05050009 CITY OF CUPERT[NO I " L � -' a
BUILDING DIVISION PERMIT C�t��i lAl1-QRANFORMATION:
BUILDING ADDRESS: PERMIT NO,05050009
10195 BONNY DR
'NER'S NAME: PERMrrL UEDATE
:NONE: SANITARY N0, CONTROL NO.
ARC Hr1ECr(FNGINEEA: BUILDING PFAMrr INFO
BLDG E12Cr PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
1 honcnY rttUm N,I I am liccn.oi vodor purr W ou of Cbsi c,9(wemcncinp
N Sccdon 7M))of Dr Wan 7 of the Bu ncu and NofcWour Cods,and my license is
in fomoomdcffe ADD 5161 (BEDRMS) /REMODEL
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ARCHrMC"r3 DECLARATION SKYLIGHT/WINDOWS/UPGRADE ELECT PANEL
I UNcraand my PWS a 11 be used as punk mvN.
U
IA Luxmcd RoI.ocal .
O OWNER-BUILDER r.DECLARATION
I hcnsby.1rvm Nu 1 1. camel tram Nc f m osyar3 L'Myr lar for lft
y
_p o whin in, raawa.(Sadao]ID1.5,Buslw apd P .&mol Cale:My caY m county
. $ which Its iuu a .m ro mnunrl,pplic bt r"so b noir a mP09 any mlrmm
rz> priorbiuiuuancV.a..,Wiru ft mvLp soft C.W'lo0ka upmd.,...num
< Nuc lkcoed pm aam70ft 0Mor.1� 3ofUseB r c�.Lla a (Op.9 C000). Sq.F[.Floor Area Valu$i®m O OO
(commellonp pt Salfmm and of Di �orr nr the Budnc men Rofmy Codnor
Ina h V eaempl Nvcfmrn and the Gsis fm tM ak;w rumpda4 Any.'lolw'oo or
Sccdw 7031.5 by any appllant for.permll abjeaa the apprcanl to a tl Pew4y of APN Number Occupancy Type
gat mons Nan Bw ha,mad ddlN MWL 35912031 . 00
❑I,u ower or do property,or my umply wW rapu u Neh mlc mmplm .
will do d1e wart and the smocmrt u wt inv ldrd ma4(W fmsak(Sec.]O.a,Bvuneu
sew Pmreaiow Cods I Commoner(.I:.....»lar aov m appy m.n axn of Required Inspections
. ptopeny who WiW aimpmwa llacrton,md rhedou atotllwahhlvuclfm dwuph hu
orae ,th bolptmor opt n ch Impmwamuart Ola imcodedmp one
V.
,uil w,dle WiWin�mhoM9 mmsu alded1d arc WI otnpmp iIm the own of
Wilda viB haw dr hmdm err pminp Nu he dW oat WWI a improv fm puryoe of '
uU/y ,
.[a 1.u avoir of Ne Propcny,am euJual.elY cbn x n{xiN rvsud mnuacbrs to
'} wnaluct do pojen(sec 7044,8u4inm ad PmfcW our Code)The Cmlac s U-
c Lar dura lwt apply m m owns or vqp y Wilm impmwad o,on,and,
wW coomm for a pojem rdb a coavamm(a)Eancd pmsuam u We Coots Ws
IIe Law.
` Dian pu Ser. .B&PC
Me '(
RKERS COMPENSATION DECUBATION 1
Ikroby aR Imderpeawy of perjury mcM Nc rolb inp dalarwlns
L 14.4 arm will In,by • dour 3 e a ft t n m c cic.for far urfocm o of
anal.a pi 'h mi fm by Istvan 7100 M de tabor Cock.far Ibc perfamuec of do
wwk for which Nis pvmlt Is Ivucd.
D 1 haw and mll un i.u6n Workcfs Compml d.hs ..u n,trin,d by Sccuon
37(10 ar Ik Labor Cods,fa Nc pmfmmma of dle wort far which this pmmil Y iaoed
My Wmkef4 Caalperuauw Wunrc canis(xmi Polity numbor wt:
Grhr. Policy No.:
CEMRCATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thbsccllm nccO our WcomrM if Net sYnitlaroonchu &II.(3100)
m b4)
I o-nify dot u Ne pmfarm xmrk roc which Ibis P it is iaucd,I"I Iter
npoysnYPcnon inm cra ueZE bao7e 4mb So do
NOTICWarkcn'Campcuwm
tarn of Cilifomi //
OTIC
kPPPl
E bj APPIJ :If,of making Nu Cer oos of of Eal,or oo,yam shumW
become,comp y we Wmh p ComPcwdon it sins M IEc Labor Code,yvu mm
,Jz forWwiNcomply with S¢h pmvWau or Nu Permit Wal Wtkamud rcotcQ
Z71 CONMUCION LENDING AGENCY
[r .N. Ibertby affirm dlud is a cowncual lmdin3 agowy fm Nc peRamurlm of .
(Y > du w k In,which wua pawn h Mood(S .3041.Civ.C.)
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r71<n4er'SAMmss
U0 I cenlfy doo 14w rtw doer application arld Suu duo the.bole Inromatim u
E rnnccl.L"'m wromply xiN w dry W county otNwlas`mu lam rtWinom
O WikinM connncti.n.and bensby"m .lcpccnuuwaof Nis shy urnrr upon the
abovc-onto W ncd pmperty for impcnim purpme4
(r"1 (Wcj gbrt on saw,m&msry am lxop ha.mlea the Gly or Copmum.panty
VB IubRld Jodpmcnm case vq eapcmca wblch m.y n any w.y umucap.imt aid Gly �J
U Z in consequence of du Panliap M this p iL
^ APPLICANT FA STANDS AND WILL COMPLY WITH ALL NO Issued by: Date f^
SOUR GU TI DNS. / _
/ — - , Re-roofs
Sip MAppl HAZARDOUS MATERIALS DISCLOSURE n.�. Type of Roof
Wili Nc apylionl or fou Wild'ug..pnt none or haotd[olb.N ,nn.w l
u hErW by du Cmpnlm Municipal Co@,Glkper 9.1;aw uti HdN amt Sam
e.S¢oion;9E32(Ot All roofs shall be inspected prior to any roofing material being installed.
Dy. _to
' If a roof is installed without first obtaining an inspection,I agree to remove
W II du aPplicuu m futons Wilding by ft ay A c Air col a dMani which
emio hsl dos air mnlamiltuu u IkfulW by Nc Bay Am Air QWllly M.naPmcm all new materials for inspection.
DiSuiclt
D Y. - �d
1h madthehvadasmaurialsrtquhmlclmunder Chaper695ofNcCeifw-
wl4ulNRsafcl Cwa,Sear"n505,25533a 25534.1ud-tvzld Nn VNcbuill ni
donro Y waleaam.Nero lth my rtaportriNlilYbmufY wa:accupnlMNc
rtgm nlnwnk uRhlYlphtr wmatnsor.cm;rn-,maro:,�acy. Signature of Applicant Date
All roof coverings to be Class"B"or better .
m amlhmVed apm Dau