00110040CITY OF CUYERI'INO - -
t �3a>: ,fr3 :,• .r
-
CONTRACTOR INFORMATION 1
BUILDING DIVISION PERMIT-'
,
'
BUILDING ADDRESS: -
PERMITNO.
00110040
OWNER'S NAME;
APPLICATION SUB DATE . -
1.1108IF000 '
•�'�
PHONE -
SANITARY NO. CONTROL NO.
Q O O
ARCHI LEC'I'IENOINCER: • > t
BUILDING PERMIT INFO
f
BLDG ELECT PLUMB- MECH,
I ICENSFD CONTRACOR S DI CI ARAriON'r
'< lob Description '
I h M1y a fl II ,1' I'' I d r : f Chapter) fcn 3rana 81
H w
w'J S t 91181) t Di,islTer 1 r IF, B JI f :, C le. nal my I wr,e
�0 a
fill force d Ir I
Lie
-
_
L .n Dart C
SEWERI_:INE
��3��• -.
ceALIGN
C O
I' I
ARCHI fFf"f S DI CI AR N ION
I understand J Y plans shelf r d: l bl N
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w
to rep0
a
+f �y
(/
9 "
Lu IP f
OWNER HIJII DLR DECLARATION
W
In nY li That ran clorria1 (he Contractors I I h
-
4
4dl g (Section 91131 5 B d r f: C Ie A y ly all
� O
wh b yFares It P t to construct,IN p dr.ivI repeir, logreard
• O
I I a 'I TI I' TI I It II a d.fl'mea
pd, 9 IP r s
.,
S Ft. Floor Area
Q'
Valuation ` x
Incl he I, In) I. nn c ill I t C 1 ' (Ch'
:(m enc,gw,hb.ct O,9uila Of
.1 with e ode)
ha n 3nflaHoene sadd Pn fes, ns Cede)
t-5
_
he
or,bnl'he is exempt therefrom nnd,re baelr for.lhe exemption. Any violation
� -
e
subjects
aFS t 9(1315nYany PPI' ill fnn,r l: M1jems,he pl pl'c ,i laucivil lwnvl,y
thel l aty
of net II , me n d d d lie, G5an
' -_I -' APN Number
occupancy Type
r
.
❑Ia fthf P,Y crolytopiny th wageser,d sI pcnwnwnF
-
well do ,h A I Th I. renta, , aid inteadedoffered f (Sec 7AG,L
'' t Required Inspections
/
Busiarks lindN f .' Codo The C I I I-cen,e Law dei,at p,l, 1, a,
owner of four, Who builds or iniplevi,d1 and whodenemh workhmself-
_ _
or through his own calployee, provided that sach'arpoverricals are not intended or
ar4cd for sale. EJ ht ,, me building ' Igvemen,s.old witnn„eyed-If
''10G, ---SE'WER- 8 WATER'
nnpledon, ,111 owner -build,, will have The burden of proving that [at nal baud nr.
' improve -
r ..
202 v
mr Pu,wasoranle.),
,I.INDERFI_DDR,FLLIMBII`,1G
anne'U �eny:af e.nlarrelYrnnrcrvingwi,1,'licensed contractor,
301. -- ROUGM Rwmpmr
eon udlhe pmjcel ISee. IlW4, Business ;,all Pn fessiana Code:)'I he COmracdr's
., <”
NAI,. PLUMBING,
Lic se Law does ire, apply to nn OwnerofProgenywhohad Ids orimprovesthereon,
)12r17 'F1
and war robact,bar rich p olecm with O comreuorLd licensed pasurat'to the
_ Y T
Contractor s License Law.
.,
-
❑I In drc ` B&PC far POsreso
F .
WORKCR'S COM'F.NSAf10N DECLARATION
In by H I IM 1'Y fP 1 Y Id lull Sd I"I :
❑ 1 11-11 vnd w111 arrialain a Ccnil ate of Consent m eIf'nx,tt fill Wooer's
•_ "
Compeuszlion, provided for by Section 3700 0l The Trial), Cnde, far the
,
m
performance (If thework ow
d. far which this permit is id. ,
t
- ' ' , -
❑ I have Fundwill maintainWorker's Cablarookilikon Insurance.required Seu'on
•
'by
3900 of the el Code. 1 thep I he work For whichthis on, Is
.
issued My Workats Cnnpenm,on Insurance carrier and Polity number rue:
r
carder:' - - Policy No
- s
' CER1 ';[CATION 017 EXEMPTION FROM WORKERS'
'•
COMPENSATION INSURANCE
t
(TI-.: f mad net be canpletcl'f T 'permit is fn hundred dollarv--
CSlfe IT lre,.)-
1 cenify that In the perronnmec I f the wo,k for which this Perini, is issued. I
- ..
shallploy , nor emtrey person in any nature,' x ax m bnanune subject to the Workers'
_
Cnmporriden Laws of Califnmin. Dale
APPluant
y ,
NOTICE TOAPPLICANT If, ft king this C If'T fEkeipion you Oculd
Q O
hem d ,t lla,W k C p eMnp : f the Labor Code, Yon
unsl
forthwith
..
ply with h 1 n Ih v pernil sh, II be declined revoked
CONSTRUCTION LENDING AGENCY
_ i
7
I nearby affmnbuurcre is a consnuelinn leading agency for the performance
v ) •,
W
of The work far which This permit is Issued (See. 3097, Civ. C.)
-
Q
Lender's Nvmc
+
••
. U Z
Lender's Address" -
..
-
I grey that 11 - if.las 'Pyle i and .tI dr „h h f 'Tot's
T � II try 1 dbv
C .
,,,
Q [�
correct. 8 ,ro
IIY ie iscT f Imingr-
sure n'ard@cu'ty to
Tobrose
p en¢n Pon
Tos..le property
men r I t 1
� e )I l�h-
'
'fy nd Ae
r Cil
liabilities. 1 dg t I J se ay In any u) v ueuaga vs, : 'd
, a a
�i Z
City' q occurdlgr n,gO Periall.
APP 'CA NO STANDS W LCOM ITH ALL NON POI T�•r
SOUR 'IONS
Issued by: \— - Date . .
.'U
oh
V
- Re -roofs - -
Sig a IF 'FoUnFowTo, naT
. HAZARDOUS MATERIALS DISCLOSURE
- - -
willfheupoicumOrfufure building (aderpvnT_nom nr hvnJle h,,rohns ma,cdul
Type ofRoof r•,u� "'
as dcfii,ed by ,he Capenino Munleipal Code, Chapter 9.12, and the Headband Safety .
r
Code Semlon 255321x)7
❑ve. - _ ❑ No -
F
All'rgofs shall be inspected prior to any roofing material being installed:
Will Too'Ilp' 'before b ld' e P t one T,u,bcr,,),dc,hr, which
Ili J
_
If.a roof is installed without first obtaining -an' inspection, I agree to remove
,it... airs L-srefined by the Bay A'let Air QualryM age to
Districto 1a ,
all new materials for inspection. Applicant understands and will comply_with
5 _
Y, ❑ No
all non -point source regulations.
' I lace TendThe hazardous ler d: re'dwareals under Chapter 695 of the
s ..
-
Celifm'a Health &SaflyC I1 Sections 25511.525533 and 255341 undervand that
•itIn,
buildingdeesnol currmnly have 1, forigr ,hail isunyre"Flabilry Io notify[be
'I.
w
m,p t q theregorc , which mus, b I p tar To is,r nc f C nllicme of
occapan
'
'
r.
_
- -
Signature of Applicant - "" Date
-
.. "All foof coverings to be Class`?l3" or better
ownerornwholieedagent - Date
OFFICE ; ,n
CITY OF CUYERI'INO - -
t �3a>: ,fr3 :,• .r
-
CONTRACTOR INFORMATION 1
BUILDING DIVISION PERMIT-'
,
'
BUILDING ADDRESS: -
PERMITNO.
00110040
OWNER'S NAME;
APPLICATION SUB DATE . -
1.1108IF000 '
•�'�
PHONE -
SANITARY NO. CONTROL NO.
Q O O
ARCHI LEC'I'IENOINCER: • > t
BUILDING PERMIT INFO
f
BLDG ELECT PLUMB- MECH,
I ICENSFD CONTRACOR S DI CI ARAriON'r
'< lob Description '
I h M1y a fl II ,1' I'' I d r : f Chapter) fcn 3rana 81
H w
w'J S t 91181) t Di,islTer 1 r IF, B JI f :, C le. nal my I wr,e
�0 a
fill force d Ir I
Lie
-
_
L .n Dart C
SEWERI_:INE
��3��• -.
ceALIGN
C O
I' I
ARCHI fFf"f S DI CI AR N ION
I understand J Y plans shelf r d: l bl N
`
<
w
to rep0
a
+f �y
(/
9 "
Lu IP f
OWNER HIJII DLR DECLARATION
W
In nY li That ran clorria1 (he Contractors I I h
-
4
4dl g (Section 91131 5 B d r f: C Ie A y ly all
� O
wh b yFares It P t to construct,IN p dr.ivI repeir, logreard
• O
I I a 'I TI I' TI I It II a d.fl'mea
pd, 9 IP r s
.,
S Ft. Floor Area
Q'
Valuation ` x
Incl he I, In) I. nn c ill I t C 1 ' (Ch'
:(m enc,gw,hb.ct O,9uila Of
.1 with e ode)
ha n 3nflaHoene sadd Pn fes, ns Cede)
t-5
_
he
or,bnl'he is exempt therefrom nnd,re baelr for.lhe exemption. Any violation
� -
e
subjects
aFS t 9(1315nYany PPI' ill fnn,r l: M1jems,he pl pl'c ,i laucivil lwnvl,y
thel l aty
of net II , me n d d d lie, G5an
' -_I -' APN Number
occupancy Type
r
.
❑Ia fthf P,Y crolytopiny th wageser,d sI pcnwnwnF
-
well do ,h A I Th I. renta, , aid inteadedoffered f (Sec 7AG,L
'' t Required Inspections
/
Busiarks lindN f .' Codo The C I I I-cen,e Law dei,at p,l, 1, a,
owner of four, Who builds or iniplevi,d1 and whodenemh workhmself-
_ _
or through his own calployee, provided that sach'arpoverricals are not intended or
ar4cd for sale. EJ ht ,, me building ' Igvemen,s.old witnn„eyed-If
''10G, ---SE'WER- 8 WATER'
nnpledon, ,111 owner -build,, will have The burden of proving that [at nal baud nr.
' improve -
r ..
202 v
mr Pu,wasoranle.),
,I.INDERFI_DDR,FLLIMBII`,1G
anne'U �eny:af e.nlarrelYrnnrcrvingwi,1,'licensed contractor,
301. -- ROUGM Rwmpmr
eon udlhe pmjcel ISee. IlW4, Business ;,all Pn fessiana Code:)'I he COmracdr's
., <”
NAI,. PLUMBING,
Lic se Law does ire, apply to nn OwnerofProgenywhohad Ids orimprovesthereon,
)12r17 'F1
and war robact,bar rich p olecm with O comreuorLd licensed pasurat'to the
_ Y T
Contractor s License Law.
.,
-
❑I In drc ` B&PC far POsreso
F .
WORKCR'S COM'F.NSAf10N DECLARATION
In by H I IM 1'Y fP 1 Y Id lull Sd I"I :
❑ 1 11-11 vnd w111 arrialain a Ccnil ate of Consent m eIf'nx,tt fill Wooer's
•_ "
Compeuszlion, provided for by Section 3700 0l The Trial), Cnde, far the
,
m
performance (If thework ow
d. far which this permit is id. ,
t
- ' ' , -
❑ I have Fundwill maintainWorker's Cablarookilikon Insurance.required Seu'on
•
'by
3900 of the el Code. 1 thep I he work For whichthis on, Is
.
issued My Workats Cnnpenm,on Insurance carrier and Polity number rue:
r
carder:' - - Policy No
- s
' CER1 ';[CATION 017 EXEMPTION FROM WORKERS'
'•
COMPENSATION INSURANCE
t
(TI-.: f mad net be canpletcl'f T 'permit is fn hundred dollarv--
CSlfe IT lre,.)-
1 cenify that In the perronnmec I f the wo,k for which this Perini, is issued. I
- ..
shallploy , nor emtrey person in any nature,' x ax m bnanune subject to the Workers'
_
Cnmporriden Laws of Califnmin. Dale
APPluant
y ,
NOTICE TOAPPLICANT If, ft king this C If'T fEkeipion you Oculd
Q O
hem d ,t lla,W k C p eMnp : f the Labor Code, Yon
unsl
forthwith
..
ply with h 1 n Ih v pernil sh, II be declined revoked
CONSTRUCTION LENDING AGENCY
_ i
7
I nearby affmnbuurcre is a consnuelinn leading agency for the performance
v ) •,
W
of The work far which This permit is Issued (See. 3097, Civ. C.)
-
Q
Lender's Nvmc
+
••
. U Z
Lender's Address" -
..
-
I grey that 11 - if.las 'Pyle i and .tI dr „h h f 'Tot's
T � II try 1 dbv
C .
,,,
Q [�
correct. 8 ,ro
IIY ie iscT f Imingr-
sure n'ard@cu'ty to
Tobrose
p en¢n Pon
Tos..le property
men r I t 1
� e )I l�h-
'
'fy nd Ae
r Cil
liabilities. 1 dg t I J se ay In any u) v ueuaga vs, : 'd
, a a
�i Z
City' q occurdlgr n,gO Periall.
APP 'CA NO STANDS W LCOM ITH ALL NON POI T�•r
SOUR 'IONS
Issued by: \— - Date . .
.'U
oh
V
- Re -roofs - -
Sig a IF 'FoUnFowTo, naT
. HAZARDOUS MATERIALS DISCLOSURE
- - -
willfheupoicumOrfufure building (aderpvnT_nom nr hvnJle h,,rohns ma,cdul
Type ofRoof r•,u� "'
as dcfii,ed by ,he Capenino Munleipal Code, Chapter 9.12, and the Headband Safety .
r
Code Semlon 255321x)7
❑ve. - _ ❑ No -
F
All'rgofs shall be inspected prior to any roofing material being installed:
Will Too'Ilp' 'before b ld' e P t one T,u,bcr,,),dc,hr, which
Ili J
_
If.a roof is installed without first obtaining -an' inspection, I agree to remove
,it... airs L-srefined by the Bay A'let Air QualryM age to
Districto 1a ,
all new materials for inspection. Applicant understands and will comply_with
5 _
Y, ❑ No
all non -point source regulations.
' I lace TendThe hazardous ler d: re'dwareals under Chapter 695 of the
s ..
-
Celifm'a Health &SaflyC I1 Sections 25511.525533 and 255341 undervand that
•itIn,
buildingdeesnol currmnly have 1, forigr ,hail isunyre"Flabilry Io notify[be
'I.
w
m,p t q theregorc , which mus, b I p tar To is,r nc f C nllicme of
occapan
'
'
r.
_
- -
Signature of Applicant - "" Date
-
.. "All foof coverings to be Class`?l3" or better
ownerornwholieedagent - Date
OFFICE ; ,n