00070010 (2) CITY Ile DR
PERMIT INCONTR O FORMATION:
STREET
07
Bun.DLUGAT111IMEM COMPUTERS INC PERMIT No,
OWNER'S NAME: b — APPLICATION SUB DATE
PHONE: SANITARY NO. CON IROL NO,
Cal ARCH1TECIVENGINEER: BUILDING PERMIT INFO
X00
TENANT IMPROV BLD, ELECT PLUMB nn:cH
I=LICENSED CIOR S RADON
I� lJ IJ
N64
,,4 C T (hereby of i n ill.,I tnO coed under mm sem if Chaper 9 hi mmmrcing Job Description
�a,,Cwith Section 700djof Divi+ion 3 oft lu,iness and Profeoinn.Csxle,and my license
y f is in full forte un
a a.ai 6 Liccnu I. Lic.N _ '
p u
3 aCa
ANCHITF.CT:S DLCI,ARA
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2rg I wtJecaunJ trey pl:mn.hull he mcJ us puhlic rwdrds ry�/
V
aai a'ep 0 Licensed l'm(e,xinbal
o OWNER-BUILDER al he CoATION M
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uai 7 1 hereby.affirm(See that I pt f th Contractor,1 A : Law county
o the 1 35@@@
following r n (Seen 711.01 S B ' J I f u Code a y 1t' ,e m n e -
a ❑ wn h 1 P r[ B e h r fo J Ilse P y nm nolo
to.,hprice e
licensed
Poletinytime,momfcan ifific ucM1pemni mfiense,Lose(Cmnn,9
mmioneracemeJ pSeifer ms)(Pmv ome.fthe eommetors Licence Lose(Chain,,Came)
.,,bar
Sy. F. • Valuation
.commencing with Section 711 anon a basis 3 of the Braine x erect ion.Any vi Cale)
or the he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section703In v any need doll for opermit subjects the applicant mecivil penult'
of not mare than five rami�J daunts cssnruAPI9 @I6mber FO Occupancy Type
O Lasnwnentfthepropengorlay employecxtwuh wages as theirvalecomP:mation. 102 — PIERS
will do the work.and the tractum is not intended or Boned for sale(Sec.7f/N, 103 — UFE1R;quired Inspections '
Business and Professions Cade:The Commcmr's License law does not apply to an �
owner o(propeny Who huildx or improves thereon,and who dotes such work himself
or through hi.own employees.provided[hilt such improventedo are not intended or 104 — REBAR
oflitted Int side.If,however,Ill,huilding or improvement Ix old within.,,a year al
completion,[lieawoor-holthu will have me burden of proving that lie did not bond or 105 .— ANCHOR BOLTS -
tmpmselmpatpmsealsale.l. 106 — SEWER R• WATER'
01,as owner of me Profanity,am exclusively contracting with licensed tvmanorsm 2@2 — UNDERFLOOR PLUMBING
icame[the project(Sop. e)a ownBusers and Professions Cadep The Commerce,
rva", 203 — UNnERFI_OOR MECHANICAL_
Liceme laaw does not apply m an owner of a defoy who) Idsma it Improve,thenen,
and who cumnmx for such pmjetx wish o mnvrnnrfp ma ad punuunt m the . " -
Cont'actorsUomodLaw 204 — UNDERFLOOR FRAME
111 am exempt rend[see. ,Bmrcrorill,reason 205 — UNDERFLOOR INSULATION
' Owner Dan,
WORKIiR'SCOh1PENSAI'IONDECLARATION 301 — ROUGH PLUMBING
Ihereby arnrmunder penally arpfiuryenmathe mudwmgdeclarations: 302 — TUB & OR SHOWER
❑ 1 have all wig andemio a Camilla.of Comer[ 1i self-inure for worker's 303 — ROUGH MECHANICAL
pomprriencen, as provided fir no section nou of me Ialxn abs. B,r me 304 — ROUGH ELECTRICAL
Coun,mnee m.[he sod for which this permit is issued.
111 lave and will not Worker's Caopen.ueiel Tasmania,as required by Section 305 — FRAME
3700 of the Lamar Code. or me pert mance or the wok rot which mix poridt is 306 HOLDOWNS
issued. Worker'sCotpaumlon insurance carrier,ad�Policy�ny m`�bcr art.
C a er:_ PolicyNo.:Zlp- C 307 — INSULATION
is RTIFICACO�ETIONI[ON FROM IN•SURANNCE WORKERS' 308 — SHEETROCK. .
rIhis section need nit he competed if the permit 1,for one nrn.thed dollar. 309 — EXTERIOR LATH '
rsln0l onexx.) 310 — INTERIOR LATH '
I certify that in the perfarmance of the work far which this permit is issued.I
shall not employ any Person in any manner so as to become sunieet to the workers 311 — SCRATCH COAT
Compensation Law,of Califon i..Date
Applicant 313 — ROOF NAIL
NOIIC1;TOAPPLICANILIf.after foiling this Candidate ofHicniptinyou
should 501 — FINAL ELECTRICAL F_NERGY
become snhjet to the Wirkcr's Compenonom provisions of me Labor Code•you must
zrinnwimeomplywimxaeltPrad.ianxar[mspmBshau aeemedrevoked. 502 — FINAL PLUMBING ENERGY
CONS1 RUCTION LENDING AGENCY
'�• 1 henby alTrm than mere is a construction per
ction lending agency for he 5@3 — FINAL MECHANICAL ENERGY
w ? nf1howorklarwhicM1hisProfitisissued(Set.3(97,Cis.C.) 504 — FINAL BUILDING ENERGY
Q Lender's Nnme
Fj Z Leader'sAddnss 505 — FINAL ELECTRICAL
C.7 O 1 o mat l have read his applicit and some'bar he shove information is 506 — GAS TEST
:a F carrot.1 agree to comply with all city and county mogrances and state laws relating
O U tobuildingconwmaion,mrdherebyauthodrempmvartamxsofmixcdymenternpm 507 — FINAL PLUMBING
>y rt' dwahule-onina tied no,s n, or inspecton pnrprnex.
a (We)agreetosave,indention,and keep hurmlexthe ciiyofcodoinnagamxt 508 — FINAL MECHANICAL
01 liabilities•judgments,costs and expenses which may in any way acerae against said
U Z citymconsequenceofthegrantingofthisYennn. 509 — F'INAL GRADE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ere@ — CThIAI ill ONhlThl fj Date
SOURCE REGULATIONS. y'
sigmnrcon Apphmmucotnou,na Dane Re-roofs 514 — FINAL PUBLIC WORKS
HAZARDOUS MATERIALS DISCLOSURE
Will the vpplicantar funs[wilding occupant mucor handle harallous malarial Type of Roof
as def recd by the CuNnina Municipal Cres.Chapter 9.12,and the Health and Safety
Cala Section 25532m)7
Ely., ON." 'ATI roofs shall be inspected prior to any rooting material being installed.
Will the applicant or future building occepamuse eyu'i,ancotordevicmwlden If u roof is installed without first obtaining an inspection, I agree to'remove
mi
et hmurdous air emanational.,us defined by me Bay Arca An Quality Management
Dimtit7• all new materials for inspection. Applicant understands and will comply with
1 have ON. all non-point source re lotions.
1 have fwd the hanaNnus materials 501,25 33 t under 4.1 un ersu of the (1�/Y / O
ifhmildong th&Safety axle,avea ts255H5.t it Nontre"nibiloyeetmndohm I y11 5 U
if mu huilJing tit•s no currently have o¢•nuns,that it ix my respotsihillry[m roily the
pram of require t et is hi the nod prior m tssuunce of a Ceniticaa of
�uro
pass Signature of Applicant Date
o�� 610
ader or�amaraed ageit Dale All roof coverings to be Class "B" or better
\ - OFFICE -
1