01060070 CITY o C DPNEISR1TTINO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
22711 SAN JUAN RD 01060070
OWNER'S NAME: APPLICATION SUB DATE
BELL BOBBY G AND RITA R 06/12/2001
PI10NE: SANITARY NO. CONTROLNO.
C m z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
cc BLDG ELECT PLUMB MECH
L.1 1_J IJ
ysn
LICENSED CONTRACTOR'S DECLARATION
H z 1 Mmb ).f that 1 am hf,hc B under i Chapter 9lcammewin Job Description
;i_� ra provisih,nsa p g EXTEND DECK.
v_+C m is in Sento=and erect. hn J ill me Bu:mess and Vmfe>siom CWe.and my li<eme
is in full forte and.Rest.
ca-a Dula
w Class Lic,p
D
Dam S DEC
i 3 a v
ARCHITECT' DECLARATION
G$ I and crsmnd,ny plans shall lx toed u>puhlic mN
cos
Licensed /�y
•I O Lid Proona
fessil ! `(Y•`/'
i OWNER BUII-DER DECLARATION
1 hereby affirm,ha,I an,exempt from,he Contractor's License Law for me
1-i< following mmun.(Section 7031.5.Business Oad Professions Cade:Any city or county C 1 500 (]
5E- which requires a permit m consimn,alma improve,demolish.or repair any s,nemm
so .primmts arts. 1requires the ap'lican,f hinsem,t. fk gnrd..a,. - - _ . . - _._.._.._ ._.._._ .__.____.,_..-...._..
n3� rlahe xlc n. Jp - urns 0!b 5. s fibs Comrx,o/eL La.Whaper9
wnt r a aougwithSnio -roan fD si 3 fineBu.nex t dRrdaslom,Cede) ?_i f'•3 �'1 /; :�6. 71j.; ,f Valuation
or that he Ond the basis for the alleged derhpubn.Any violation r
of Section 7031.5 by any applicant for a Permit ubjests me applicant to a civil pcnalry
or not mom than rive hundred dollar,(S50(n. 101APN NVENtAT ION :;- ;, Occupancy Type
❑Lasuwnerof the pmpeny,mmy employees withwages as their sole compewtion.
will do-the work,and the structure irrml intended or offered for sale(Sec."7W,-- ,
Btoin<x:tied Prokssmas Cade:The contractor.License Law does not apply to an 103 - UFER Required Inspections"
r of property Who buildr or imro
Pvas,lonam.and wha does sect work himvlf
Orathrough his own employee..provided that such hnpmOrmems am not intended or 104 - REBAR
Offered for ale IL for can,,rte Wncim,m Km
imirmcn,is sola within one year of - _- . . - . ._-__.. -. i_.. . ._......
_-. . .
completion.the tnerbutder will have me burden ofpmving that he did not Data or 105 - ANCHOR BOLTS
mprove rnrpurphaafsme.). 106 - SEWER & WATER
-Oi•a owner of Ne p�opcny.gird esciusively contracting with licensed contractors to _ .... .2.02__- UNDERFLOOR PLUMBING ,-'rI�•`:r _.____.___..
amine,the ProPm,Sec.7(N4.Business and Prafevima eedeo To,Contractors 2 0 3 - UNDERFLOOR MECHANICAL!
License Law does not apply to an owner Or pmpeny who builds or improves thereon,
and who contracts for,such projects with a conametons)licensed purcuant.ro she
204 - UNDERFLOOR' FRAME-- ----
' Caotracmis LiccnsaJ_aw. n :uJ ' '* ,-•
❑lam<xgm naersm,. "ePefor this mount 205 - UNDERFLOORI' I'NS'ULATION
_ Dwner '" "` "" 8��fr ' 301 - ROUGH PLUMBING
WOR COMPENSATIONDECU ATION 302 - TUB & OR SHOWER
I hereby M.arta; rally.1 prritiy.-n Orme In Irwin,dechoanunx: 303 - ROUGH MECHANICAL
❑ 1 have and will maintain a Cenircale of can.chl-to elf-inwm for wasters 3 04 - ROUGH ELECTRICAL
Compensation, as,provided for by Section 37x1 of ,he Labor Code, for ,he
rwnee
perforof the work In which thin permi,,is issued.
305 — FRAME
❑1have andwill maintain WaA 'sCShvpe I' uFanc< required*Section 306 - HOLDOWNS
neo or the Labp7Cade forthe perform of the .�f which this parmt,is
307 - INSULATION _
issued.My Worker',Chropernotf Thouron,e crarric,and..pdicynd!Tbe
tamers a,r'tv`4, _ .:.ksPoecydo 388 - ,.S'HEETROCK ,., e . v'
I 'CERTIFICATIONOF,EXEMPTIONFROM,WORKERS'�', 's - 'I� ' s 309 ' - EXTERIOR •L,APHi^
-.-•`K(Th\neer un need sol he
COMPENSATION INSURANCE;, n -310
COMPENSATI
310:`:-: :INTERIOR LATH `: - ca1�,;1.,
ea if pc it is far ane hundred dollars 311 -SCRATCH COAT
ISIWI I 1 1
-hP Ic nfy.tht nide pert cliM1 at w
th. pe t etlI
313 = ROOF NAIL - - -- .. .._ . 1
it,atl n 1 emp by any N n any mann. rho bceome bJ t i ma'worker: 5 O l - FINAL ELECTRICAL"ENERGY
Campenatihn Caws of Califomia:Date:-
NOTICETOAPPLICANT If fmrmekr n"is
r�m,<i1�n aero 502 - FINAL PLUMBING ENERGY- - --
hnhelab«sedgy moa 503 - FINAL MECHANICAL ENERGY
f E pu y hnaid
Z became,bpo"m n wort.f Compe t p
Zp forthwith
an m ,plywm. hp ee,ned,evaked. 50A - FINAL BUILDING. ENERGY___
F'h ". - CONSTRUCTION LENDING AGENCY - SOS — FINAL ELECTRICAL• s'
C-,� 1 t by off nn that n ',n.an finding agency r M per(nnancn —
�.,, afro kr ncntn Penne ssued(sec 3097 C.v c) _ 506 GAS TEST
n Lndc " 507 - FINAL PLUMBING
7rZ Lcnde Adds. • .mr•1•,- ..- tit
V'� o airy to I have mad phi,application acd stem rho me above mr rmanwn is
508 - FINAL MECHANICAL
w=F ca:eB.I Ogren tat on Iy with all city'Ardcauptxammances and state mw,relating 509 - FINAL GRADE
O,U mbullding construction.and hcmby subt mpmsenmtivcs onhecity theater upon
>}._w heatwe-mentionedp!openyfor impartionpurpOses.. 510 - FINAL PLANNING
[...6r (We)agog to save,hdemody and keep harmless the City of Capenino ageorn -
r liabilities.Judgment,,cents and a Penes which may in anyway"cease against said 514 FINAL PUBLIC WORKS
U..,,Zcitymconxequenaanne nntmgnnnis nits • Issued 60 - OF L D NAIL Date
APPLIC UND RSTA.
NO, II ''COMPLY WITH' ONP NT''
J!
C)..�QJ' ✓a-g d
Signptyre.fApphesmlhmrdclor n,:;.: '.,+. D.IF1;," Re-roo1604 - ROOF IN-PROGRESS
.HA RDOUS MATERIALS DISCLOSURE
Will the applicant f are hd Neill CootpWal score or handle hamrdoas material. Type of Roof. - - - ^-. '------ - '-- - -.
as&r <d by he C.Fertn Municipal Code.Chapter 9.12,and the Healed and Sa fay
Code Sect 25532(.) t -
❑V. 1 J( '" 1 x5 } >'4.]rp•1
"• ._-.All roofs.shall be inspected prior-to any roofing,material being.installed...
w u me rld_cat r t m Wilding potequipment tdevices_,.n which If a roof is installed`without first obtaining an inspection,I agiee'to remove
it h b nt t d d d by, B y A A Q I ty M 'agement
Do, .. .1 _ __all new materialsforinspection. Applicant understands and will comply with
' ❑v , No I ,- ,. , I' all non-point source regulations
I have ad me h...olm s mincr al.c mghim ments under'Chapter 695 of the
Caliro i is Health'&Safety C°de.'Sections 25505:25533 and 25534.I understand that -
,fdanimildingdoes not currently M1 mn ,n11hun smyrosponsibilitymn.tifythe
Occupant of,h q e , h h into,^f met p , iv mmwe f C r Ecea or h
°"°pa" Yom/ J �a b Signature of Applicant - Date
,. Onrarmamonce a t V D e. All roof coverings to be Class "B"or'b'etter
OFFICE