00120127 (2) CITYOF V; N
CUPRONO
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - I'ERMI'I NO.
1l
OWNEH'S NAM :L GG ' s'' ' •V APPLICAf[ON SUB DAT[- -_ -
I'IIONE: W 1 - SANITARY NO. COH HOL NO.
Orc]. ARCH]'I F(7r/ENGINEERBUILDING ITRMI'IINI7O
BLUG ELECT' 11 1 MECH
<L 1=1
G<
LICIINM?D IX)N'IAAGnder p DICCLA RP.Chapt
Job Description
1 bercby)0)ol is ran 111 the d sines provisions of Chapter 9 and
an,license F:Cu with Sectian]I111)nl'Uivi"ionlol the Business and Prnlessiam Cale,and mylicena
a y�� is no Jeen l Cl... ytl tI L 7�IR5
z te < oil,w ls„ 'a' Comdr
o a Dmle is�_]a c,mnarn,r P.F PIPE
Til t w n ARCIII'ITci'S DLCLARA'1'ION
l un u i Inv I Jas Nic record, Da"
t °5 pa
m O O Limn.W Prol[nsinnal T
OWNEin exc LDr:RDECLARATION l ��
1 hereby Wtinn that I ran exanlpt R D Nc RSHOinr-,hir'et,c Law fir the
�?a follow ingreason,(Section]IOL5,Itminc.s and l'mfe..iom Code Any city or county
a,F M which rculture,a,xnnit ,,u,ncwn,alter,imrrnve.den lid.or d,,air any ntmcarc
3 m priortn enisxnanrr.al...rryuires be nppliamtt losucl,arm" ,file n,ignel,manmm
I
fr�
hat he is licensed po Nout m the pn.Ienn.nl'be contractor"License law(Chilver 9 Sq. Ft. Floor Area iyytklh
Icmn co Ing with Slvalon]1X11)of Uivlvon 3 it the Bu.ine.s and I'mftt,il ,Code) on
��
or ,that he i.escmpl Iherelmm cad he basis far the alleged cacmptinn.Any violation
W Section 7031.5 by any aPPlicam for a permit wbjecl,the applicant to a civil Penally ---
,If nntlm,rctianfi,chundred dnmlr,lrsl111. APN Number Occup nb ype
❑1.nn of ateprapeny... my ampinyce wagthick-lethick-lex ith e, thwle a,mpn
ersao".
will Jo the wink,mill the soucauc o not ImnWcd of o11e,,d for sale(Sec.7W4. awl. Irl,_1
nu,inese and Pro2s"ion,tilde:me Cn rmont's License U%del not apply to at, equired Inspections
orr al Pmpemy Who bunds or intpowea therom,are who dine,nuul wore himself
through his own employee,,provided that such int uncenmms arc not intended or
offered ror sale.If,however.the building as improvement i,sold within one year of 202 — UNDERFLOOR PLUMPING
mplelion ..
,don .... hold,,will lnve oto I Is,,of pm inS th:u hid oa
e did build at
s.provefor par o,c if sole.). 301 — R01.lfll-1 PLIJI1161 HG
❑I,a it the prola.dy.a esdillicelye,n.unngwahfen,edcommemnro 502 — FINAL PLUMBING ENERGY
mthe project(See.71W,Business and I'rolrssium'Code:)The donors,consumer iiecu,c Law does not;mply loan wR,,of property of build,or improves mereon, 507 — FINAL PL.IJhID T hIG
and It,,condo,"lin such"tic to will a...mmemr(,) li'm'ed Pucwmnl m the
Comments'.Liec o,e Use
❑I..It oxvinl"under Ser. ,861'C far this reu.on
Owner Use
WORKER'S COMPENSATION DECI,ARAnoN
I hereby aflinn under Penalty of perjury one of the following dcclarminn,:
• O 1 bare and will maintain a Cenlficah,of Consent m velfinmre far Worker's
Compenmtion, x, Isovided far by Serfion 3711 of the Labor Code, for the
perfimnance al the work fir soh di Ibis permit is inw.J.
YI luwa unit 1111 Io limuin WoAres Campeltwlion Inatmnee,us N,:ired by Smlilan
3700 of the LuMr Cagle lot the performance of the work l,r which this permit i. _
j.! J k rLF`SDU a�t`o I(W,, ,command Policy nullbcrvtm2: n
CCaarrier: ID 1,Porlicy'NNo.: I'i a ""Zt/" I
CERIIIICATION Of ExFMEI'[ON FROM WORKHRS'
'COMPHNSA'1'ION INSURANCE
PILI,11....I"ed no,be anmplesJ II the"'odl is fu one hunAmd dollws
IS 100)in le...)
Ob ,
y That in he
Pcrtiulmm�cv of the work Ior wbicL IAh Persil i,i.aucJ,
r •y,-u,p in any manors.o a,to Leconte,ubjtt't to the WmrAen'
I- ,of CnliB,miu.Dam A heam
P 'AN'I:It.after making tis CemnT 11LLscni lion,you should
m id Worker'.,Cnmpem.wian prnvl"in t,or the Lubar Code,Y o inns,
Q O forte iN comply with such provisions or this permit shall be deemed revoked.
Z
CONSTRIIC'I';ON LENDING AGENCY
a } I Inclose anionthan IMre is a conamaion Iemdin6 agency bot an
the performce
W of the work for which Ni.permit in i,.11CJ(See.J(M)],Civ,C.)
1 Q 1<nder:Name
Z Leader',Address
U I cenily that l have read this application and state that the atawe iolin nation i.
"'Reil 1 amee tcomply with"11 city and county ordinances and state laws relaning
O �) abL .I ale II ly' II P I cv
I "I'his tyt enter lip
the above
i
} c to d pec pony pest purposes.
;LI the g
t.., 1IW) et :. ,J ty andk 1, theCity a fC pen ag;tmm
V) 'Iab1l:"' judgme ts,cn.I.and expense,xh OI Indy In any way accrue mpain.I,win
U Z city see the Smatintl dti,permit. 1
A,URGEREGI s,I TNDS AND WILL C ITfIAL11t�'YOI� Issued by'VQ` �'�'<y �L! Dale
%,nllltl A'I . Ilweomtanor Date Re-roofs
�IIALARDOUS MAI'MAI S DISCLOSURE
NIU Ilse applicant or fxtnm lvllding ne&ulanl..lore or handle hvmNm,meterial Type of Roof
m,defined by Ilia Cnpenino Monier,,chapter 9.12,and The IIcaIBI and S,d,c
Calc.Section 25532(x)'!
°Ye" All roofs shall be inspected prior to any roofing material being installed.
Will the applicant I furore bui111 r,.1 panI a.e egaipmrin dcrier,»hich If a roof is installed without first obtaining an inspection, I agree to remove
mit hw.uldous lar aualullnnnn xv d' mA by the Bay Arca Nr Q.dry Man., cot
Districn all new materials for inspection. Applicant understands and will comply with
°t'e` °No all non-point source regulations.
I he,c mad the hvardnus material,requirement.scatter Chapter 6,95 of the
Culiton,il.Health 6 Su( y Conics Scat 25505,2553]and 25534.1 muerslund Ilial
tithe JI 'do,,rul Ircnllylu-olenam.1mlili"my rc,pnnsibll'aylonntifythe
,cc Pam of 1 e reyuirel eon which mu>t M:ran prior to issuance of a Certificate of
"I"11ey. Signature of Applicant Date
/
ow,trr as arI ,odard agnu 1"),',�-1-�- All roof coverings to be Class"B"or better
OFFICE