02050139 OF
CUPE
CI sur etc DIVIiSSIiONNOPERMIT CONTRACTOR INFORMATION:
BUILD�CyppD Rt RA VISTA AV PERMIT NO. 02050139
O UMNVV�'ll��llll& FAYE KERMAANI ALPSC"M)cTO'U2
PHONE: SANITARY NO. CONTROL NO.
{Mu O O ARCHITECTItNGINEER: BUILDING PERMIT INFO
&Iv BLDG ELECT PLUMB MECH
Fa,i E U IJ C'-3 I__7
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LICENSED CONTRACTOR'S DECLARATION Cr1ptlDn
Ition7 )ofDhatlamoftheBusinensed espndPrumofd,Code.andr 9 license GAS LINE TO COO�@'�'
j=t; with senior e and effect. on 3 of the Business and Prefcssions Calc.and my license
is in roe Corte and effect.
i rc a.a Date CDssLic.x
' n V Dam
3 3 u,G ARCHITECTS S DECLARATION RATION
V,
O;to I understand Illy plans shall be used as prelatic records
ibe8 O hi<cnncJ Prolb"ruml
OWNER-BUILDER DECLARATION
^-v, I hereby arum that I am exempt nom he Contractors License Law for the $500
t- a hollowing mason.(Section 7031.5.Business and Professions Code:Any city or county
E F C which milr ims a permit in construct,alter,impose.demolish,or repair any structure
a3= prior to its issuance,also requires the applicant for such permit to file a signed statement - -- -- - --- ------ --- -- - -
thdibeislionsid pdnoint to the preisions of the Contractors License Low(Chnpmr9t...s Valuation
(commencing isith,Section,7")of Division 3nf,he Business and Professions Code) _ !,Jy� Ili.k•. . '_tL, e �.r•n mit�'t.•.) a�'."
or Ibar he is eaempl Iheiefrnm anJ the basis for the alleged cxem Elm.Any violation
-of Section 7031:5 by any rl fur s permit suM1jcns the apPlicam m a civil penally
of not laore than Eve hundred
ea dolaonam cas(xn. 202APNOccupancy Type
❑1,a.sownet ofthe propenv,or my employees wimwages aetheir sole eomperiolo n, 301 — ROUGH PLUMBIN
-will dohework.and the'swnnre'is nm intended or offered for sale(sec.T)oo,
Business and Professions Code:The Contractor's License Law does not apply to an
S TE S
oxine,of property Who build.or improves Ihermn,dna who does such work himself 5 0 6 - GA
or through his own employees,provided that such improvement%are not intended or 507- - --FINAL
' -PLUMBING.
-'offered for sale.If,hawevcr.the Wilding'or improvement is sold within one year of - ----- - ---- - - - - -- _
completion,the owner-builder will have the burden of proving that he did not build or
Improve for lempam of salcJ.
..1 ti nwne Isr the pmec.7 am Business a Contracting with licensed contractors to - N.•;'.h'
r
onswct the project(.sec.]loan Business and eny who
Code:)The ves Contractor's •G I:I'.,'! h' ,
License Law does not apply. an owner of propcny who builds seimproves thereon, _
..mrd actor's kens for such.pmjeea with n contracmrls)licensed pursuant to the. -
Contractors Liana law.
❑lamcxcm w der Stt. B&P C,forthis as son Jf' r '' i•i: it,
own e, ute 2
WORKEI' COh11'ENSATION DECLARATION
1 hereby nffirnt under penalty of perjury one,of the following declarations:
+•O 1 have and will maintain a Certificate of Consent to self-insure for Worker's
. / Compensation, as provided for by section 3700 of the Labor Cade, for the �®
.performance of she .,it for which,his permit is issued..
O 1 have and will maintain Workers Compensation Insurance,as required by Section
- 3700 of the Labor Cotte,for the perfomunce of the work for which this permii is
issued.My Worker's Co npensation Inormince center andfolicY number art:
Ca ill CERTIFICATION OF EXEMI No.:
FROM.WQRKERS I
,. COMPENSATION INSURANCE
fTh
11' s union raid not be,completed d the paternal is for one hundred dollars "'t dJ l '
IEIUO)or Icss.l
i
1-ce.I ify mut in the performance or the k for xhtch this', t is Issued 1
stiall no,
empoiany person m any man t c s b�d�n the Workers t
ore s'
CompensationLaws of Cal for al
are
. Apple m. ._ .. . . _ .. _. . .. .. ._ _ _.
NOTICE TO API'LICAN P IL after ak g II Ccn f eser Exempnnn you Should '•`
O OI heroine subjerb m the Woder'S Compensation previsions of the Labor Code, ort
forthwith comply with such provisions or this permit shall M sheered revoked,
•' "•CONSTRUCTION LEN DING AGENCY."
''I heeeby Afrrm Ibar mem iia cont nd rho lending agency foi do periormbnce
r
work for which this permit is issued(sec.3097,Civ.C.)
Q Cenderi Name-' -
O.z Lendcr's Adtlress .. .. ..
UC I cenify that I have read thio application sena state that thea above information is
la, P correct.1 agree to comply with all city and county ordinances and state laws relining
, O'U to building consloiclion,and hereby authorin representatives of this city to enter upon
} W theadwye-mentioned p, pony f inspection purposes.,• _
h 0. (W) g rex indemnify and keep harries the City of CLpenino against
(A liabilities.judgments, t d wxpensics which may in any ay accrue against said
U.. - City nconsequenceof the Brom ,fifth pemit '
Alt UNDERSTAND WILL WITH ALL NON-POINC Issued b r Date �'S �' Z
SOURCE REGDI ATIDNS �J/ZZ/0 Y'
Slgmre of Appli,rulUomri,me "' / 1- Re-roofs
nz
= � HA5ENRDOUSMATERIALS DISCLOSURE
wlidiappfte t fm' building w p tentreorh dl hrousel nmerial Type of Roof.
asdfed by Ne Caliendo M Pal Cut Chapter 9.12.and the Helm and Safety . i r• . f t
CN s ion 2553311 ✓ l� ('S'! 1"i(�.
area' ,i;�.T:. No It ''• !,' :- ' ;. i _ pll.roofs.shall be,inspected_prior to any roofing.material being-installed.._. ---_ -
Will dupplic t i Wilding patequipment devices him If a roof is installed without first obtaining an inspectioni'I agree'to remove
co
m, Icontaminantsdied by the Bay Area Air Quality Management
District? e/ all new materials for inspection. Applicant understands and will comply with
❑
r t Ye rvnall non-point source regulations.
m to ,...'•,
I have read the hnmrdo. r I. cyst 25533 a under Chanter(.95 d me
hat
if
Hddh&sdcur Castle,haveta marins 5O5at it
ymspond 3a.lity to notify the
if the buildinglikes
notcurrentlyvkhr It a Ibe that it is myrtmance of
toonficat the
acupam f the requirtmems which' t be met priono issuance of a Certificate of
Otcupancj ,-" j
Z 6`L Signature of Applicant _ Date
Owner or,enmmlaed dg rat .� All roof coverings to be Class "B" or better _
,., ...._ .. .. .- .,. . . .OFFICE _.. . . _ ... .. _ . . . . _