00070095 in
cfTr of corFxTrNoCONTRACTOR INFORMATION•
BUILDING vISION PERMIT .
BUILDING/8J11R�Fy`8' AMULET DR - i% �- � THE'.SEWER. 'DOC PERMfrN .
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OWNER'SMCECHEN. 4` ,1743 ROGERS AVE.. r' APPLICATI
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PHONE: i.(408) 452-0669 _.' SANITARY NO. CONTROL NO,
a e:Z ARCHITECT/ENGINEER,. - , - ' 1, BUILDING PERMIT INFO
BLDG 'ELECT• -- PLUMB MECH
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LICENSCD CONTRACTOR S DCCT ARATION
o��o In bye as ran[,tin licensed dap - rche"n9( s - "t Job Dese Inn - • ' -'
HJis ins.
S n 7one000),r Division 3.1 the at dPolurva Cd any[ „•,fi RE-PIPE„
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Lecove Clans I .'� 'id.K, f '�o .f. r I°
Eric�. Commator ,i- - '
H a 6 ARCH ITLCT S OECLARA - • f '
1 d d lilyareashall t,A,c public mcnNs - - -. 1^ -
z6 Lic d
m - OWNER BUILDER DECLARA'I ION s
M. - � 1 hcaby ap ma that I-am escmpl room the comanneam,L' nee Law for(lie '
C$a Coll x o,case,Section 7031.5.BeAues,vild Profession.,Card At y tY n,cup - - -
=❑ which pro,moc,apermit t 3 t Itr, p danchsh,orrelmirry:t - t •i ' d, '
pr, t t f y .th plln a u such fl signed vaImern - -
mxl n . il p t t top o. n t na act 1 (cn war 9 : Sq. Ft. Floor Area - V
or��ihoyna i,,Se cenh amerRum and thho basis name Business.cod Y-nlArysi Code) _ -
p go P y vinPlon .
I oCSadon 93315 bya yappl'- tf k n pubjersthe alipleartnon civil pe airy '
ornm more than 1 ve 1 a cored d.ILmYssnol .8.,00- ,. ' Occupancy Type
0 L is owner ofth P P tY Y calpluyIlltit their 1 safe n. . .
ill do the A d'he strusamont ancrand ou'rforephir salec(Sic.9044, _
Balkunit and Pr 1.:or,Code:TIN Contractor',L cense Law d,c oot sppl,to an c02 UND LI3IIC1 51 [IditfiB T NG
owner of property Whob Id I (hereon, 1 h d 1 workh nsell '
oro bl1 pI , pr., l lthl h p taatnld or301. ROUGH PLUMPING
offeredf sale moan Ih taintingimprovementi. fee ld
n Y f 502 r— FINAL ,PLUMBING ENERGY ,*
completion,a b e wJI have Il denofpratingyof M1e doe not built r - '
imp' r r m~pose or l ). -
I 'ias 507 — FIfIRL . PLUMBING
°I as ow of the p e Ib'a excial
tai,very Po t g Ih licensed t 'm e to x - -
.I.icei t u Project(Sen.]toM14 Bus ors aro Pry,who s Gde)The Com money,
Lic 1 d r troy t corporal f pmperry,who)o lid. 1 tl Irc h
Cul the wnmed in such pmjcars wllh a umvaumr(sl I'evnsW pa ret ant m he r
D I.,act stn g anan Law. .
' ❑tan eze opt nose~su - ,a'&pc rorthis person
-
t.
OperN D,arWORKER'S COMPENSATION DECLARAIION
Ih hY fr d pi fp Y (if the fll ,d I t
' ° I h e d 11 t aC tf t fC t t I f roI Worker's
Col p r' provided f hY Section 39W f Ih kL h r Code;To,th 3. .
- pert mance of the work for which this pe t s Ismrd,.,r+
°1 h - and will mhinr' W k rs Compelectionfnsuranc a:reyuicd by Section _ ' -
391111 of the Lab Cude?fer the performance of the week ler which this permi,is. - .,, r
,mad M ahev'.eC pea t I su'atey carterand Polcy number are e
pally No. W N�� L4 lI�
CERTIFICATION OI E%EMPTION FROM WORKERS'
' .:COMPENSATION INSURANCE
(TM1`.entlun neW ern he2onplcac l'f0-pvrnit ish el undred dallnrs " u„ ',,' °
, rS con) rmss.l I: ' . - •
'•�,, .- i
` I rfl 11 at'nthe erson in
manner
work far me sa .p t issued,I
~shall notation Laws
peak n u,y to .o uv m haeme subject m the Workers' I -
"Gnnpcnxollnn Lows of California.Damon ,
Applicant- -- -
NOTICE TO APPLICANT It Eric, k' g lh Certificate I Ex Iopti y should q "'
ha+ rte detI [new k C a npr provisions ilei b Cd y must.
forth :th comply with 1 Provisions or this permit shall he d ped annelid, 'f t -
4,F j CONSTRUCT ION LLNDINGAGENCY ' -
I hereby of ere that tl construction et lending agency fo the perfomwnee
'a �. ofthe work for which havprnft issued se,3097.Lie C1
A
Leader',Name •'s r _ . .
z .
Lender's Address.. .
V 1 ffy that lh plead this-ppl' t dant ral theh information - '
wire t I agreet < plY II city 1 county I' on d a l f g
(, to hatldtgcommefn dl ren, unhm p,scro vas 10 e city enter upon ,
'the ab t dp party f p t p p {
[rtL twig t d ryt,ekcpn yin toy we,
got -
` hunt t 1 E t d p "rich may -,Icor Y ga^a d
V Cf tl gra t tg f the p t
APPI CA INDERSTANDS,Q�jpD WILLCOMPLY WITH ALL N NPOINT �.'Issued b Y f -DatC
ITTIIICC/oohll}L, Dan Re-roofs
uhwJ (pfen cot
Dan
UAZARDOUS MATERIALS DISCLOSURE'
wtu'tne apps ant or Ihmm building o,Chapter
score or handle m : d .w material ,Type of Roof -Code:
the 321t'nt Man'c'pal Cofe,Chapter 9,12 old th Bickford Safety s .1
- t Cnde;Schon 25532p0? - c - - .Y
°V °N + ~All roofs shall-be inspected prior toany roofing material being installed:
wu in u.,' ' t return b 'Id g c p .,Air 't rya" wEun If,a roof is installed without first obtainingan ins ection,I a ree to remove .
'endf h I a ,Lic vans duhned by the re use t a A Quality Mices which
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Daniel' - all new materials for inspection.'�Applic;im upderstands'and will comply with
El yet.
" C1 No 't'` all non-point source regulations:
a I have read the miaadnus materials permit ander Cinner 6;'S'.t the
Car fnmin Heal Ph h S, ay Code,Sections 25505,25533 end25s34'.I understand that 1 - -
fth�htilJ' gd rntlyh fa tllm't : Yresponsibilityf nffy lh _'`
on,p it"oft a rem t which n ab tpH Her of Ce_rtfirm f - - -
Oc
n Signature of Applicant Date
l 7_w
owns d,goon Date. All root coverings to be Class's-'B"or better'