06050194Co nPERToNNO
MTIONh
1LoF PERMIT
W-6 RTQR IIdF
�'•a. f"ShAN'G
ADDRESS:
F
YESSNE
p�MrtN006050194
68 BES
NAME:
PFJthtTr ISSUEDALE
YESSNE
NE
SA ARY NO. CONTROL NO,
ARCHRECT/ENGINFFR:
BUIIDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
1 hereby ulbm that 1 w I{maui uab pro+itim. N Oupa 9 (caomeruMy
whh Scctiun70M dDlvldoa 3aft Buvxs+md Prdmakm Ctde. and my lkcne 4
lob Description
�� ■ F
in mufmamddre t� OLD�P
^'-'1�i7� •_
INSTALL 3 SKYLIGHTS FOR SFD �L.Aj,
-
I.icen¢(ftnyL—Lie..
Dae-G.Tt2'LtOV�_ CaNtawr
ARCHITECTS DECLARATION
rnn be toted a public rtacda
I urderoaod my Pl•'Sha
(� �J
V11d /�Y- 2001
jF� I� A �'I+.fa I 1,
ti®((1�j�nF1/ tl��fglf 444
Lixnscd Prof.untol
OWNER -BUILDER DECLARATION
I hereto .from on 11. uaop fmm the C IJccmc tyo for tM
er. and Hofcsu0m Cork: My city our county
folbwing .On. (Scion 1.5. B ecian; Code,:
c tar.
which ui , Permit w cmurva.
mPruon dpermit «rtpuo my sternen
_n /(]�c
f.rw,
dto permit Gkaugrred
Prior itsfroud Wunt1.ft M1c.pplk
ju iu pplu
f.Ilanelaw
Sq. Ft. Floor Area
Valuation
afors«h
.(Ctpucrel9
(OUPer9
iwnwncing udlwumt to tic a Ditlbmaf othe f din B W
(eororxMnd wiN SeNoe ]000)d DivtuortJdde Buolrca and Prafralm.Codd«
tlw be 4 e>®pt draefrnre etd ttr bad, r« the uk'ted eaemptim My "OlLdun of
Occupancy T�(K
Seal«t 7031.7 by my.ppBam for. P,onot ab*U tbe, WH Lm, arB WuItY of
twt mart em fiw keedred dollen (5500}
Q L on war of the property, co, my —InIm with wyo or Thew ere campen edoo-
Required Inspections
9 P
wJl de thcwOrt-arlt the..mrnne bed, heeded« oaered wr edc(SM. TOu. Btmrc..
W Pmreti«u Cade The Couacme. Lane, law dun W r npWY to m owner a
property wM bWld, orimpmw. thvmo, W vAo doosceb wok M-11for thorough but
Own ernpl y provided eu airb Impmsememt, one notineMN moQerod In, ale U.
howevo, the buRdIng « Impmwment iSSM w - woe Kar a muplooke-due wmer-
buOdm win law de Maden of prone, tbu be did no, WU «irep me f« p.Poe of
ale.}
❑ L u Ower a the poperty..m aduuwly canu.cuot vW Bmnd Lwimms w
c00a.run the Pmlece (Sec 7W Buunev .d Pracedr m Code) rhe C"o ' Ll'
au.e lav deo on, •pPb to m owner o[AmIt "wba built. W npowa them., ud .
.
.W eanuwm for u ptoJec4 with,mnu.amr.) I11ea2d Puma—t a the CoauanOY.
Lkxns law'.
❑Iw cssmp uric See ,B&PCfordbis e
fiver Dow
WORKERS COMPENSATION DECLARATION
In," al4m mtder petally Of prjury nee d me rolbwing dea.r.li«m
❑ 1 baw.m w01 m.intuo. CW floe of Cana.In elf -lane for Warkcf. Cmtpm-
.
sotic , n poHded for by Seem J'RIO of rho labor Cock, Into the Performer« of the
wort for which this permit 4 ia«d
p I bare urd wd, ondn,d r WortrY. Compmvda. Inarm¢, u reel by Section
.
JT(10 a the UbO Code, far the performusa oftba v r« whichdu.�pjunat btiered
MyW«ref, ernpeaarian'i cya"Ur tosA J1e�
CERTMCAATTEE OF EXEMPTION FROM WORKERS _
COMPENSATION INSURANCE
r
(IL'u rttds rcN mtbe co^tpleml if th porch 4 f«aac hnn6ed doom (STOP)
e leu)
I c+tify WTI M 0c puformuu d we work fa wkkY e4 permit 4 Loved. 1.baB ret
my pane io., mover.o u e beaoc abjtst w Ue Waritos' C«nprnvdm
Loons of Callfomia Due
Loons o
NOicenra
TICE TO APPLICANT: If. don,.. t thin Ccrdficae of Ercmptim you should
become ubj= on NC W« s Com on.don povivom Or the, labor code, ymr moa
forthwith comply wdb .xh pm,,bno u no win permit Cull be doomed mmkcl
CONSfRUCn(YN LENDING AGENCY
Thor b1 offer. Thu den4a perfievurtad
mI.
ciny.Cnc/f«de
a the woh for whiN tic, permitb Wucd (Sc ]09'I,Ch. C.I
lotted
LcMct. Nana
'
� Isrtdtf. Addma
I ,nd y that I bow mad thin aWkadan vE .woo est the .bow id«m.don u
' carnet I .{rte . comply v'tth ul city and cotnty orJirvrt¢. md.... 4v. mining w
building courn the, and both,.ufnm rtpresmutiw. or this city to rota upon the
whew-trcntiut fon im,.,ectJon purpoea
L(We) agte to aw, iMModfy and keep hurt a tle City d Coperdn0.g.imt
Il.bilidn,}udgromu.cov alt caperta. wtich maYeuY w•Y •cnw a5umt aid City
..c
Z is eomeque cee of the grounded of this perook
AP% DANT UNDERSTAN $y/Q WILL COMPLY WITH All. NON -POINT
Issued by: Date
st>cuLA VlA'w� 6I�y��
Re -roofs
Type of Roof
Si a P""
S MATERIALS DISCLOSURE O.e
Wlu
ub b
wth toolsday
er dcnrea by ate enPeniea Maakilai cave. chapter 9.1z .tm de fJwm ,tm 5.fa,
yet CBan«town ipodCo ,-CoLPvo 9,IZ ami
Code. Scalae 25533(.)'
All roofs shall be inspected prior to any roofing material being installed.
❑Yu %Ne
If a roof is installed without first obtaining an inspection, I agree to remove
WJI No.pplk.m or future building Occupant u n egWPneot Or dcuaa vhkb
croft hvudouo ur conwnimnu on, dc0red by the Boy Am Air Duuily Mous anent
all new materials for inspection.
Diu iz7
❑Ya -.fTNo
1 haw rta de WnAeu. utmablarcW'vctmeu urthv Cbpterd.95 ofde
Wining
doe Wining
Isen-tel it4 MJJuW355N.I�tvuedtka.IfNc
Jon mt nvmxry Nw . tm.q Jw It 4 my rmpoonbBity a mtif] Nc of tk
not
Date
rcge vhkEmust I un"," ar.0end".aryc
Signature of Applicant
cS
All roof coverings to be Class "B" or better
a e m.I Mk