99080076 CITY OF CUPF,RTINO ' I C- WORKS o
BUILDING DIVISION PERMITONTRCTOR1NOFIV
BUILDINGADURESs, 603 — ROOF BATTE V5,ITNo. ' .
t — RnnF —
OWNER'S NAMIi; - 1 AI'PLICA'rIONSUNI)NI'R .:
1.0537 MANZANITA. CT LT38 U3 99080076
_ PHONE: - ,+ SANITARY NO, CONTROL NO
THE OBRIEN GROLIP
C C 2 ARCHITr;CT/ENCINEER:
- BUILDING PHRMI]INFO
P w BLDG ELECT PLUMB MECH
-
N I.ICENSIiDCONTRAcroR's DECI.ARA'1'ION . Job Description `
O m_ I Mreny uf0 dot I mn licensed m,Jcr pnwisinn,ar Chnp,er 9(rnmn coring - _ ..
F'^C�
with Section]IKKO an lnfthc tlus ncss andP ode lid my license a' • +
is inflit 'an 11
3 N Doc - C Imctor
r irCr'S DECLA \TI
rrd.ran tl p ,.polnen„Ia,ptnl'c +, " 3583 CONDITIONEDISPACE,,• 481 RESIDENT.IA
ca S O O •'LimnseJ Profcssianal, —
°'k o a" : OWNER-IIUILbER DECLARATION
m'—�v. 1 hereby affirm that I am exempt fmm the Coimbra's License Law for the '
3 2 following reason,(Section]Ill 5,Rusines„md Prnlessior,Cale:Any city m roomy -
IFC which y 'n I to notanc,, It r d M1 p' , muse' • - .•
to 3 m priortits issuance, I y the applicantfor:u hpennin Ile -6adstatement
thath licensed p nn theme inn fthe C tart Licenselaw(Charter9 S Ft. Floor Area Valuation
W u
me 'ngwtl S,Ctlo ]Boh)tr Divl u n
n3,11'0n,Riail lr fen ,,,Code), �' - V
or that he is exempt nere(rom and me hosts for the alleged exemption.Any sloMliom,
of Section 7011.5 by any applicant for a parm i stmiems the applicant to it civil penalty
of in)(more man live ntmdied dollars($5(,). APN Number Occupancy T/yype'
i ^ 1 $351678
OL as owe of the,no he unc,ny cmp.no imicathwa,e fffeedilot s compensminn.
Business
the work. ssi the ode:The
Counselor's Lie offered roe ante apply it)an Re uired Ins ectlons
Business,ou sny Whom Cude:The esInm License Lew does nm apply us an - q p +
nrvherof property chnbuildsor ovidedi',ot sash iandwoodews such work himself
(nrougn his own however.the
building or such i em nrcmend are not iinendc r of -
oome Ibr sale.IL however the bn tiding or improvement finen(n sold within not year of +
into'tion,then,C cfuilderwill have the buNawf proving that rte did not build or. _
m,pm,eg,rpulm,en�aale'!, 101 — FOUNDATION:;,. .
°1.as owner of me Pmperty,am excwsimly contracting with licensed contractors to - - i.02 — PIERS .
unslmclwmc project(See.]1044,Nosiness and Profession;CcsluJ The,Connaanr's ,
cenae Law doe,ma apply b,sonemc,arpropeny wIImhdaor lmpmve,11me,m:, +. 103 — UFER
and who contracts for such Pmjcets with a comm�o l liccowd,pursutnt In the f'
contrectnrsucenseLaw. 104 — REBAR' v.
°I am exempt order See a. ,B&P C l inlhis re:u3m _ - „•y• -
owner Data 105. — ANCHOR- BOLTS
WORKER'S COMPENSATION DECLARATION 1,06 SEWER & 'WATER, o. .
I himcb,rflfi�m under penalty of,arjur,one of the following declaration, 202 — UNDERFLOOR PLUMBING
° 1 have and will maintain a Certireate of Council to aelf:imare res Worker. 203 — UNDERFLOOR MIECHAN T CAI_
Compensation, asprovidedres by Section 37M of the Lannr coon, far m` -204 — 'UNDERFLOOR FRAME.
performance oI he work mrsket,this pen»tis issnell.'- .
❑1 have and will maintain Worker's Compensation Insurance,as reyaired by Section 205 — UNDERFLOOR ,I NSUI_AT I 01\1
37110 of lic I hnr Civil,to, I tw fon rice nt IIIc w,rk For h ch This pemla is '
issued:My entp 'al nInsurance csmerand poi'y re: '301' — ROUGH PLUMBING .
302 — TUB & OR SHOWER
COpll'' " 4 °NA " '"'' 303
'ION NS ROUGH MECHANICAL
IiNS At
anis aec' o ora ,e, in e. mill,Ibr et m oilm. ' 304 •— ROUGH 'F_I_ECTRTCAL.
t31aB)dr m,,.) 305 — FRAME' .'
I certify that in me perfmm�na el the work for which Ihis pemut is i„ora,1 306 — H01_DOWNS '. .
shall not employ any person in any manner m as to became su
bbjee(o Workers'
the Work '
cram am,ndon Last,orcaliraraw,Dam 307 INSULATION,_
Applicant -
NOTICRTOAPPLICANpIr.aftermZngtn.Certificate of Hni you should 308 — SHEETROCK - - -
becomesubjecttomeWorker,C moat npr ,ono 1 ho coil you must
z C
forthwith nchpro or p 'I mlBn de d 'kcd 309 ^ EXTERIOR' LATH
F ` CONSTRUCTION LENDING AGENCY 310 — INTERIOR 'LATH
y
I hereby affirm that them v a con,traction lending agency lot the pod(Cromace 311 — SCRATCH COAT
W of the work for which his pml
cil is issued(Sec.3097,Civ.C.) '
Q Lender',Name
z Led ,AId . 31.3 - ROOF NAIL ;
1 rtrymtin dm:applicationand.tatetotes no t r 501 — -FINAL ELECTRICAL' ENERGY
W Ea papah.1 qncc to mod,vvithall city had OfJ county J I I' c , g
to ad in ,sIr ftl . y. cntrry
502 FINAL PLUMBING ENERGY,.
Ihe no` n` tmcdp achy for' ,p t pp'. .
503,•` FINAL, MECHANICAL..ENERGY
IWyago.ti” dConn'and Aph ,1 ,hcC lY fCj fOng`.t
fr h liuh Int ,, dgmcnts t. and 's'a", hlcl Y n any y a against 'd
t.> City, a,Came,of the grantng oft peons \ _ '
SOP Cr "GUIDERSTANO4�N ILL COMPLY WITH ALL ON•1 INT eISNUedby: a Date
S. a`
Re-roofs-.
HA' `. MATERIALS UISCLOU 504 — FINRLBUILDING 'ENERGY
-
Wiillmeappbcamorinumbuildingovemml„am ere handlennammm,man..[ TYPeofRoof
C,defined by he copemina MmCpal Code.CM1nptcr 9,12,mil the Healm.,ad Sarelr ,'1'-.105 — FINAL; EL,ECTRI CAI_. -
CoJ Sed 55321 )'
°ye, All roofs shall beffl*ected rRl46toTiFF,%*6ofing material being installed.
Will the ppr 1 r °v'Id',goceap,dtdae yapmt a ice, Iieh If a roof is installt�Ztq{thoutlR$hid6i[ai fillglAWli IlBAftion„1 agree to remove
small t Imi dons air Communal,as defined by the Bay Arta Air Quality Mawm
geent
Di...C', „• all new materials ��spectiog.NoUliplMqkq,14DOHpnd will comply with
°Yes- Nill-non-point sour ulati o -
rdmed �s: �t I: 9 tsmnderco-mra9s ,rme ,. +�� NAL, TRADE
..
• Can m
California Health&Safety CodSectSecticin,2550625533land 255341 understandll t - 510 _ 'FINAL-PLANNING
if buldingdhhsw ntc dyh aactual,that it's myrepu blaI ufythe
an I ' t h nmusl he met prior ss pC `' C Aiiicahc of
Signawre of Applicant Date
m,r or numt Date All rbofcoverings to be Class,"B" br better
OFFICE
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