00070148 crBUloHDIVISION o
NG PERMIT CONTRACTOR INFORMATION:
INII.DING ADDRESS: PERMITNO.
OWNILR'S NAMI?: APPLICATION SUIT DIVE
1.0626 N BLANEY AV 00070148
PHONE-. SANITARY NO. ('ONIROL No
WALSH 07/24/2000
O ZO ARCHI'I'HCTBNCONEER: BUILDING PERMIT INFO
y BLDG ELECT ,� II MPCH
LICENSED CONTRACTORS DECLARATION Job Description
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IS9""z_z 6 Gill y (S r 91131.5 Il i t 1 Code:Any I, n ,
EE, .utl1 .. 1 f 'll 1 I:h I ya'r.0'e
yam Prr I. 11 'rili 1 earsarch I In fibiligned stainciancial
«01 lard-„iCsoria l9000)el libe til,1 rise B til 1oo I dl r :�C Coal Sq. FL Floor Arca Valuation
nr 11191 he IF CEIII,IN therionce Led the basis in the al bored e%Clnpliess Any lio latern
of Semmll 9831.5 by ally appl'mrm for a permit subject.Iba ap Iri In a evil"nilly
„fnrtmamonto See bundrcddollar,S50o). APN Number Occupancy Type
❑LEll ,,neroflirepmpeny nrllyempinyecc with amges tither snleeI na'al $730
will the lork. I(lie stiocaret 'intended0' d for. (So,,9044,
Baroo.,dP r-. c The C li t _1i 1 11,IymI, Required Inspections
I'Llool ,,,Perry E 1 fl.I,, npova. liers,a and.1hodoe,Inch work oneself 31.643014. 00
n bmnyh his rara cn,ploymspmvidnl firm sets iinlpnw...enlx lire nal Intended or
offered far sale.If,however,the building of itepro-ia.nt i,sold within are l nr
Inplefmn.11,c law,,,,harder sent have in.harden of paving that he dad not blind no
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repro,,for Particle aLbalc.) 304 — ROUGH ELECTRICAL
❑1,a,nwnaranhepa,pony.Los e,elilrVelycoloneefirbefollhatl„edr„nlnletnnta 501. — FINAL ELECTRICAL ENERGY
Lo
antsel(Sec.9044,Business and Prfdnvnns Code',I'the Conlnictors
Loc:n,eLa,'ho,tall"ply manawnernfpmpcaywto,bfNdsaeirtlpmve.111emnao 505 — FINAL ELECTRICAL_
and who ennnt,lo, Ga'.nab Projens ,In a conuva,or(s] I'mcaId parstuml to the
Cor inth,'e License Law.
❑I and exempt order Si ,B.@ P C fnr lhlx ruuon
owner nate
WORKER'S COMPCNSA I ION DECLARATION
re '1 1r 1 1 I,Y fI if 111,1 11 g l f Yto
❑ 1 1 I II t Certificate A 3 I t I I f Woor
k is
Col P f 1 T 1} Social, l]00 or (lie I.ahni- Code. boInct
penX
,Lf tire k If,,whichin,pnint is
' - IQ�1
El I h and 11 , Worker's C nP tan Panreliance!
a1J y SwTon
1 f fLI Cn l f II r' f m s lot, i
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Site\4 k c l 1p Ia c - I Ph1 y If amt
Car ��IE 1 y N 6? 0/
LR'I IMC\T OI I XChl4 IOV 110M W IiK R5
COMPENSATION INSURANCE
(Ile.section need not be emnple ed if the Permit ie for one hundred dollars
100)or less.)
I certify that in the perfannance of the work for which Ihix permit is soled,I
shall nal employ any person in any manner so as to bcco ne subject be the worker;
Conlpensution Laws of California.Date
Appbeont
NOTICE TO APPLICANT IL ubcr making it'I'Con nHcam of P mnpdon,yon should
z
beer nlc xuIT-IIo the Wefeass Compensation pro%isiunv of the Luhor Codc,you nasi
0 fam,wid,comply wire w¢h Pro%isinn,or P eon1 shall redeemed revoked.
ti CONS hereI.. ONLBNDI NO AGENCY
1 hereby oiffironlleh that there iv a mmtn(So,. 097,O agency fnrlhe Pcrformunre
I,[the work a,r whlcb Ihl.permit is issuti ISm.3099,Civ.C.)
Q Lender'.Nnnne
� z Lcuder'c Addrrss
V 0 I front, loo11 coal Iii,'Ipl f LnI that h fnman,is
:tq tE, ("I'll
'r t l.,E,c II II 11161, I ' my ordinances J nalI .mltin,
0 [� toNodlg ,as...mfinl.and nereby:author b eprescmauves N this city to inner upon
�y W he above-mc ltecnCd prcpany fnr lnspuAlon prmases.
� Qd (W ) y f .� -J 'fyndk lir Is.WeCity f( I Yrs ay'I2a
V] Pair I'f 02,P111are
f." 1 .cIi 'I r l , In my y.. kalnst:aid
V 01 ler .. l ,eg all toiefies pernuf.
APPLI TANDS AND WILL COMPLY WITH ALL NOTE IN ted by: Date
re NCanvanor life Re-roofs
AZARDOUS MATERIALS DISCLOSURE
wiar mare bdhfing ocelli as store nl binall, mmar.i ineithType of Roof
a.danced t Mnn eipal Cade,Chapmr 9.12,and Inc I letlllh and Safely
Circ,Seelien 2553200?
0Ill 0 N All roofs shall be inspected prior to any roofing material being installed.
Wi111hellpl,raam orbare brad.ng aeelrptmr all,re,prem ordeviees whim If a roof is installed without first obtaining en ins ection, I a ree to remove
n'It hoeaalras aircrowminannies de Bned by the!lay A rn AAn,Dark,Mtlnagemen, p g
oii.taa^ all new materials for inspection. Applicant understands and will comply with
°Yc` °N” all non-point source regulations.
I haeo real tine haeanlmm mwairts rerlairnmoma trade ChtTter 6195 of the
Ctlifornla Health sl,Safety Cade,Sectlnis 25505.25533 and 25534.1 nuMrxmuJ thu,
if a building don nm currently bavc it earth Illus II Is my respnn.."Ibly to amity the
cntprinf athe rerryfremcno,,v inch nest he mel prior to i.s.uance of a Ceniticam of
OeeupencY.
Signature of Applicant Date
Ownern,"llar edrgel„ Date All roof coverings to be Class "B" or better
OFFICE