct, almr, improve, dcmalish. or repair my suumum
prier in its issuance. also mquims the applicant for such permit to file a signed summem
Nat he is liccrod in lW of time Conerectofs Lice= Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant pmvisiom
11000
(commencing with Section 7000) of Division 3 of Business Businand Professions Coal or
that he is exempt Nerefrure and the basis fru the alleged eaempdon. Any violation Of
35720038
Occas
Occupancy Type
Section 7031.5 by any applicant for a permit wbjccts the applicant o a civil penalty ofNumber
mtmm Nan
ofiwhuMmddellus(S500).
❑ I, u owner of Ne pwpmsy. w my employer with wags as the'v wk compewtien,
Required Inspections
caw mdm 7o
aid dothewwsCode:
he Commodesmiinmmedw
moner of
Pwfesdons Calc: The License Law dote not apply rf an Owner
not apply
9 P
preand
is
vesTawas rubs doustN work forge hf
essywMbuiWo mimpwwsch
'
aroffe edor
improvements art not imm�dW wolfcmd for We. lL
awn cmployms, provided that improve
Own
boweov. the building buimPmvernemishat within and )eat ofimnPktifor th
ver
ase of
buildtt Willi have Ne Wrdco of proving Nu k did Out build w improve for purpose of
wk.).
❑ 1, as mower of the pmpcol, am mtelasively c..=do, with licensed con taewm to
mutruct the project (Sec. 7044. Business and Professions Code:) The Committees U.
ecme law dors not apply to an owner of property who Wilds or impmaes Bandon. and
who contracts for such projects with acomtantor(a) licensed pursuant w the Contractor's
License law.
❑ I em exempt under See ,B&PC for this mason
net Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under pe rsty of perjury am of dm following decbnti.as:
1 have and will mainuin • CeniBnmof C...11. self -insure fmwmxceseompen-
Wdon, as provided for by Second 37W of Ne labor Cade. fru the perfamurnm of the
wort fm which this permit is issued.
1 have awd will maintain WorkGra Compensation lasumm , as required by Section
3700 of tiro latter Code, fm me performance of the wort fmwbich this permit is issued.
Worka"C na, do wranco friar and Policy cotter am:
My a
Cam Policy No.:
ERITFlCATE OF EXEMPTION FROM W M1113%
COMPENSATION INSURANCE t
Crib suction rcN Out W completed ifft permit Is foram handled dallam ($1 011)
or leu)
I ewtify rhm in me perfanno. of de well, fa which die Permit u issued. l small not
employ any permn in any mmorso as to become ubject to the Wwkcn' Compensation
laws of Calif rmio Dam
Applicant
NOTICE TO APPLICANT: If, afmr making this Certificate of Exemption, you Nouk
became wmfm w NC Workers Cmnpenaatlon provision of de fable Cock, you most
fnnhwith comply with such provisions or this pennb "I W deemed rewked.
CONSTRUCTION LENDING AGENCY
1 laundry affirm Nat there b a construction keding agency for the performance of
dm work for which this pconit is issued (Sec. 309'7, Civ. C.)
Undoes Name
Lenders Address
1 ratify that 1 have most this application and sum that the show Information is
correct. I atra to comply with all city and county ominarvaund sok laws relating be
Wilding construction, and hammy amhoriae mp.udm.f this city m emu upon the
lmave-mentioned property for inspection pelpnRy
nCity of Capetian. agurnat
C%) agree to save. Indemnify and keop.IWrlky dm
j liabititie;judgments.com and calicoes which may in my way amus agalnst mid Cit
in comcquenceOf do granting of this permit.
APPLICANT UNDERSTANDS D WILL OMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REG LA
Re -roofs y
Type of Roof
S.
Signstu of APPlican ntmcmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant w future building mcuPUL Store or handle hasuNoss material
road by dm eupar ire Municipal c.ae. aapmr 9.13, and the Hath and safer
. Semon 253324)7
All roofs shall be inspected prior to any roofing material being installed.
❑fa. PN.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use aquipmmt of devices which
emit hvaAnm if co idermanu as defined by the Bay Area Air Quality Management
all new materials for inspection.
Disi icrt
❑Yea ()&INCL
1 have mat the haramoessmamriab oxmikemcnts under ChaPmrd.95 of the Califm-
meHcalN&SefmyCode,Satimu 25505,25533 am125534. 1 understand Nairthc Wi1Nng
der Inst currently have a mnana Leat it b my responsibility of ratify the accupant of the
require ntsw mm�a m w n acemrm.te.rzmpatmy.
O f r a>6
Signature of Applicant Date
All roof coverings to be Class'%W' or better
Owner nudorimcoal, Dam'