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BUILDING DIVISION PEy�1Y11T x
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FISCHER PLUMBING & CONST
PERMUNO.05110087
97 ADRIANA AVPERMIT
JBUI�INGADDRESS:
NAME
SUE DATES
GREGORY CAMPBELL
2766 SCOTT B
SANRARY NO. CONTROL NO.
(408)727-2426
ARCHTfEC IENGINEM:
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
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UCFNSED CON RACIOR•S DECLARATION
lob Description
1 bertmy of Wm Wu 1 w Ikevatl vdv gmtum, of Cluper 9l�mvmvcin�
wiitf amert " .fofaHaim]a(NcBWnm aad Profcnm.Cod., aad myIiceAs
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REPAIR BATHROOMS (HALL & MS.)
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ALTERATIONS
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IvNc'v,na mr W^a Ltudl b alWl be vacdupvblj i
L.d Pmfeadaul
OWNER -BUILDER DECLARATION
1 her.br a1Erm mm I w uuvpt fmm Ibc Cmunlda Liana L. fa Ne
folbrinj tuaan. (Sema m I3, Borates. ad Pmfemvu code: Mr "Y m Amy
W h IC♦ i=p i, m CpWNeI- a . Impm.e, de t lah.. mp�da Ny f1fICOrt
Pna mea iS .ofn oma We applc,nl for aoch P—itm Ok. ujod .lcmcnFt.
Ia 9
Sq. Floor Area
Valudo�19000
Nat he ubat Pmw,, ft Prorui. a ft Cone W'l - ur lCh rP
(rnntnradnS Dim S=W Mai of Divitiaa] of the BWrc Codo)a
—a�d.1Prafmiam
I h l u aaempt by m and the hada fa the Owd ea...y d— A" Mortlan ar
p�NN
U anC
Occupancy Type
Sealm 1031.3 6y any ,ppikam fa , pemdt anbject. the app&at m , dull paulp of
va mae thn Ow hoemed doBan /53OB1
LL
32620022e.
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Required Inspections
.fladm.
daaW re m(see 1011,aW
wmm DurkuWdc,mctmebima) rbu (Sm
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.ttd Pmfesdmu Cade: The Cootraemh Ucvaz fur doe oaa apply to an was Of
f
popenY who binld. m Impaveu Naar. aed who dou and rook himallmmrvu5h hu
owR cmPlaya, paovidrd tW aeA im au w two imtnd.d aaBaei fa u)e R,
baeac.dK bdldlo{a Myra Is Wd rubin arc )car of mepkam.the owner-
Pa s ,
bdlda wN W.e tW Adm a paaNnS mat he did not bdW a Imprme fa Wepon a(
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ale).
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0 L u awns N tb. Mln/. am udod"dY amuutiy rim Ikeeai artma. m
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can.voct Ne Pmjea (Sc ttW. Bill ad Paofedw Cod¢) The coma z LL
. a ad
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. UW doe ea applymn o WWY who wimimaaaea
wM fm aah pmfeaf Duh a cmua:mrtawn .) ll,md pm me Canu e.
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WORKERS COMPENSATION DECLARATION
1 baby aQua ttMer pcm yaP.tla)' ave of me fa0owln, dc•._.i_-_
❑ 1 h,.e and wm mnetda a eadBem of Cotmnt m xlr-ram ra Werkef.Cmtpen-
adat u prwMcd ra by Scabs ]100 of ds Lubar Code. fa th Pedamaom of Ne
work fa rhkb tM. permit a imml
I h,.e and wi11 mdoub wdrtr C.Peurim Itmuaatm, u mgwaed by Smim
..
]T00d da: Labs Code, fa do paramapc. oft wok fawbkb difpecmuuIvuea
My Wa sCanlevaum barna ortic ad Polity ttwbcr arc
Caic.' Policy
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tbuamlm aaa oat W mepk¢d YNe p.rmit u fame ItmamN doBu. (5100)
aha)
I ratify mu b Nc Pmfam of ft work ra Which th It It it d. I "I vot
emPbyaagpenrtln,nr maarcr c bJ&t war/xn'C.P,-.,
L errCdvaala.are
Applba
NOTICE TOAPPU NT: I r 0(EccmPUW. yw .ItauW
bourne abJ m the Wo . Jae u N W ut o Code. Y. mtm
Z 7a db mmply w J Poo von. a tba Permit bd he d mated.
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CONSTRUC171014 LENDING AGENCY
1 hembya = Nn Nem u a comtuMM W 09 apeay fm m. Pcrfamntc of
.
> the wvt fa whkh mu pmou is -,J W. Ch. C)
latrli Name
.
.
l<ad.e. Aedma
jIapfyda11b,..wmrw,h a.wpalemam..b.i.(.0 r
�` cmvct 1 M= m comply r all aty ad county adiu ad sum rw. mWftgn
Jhuilaitt5cmvutba and hakmmfyoa mp alCk dtymertim
,bvw-memloved popmy fa h pc . p rpo
d
Wmku aping
y (Wc)apee maKiodomatilr Nd trop hnmka the City of Cupvtivo aP,iut
A Ii,GLtietlaapaenu..omwe.PNayau�.m YruY waYamue.plmlab atY
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APPL�� M W SrNtt NDS AND i COMPLY WITH ALL NON -POINT
Issued by: Date
souacE
Re -roofs
Type of Roof
SI «App HAZARD US MATERIALS DISCI URE Oa¢
win Wappl afuture WUmvp oavpant pas a Nome b, aNau..arson
y I defused by Ne Cupetdm Mtm W Ca@. CUPmr 9.1; ad dw. Hd and Safay
S�u3]xa)1
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All roofs shall be inspected prior to any roofing material being installed.
❑Ye STN
If a roof is installed without first obtaining an inspection, I agree to remove
will m..pplicwl a mw wiwa5 aa,a am'W'n a de.l¢..bkb
wit w,Nw ur anumi.0 u dcrard by th. B,Y Arta Al+QWItY Ma-li
all new materials for inspection.
Dmnn1 t,.w
❑Yo pN
lluw mid do h,aNwsmLedd] Ia11e11L11mdCr GhaPLr A9i Cr NCfJ11rIX-
ttuHWN&Sdttr Com, 13303.15 ]aav1253]d.l undmuMNm if Nc bdkii,
-
dou rot Awe N • L mu It y acpmdblitY m ^Wry Ne aFttPam nr de
teyvitvtc map t aanam.CwrcamM
Signature of Applicant , Date
j
"B"
All roof coverings to be Class or better
Orra tl, m am'