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Ru I DING D-1v'sioN PERMIT I CONTRACTOR INFORMATION: I I
BUILDING ADDRESS:
OWNER'S
ARCHITLCVENGINEER:
LICENIED CONTHACTOII'S DIiCI.ARATION
I hereby aft ism that 1 an licensed node. provisions of Chapter 9(enfnmmcing
with Section 7000) if D.Xilkm Sot the Bodaw,,itail Prafessioma Cmle.and my Been.,
is in full force ameoa t96 7 /�
Liver- Cly` VV Lie
.x
Date _k] �_ =pContractor >lyfn.
C111TECF•S DECLARATI N 1
I understand my plans shall be used as public awards
Licensed Professional _
OWNER -BUILDER D13CLARATION
I hcrehy hiRrnh that 1 um exempt fount the Commit or's limns, Law for the
following reas..n.(Section 7031.5, Basinnn:ted Professions Code Any city or,nonny
which requires a permit n) cnnmmct, alter, improve, demolish, or repair any aructnfe
prior m u, issuance, olio requires the applies., far wch Penni%, file a sigaed statement
Nat he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code)
or that he is exempt therefrom and the basis for the alleged exemption Any violation
of Section 7031.5 byany applicant fora p,nnit subjects the offbeat to to civil penalty
of not mere than rive Is dad Jolla, ($5(101.
O 1, as owner of the pmpeny, m my employees with wages as dmir.eale eantpensatlon.
will do the work, and the structure is not intended or offered for sale (Sec. 7044.
Business and Prior ions Code: The Contractor's License law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are not intended or
offered far nate. If, however the building or improvement is sold within one year of
completion, theowner-huilder will have the burden of proving that he did not build or
improve for pugnre of role.).
❑ I. m comer ohne prnpuny, am exelmively wnotracting with licensed contruumm u)
amus the project (Sea. 7044, Bat fid Pxfl2,00ior, Cod, )'I It, Co.,funors
Ijeense Law, does oat apply to on owner of property who builds ar inc m e,, Iherton,
and who contract% for such project with a xnntmctors) licensed prominent to the
Contractor's Littme Low.
Cl 1 am exempt under Sec.. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION D17CLARATION
1 hereby ut'fmn muter penalty it pttjnry ane of the following declnnnionn:
❑t.I have nod will maintain a Cenilicule oil Consent m self -insure tom Worker's
Cormvruiamr as pmvideJ far by Section 3710 of the Labor Code, far the
peffonnance of the work far which this permit is issued.
0l have and will maintain Worker's Compensation Insurance, a% respired by Section
3700 of the LuMr Code, for the performance of the work for which Ibis Penni, is
icrue.My kern Com tion) mace carrier and Policy number are:
ni 1 INn.:FRBMW—�4''I
Cs�^w CIiHI'IIlGV10NOFF.XEMY1']ON IrNOM0-3ES'
COM PENSNI[ON INS U RA NCE
(This section need not be completed if the permit is for one hundred dollar
(SIBB)or less.)
1 certify that in the performance of the work for which this permit is issued, 1
shall not employ any person in any manner so as to become subject to the Workers'
Compensation Laws of California, Date
Applicant
NOTICE TO APPLICANT. If after making this Cimoti eof Exempt a. you should
bmnme subject to the Workers Compensm inn pnrvieions ofthe Let Cade, you nmat
f,rthwith,aally with snch pmvkic m, or ads pennh shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a combustion lending agency for the performance
of the work for which this .it is issued (Sec. TOO, Ci, C.)
Lender's Name
Landers Address
1 verily that 1 lave read this application and slam thanhe above information is
cormet. 1 agec to enttptly an all city and county ordinances ;and state Incas relating
to building ennswellon, and hereby amhnrim cluescntntivu, of this city to enter upon
the above-amnlioned pnhpcny for inspection purposes.
p4'e) agme no nave, indemnify and keep harmless the City of Catawba. against
liabilities, judgments, coni and expenses which may in any way accme against said
City in consequence of the gaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Signature of Applicanl/Cuntmetar nate
IIALARDOUS MAFLHIAI.S DISCLOSURE
Will nm applf, ar eros lulld'tng aecapunt"i'm or handle na,aulks" mwm;ul
m defined by the Cnponim, Municipal Cod, Charter 9.12, and the I laahh ami Safety
Code, Souien 255321sT!
❑Yes ❑ No
William it,licam or future bullring occapanl use ep pumat or device, which
lemic h teardom air contaminant as defined by the Bay Arca AU Quality Management
❑Yes 11 No
I have rad Om hautrdmw materials requirements hander Chaptn fi Js of tam
CaliforniaHealth&Safety Code,Seniors 255(1.5,25533 and 25531 mWcamnd tam
ifthelaidng Jnc%Q ,currently haveaten:ml, lam it is my respmtihiliry mnntily the
worn", I thl rty rooms which must he mel prior.., issuance rf a Cinificate of
r-�� ��I.,�� PERMIT NO.
EpIyl0
APPLICATION SUB DATE
SANITARY NO. CONTRO
BUILDING PERMIT
BLDG ELECT PLUMB
Job Description
COPPER REPIPE 8 WATER SERVICE.
Area
Valuation
`. _,_.._--R&y6ired Inspections
202
— UNDERFLOOR PLUMBING
301
— ROUGH PLUMBING
502
— FINAL PLUMBING ENERGY
507
— FINAL PLUMBING
Re -roofs
Type of I
All roofs&hall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection. Appliearit understands and will comply with
all non -point source regulations.
Signature of Applicant Date
All roof coverings to be Class "B" or better'
OFFICE