01020070 OF
CI BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION: "
BUILDING ADDRESS: PERMITNO.
7402 ROLLINGDELL DR 01020070
: SANITARY NO. CONTROL NO.
COO ARCHITECDENGINEER: BUILDING PERMIT INFO
E B,DG ELECT PLUMB MF,CH
y ZQ
LICENSED CONTRACTOR'S DECLARATION Job Description
$z G IhcrcbyaffirmthmlamlinnsedundcrpmvisionsofChaprnr9kommcncing p,DDTN 923 SQ. FT.
t
,: withSecrian]1XIn)of Division3 of the Rosiness onJ Prolcssioro Cade.and my license
is in full farce and effect, r ���\
O U License CI ss Lin.0 II'�
a O N Dale Contractor
ED
ARCHITECT DECLARATION
y j I urrdcmand my pians shall he used as public records
t o o Licensed Pmfessianul AFIR 1 4 200
E:
�� OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Commenon's License Law for the
tza following reason.(Section 7031.5,Business and Pmfeaiam Code:Any city ser county U�LI"1�t�t^ $89171 '
IFC which requires a permit to construct,alter,improve,demolish,or repair any strvnure 1./ ��YY VG Y
u13^y .-purser t e,also mystics the mfg,mfor such Pcrnuo,file a,i,.d statement - - -
shmhgti licensedpunmrt toted pif s vision the Contmeols License Use(ChapterCode) gt'x+la3 p�, '.q & )ql ys'� r <- Valuation
or rhe is
withSectionFI00) rDblsoaendic iliguid sand Prnfesnyvid de). f'hJi.• r. l Z Cf`a ,{R :.1 of L
or marheis 31.5 bf tan&rom'and the aver far the alleged eumant to Any l perebn
of Senior 7031.5 by any applicant for a permit subjmts the applicant m a civil pewlry- t�y..a�p��,..,
�ornotmom,hanfivehandreddollars(sew). 10#1PNl •1'ti.ftMATION `- Occupancy Type
namen of the pro,my,or my employees with wages us their sole compensation. - PIERS
-' 'do'the'work.-and the structure'is nor intended or offered for-sale(Sec.70".
Business and'Professions Code:The Contractor's License Law does not upply to an 103 - UFER Required Inspections!
owner of property Who builds or improves thereon,and who docs such work himself 104REBAR
or,Hough his own cmpluyces.provided thm such imprnvcmenr are not imendcd or - __
,cffienid ompletion,
sale. wner- walhe Wilding or imen of proving
told within one Wildof 105 - ANCHOR BOLTS �'•'
aomplaion,the owner-Wilder will have the burden o(proving that he did not Wild ar
imporwhonpntposenfmi..). 106 - SEWER & WATER
- . . _. _..
f91: ca _.. 202 UNDERFLOOR... PLUMBING -
Los caner of the pmpeny em exclusively contracting with licensed contractors to - r t
consume the fe.h.(See ]OLS B 'nes,and Profssmns Code)The Contractors 203 - UNDERFLOOR MECHANICAL
License Law does no,apply to an owner of property who Wilds or improves theme.
and.who.contracts for such pmiats wish a.conrecmds)licensed pursuant to the .. . .. ,-204 'UNDERFLOOR- FRAME-
. ' cMPDeNsATio4�Lcuawnory 301 - ROUGH PLUMBING
- 302 - TUB & OR SHOWER
u pg allyor perjury.ancntthefollowing demamaons: 303 - ROUGH MECHANICAL
1 hive and will imintain'o CeniOcme of Consent in self-insure for Worker's
304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Code, for the
perfmar once'of the work fur which this permit is issued. 305 - FRAME
_ 0 have andwilirniimalnWmkersCompansstionInsurance,urequired bySection 306 - HOLDOWNS
3700 or the Labor Coda for the performance of On"work'for which this permit is 307 - INSULATION
sued k I MY W C pen n n Immense carr r and Palsy numher are
308 '- SHTTEETROCK
Erode
. .
Cs s a.v.:e ".posey +t
C i CERTIFICATIONOFEXEMPTONFROM WORRERs ' k + ° 1309 "-1,EXTERIOR'f LATH;
g .,_.'.,.�,CQMPENSATION INSURANCE-
me
:,. . 3'T0,<<-.INTERIOR--I;ATH---;-
This'uctiun need rod be completed if the permit is for one hundred dollars ` ``a. <t"-} ..0•
($100)or lea,.) 311 - SCRATCH COAT
313...,_ -ROOF--'NAIL- __
emfy then in th per(rmance of the work for whch this peirnit n rsmed;1 - - �� ����na�� �•
shall`not employ'anypenon in any manner so as to Immune subject to the Workeri 501 - FINAL ELECTRICAL 'ENERGY
camper t n a smfearrama Date -FINAL .PLUMBING .ENERGY.
.A CE - : .._..
oilof _
NOTICE TO APPLICANT:If Comps lel ion his provisions
the Labor
on
503 - FINAL MECHANICAli ENERGY
acconm mblecuothe W rkers Compensation o sof the Code you shun
zrartnxthnamplywhhsannprosran,arshtapmtshanbaeemedrevak.c 5.04---, FINAL BUILDING ENERGY_
p.21,0 °' + .'CONSTRUCTIONLENDINGAGENCY • 505 - FINAL ELECTRICAL. '
I today of in.that th r < mmct n leadm agency,f th perfnimince
W (] Lends Name
wh h thrs perm u.'tssued!sec t09] ern,c l 5 0 6 - GAS TEST
1 cemf int 1 have mad this application and state thud th W infonne - � _. ._
Lend rd Addrc 507FINAL PLUMBING._.,
V > pp tion is 508 - FINAL MECHANICAli
collect:L agree to mtnply.with all city and county migraines nod stare laws refining 509 - FINAL GRADE
V to building cunstirmdon;and hereby mthoriie ieprceneiiws of Nis city to enter upon
'y:.w the aorm-hmnionedproperty for inspection purpeves.,, 510 - FINAL PLANNING
t.p,,. (We)agrcem save,indemnify and keep harmless the Ciry'of Cupcnin'oagainm
U] liabilities,judgments,costa and expiation which may in any way immure aguin,t said 514 - FINAL PUB I C WORKS
C.7 z City nbo uqu race of th<grani ng f Ni,permit
All NTUNMERS SAND WILL COMPLY WITH AL:ON-Pt]N-" Issued by: Date
-- ' : ifai;'a" Re-roofs
-HA US MATERIALS DISCLOSURE
j' will Jte app!eefu re Wading occupant tom or handl hat dou mm al .Type Of Roof - - — --- -as toed by the Criterion Municipal Cade Chapter 9.12.and the Health and Safety - 1 •' " - s t P.i.ve` 1, •% sa- 1'., l. :V -'
Code Sect x25532O7
❑re fit ._.All.roofs shall.be,Inspected prior_to any.rooftng material being installed. ... _
l hQWill theapplicantorr from,Wildm he'pant tieequipment or devices which If a roof is insialled'without first obtaining an inspection;I agre&6 remove
hI iimy coam ntrant asd I by the Bay Are.Air Qoalny Manage me at
�4ofict' all new materials for inspection. Applicant Understands and will comply with,.
Ove t
ON. h. „ all noti-point'solirce regulations. i . •1 : .t;
"If 1 have read the hem do s'm limit egmrements and r Ch ptemh95 of the
California lfeulth&Safety Code;Sections 25505,25533 end 25534.1 understand that
'ifdiibuildingdoesomcurich Yhave'tectarataheninismyrcsponsibilitytonotifyihc
necgpquirements sahich'mus,be mer prior to issuance of a cmificate of '
/ Occupann a req t..f ..
" �a / Signature of Applicant ,. ,- Date .
nate, All roof coverings to be Class "B" or better
c
OFFICE .. _. ...... _