00070025 (2) CI out of c D IRTINO CONTRACTOR INFORMATION: -
RMIT'
MI-122EY PROS INC
BUILDING ADDRESS i - - - PERMIT NO. f
OWNER'S NAIP 4M APPLICATION SUB DATE
'HONE: SANITARY NO.i CONTROLNO.
D
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
C BLDG ELECT PLUMB MHCH
Z"Z IJCI I� 'IJ
m N Z UCFNSFF)CONTRACER R'S DECLARATION
Job DetiCl1 Tion -
z24 C P
OZ IM1 Ly ffmuM1ll' I' nvW p snfCh'1P¢,9(e,mneneng A .
'4hS ( 7000) fD 3 fweBu l I salomC do and
te" C�S inf fail
�M It )���� lease
}tcem r
K�W Lice ve Class( . La N O
Convmror
RIHI ECT•S IIECLy�WTION
sh ��
undentnnJ arty Plum all beusedds pu io oldRt s
Woo LicenxedPrnfexxianal re JUN. A 2001
OWNER-BUILDER DECLARATION "
is 1 hereby aftinm that I nm exempt&on,the Co unicau s License Law far the
fodooingrexsoa(Scatter,70315,Business and Prefcdmns Code:Any city nr county BUILDING ell''S C which requires a permit to conemaer
.do ,improm
ve,denlirh,e,repair arty micure IDN V
m parimto It ;' one oI he applicantf h p,mett file rvinad:wlemem
hour he is licensed pa the provisiours of theContractors License r Icnapta9. Sq. Ft. Floor Area - ValuMi n
(c,ancialcon,wall Scat on 7000)of Division 3 of the Bions,and Pronsduce;Cade)
or had he is exempt therefrear and the basis for the alleged exemption.Any violmwn _
of Section 7001.5 by any appl'eare for a permit subjects the applicant to a civil penally
of not mnra than five hundred dollars($sea). APR Ndffif?NOccupancy Type
°Las owner of the pmpeng ar my employees will wages as lh,Ir sole compensation, -
will do the work,rind the structure is oat'manded ar'mifercd for sale(Sec.7044,
Easiness and Profession,Code:The Cninmaor's License Law docs lar imply to an [I S ,
w r of pmpeny Who builds or improves tbemon,and who doe..such work hlmwlf ,301. — ROU 9 t5 -
or through his awn ound.ycas.pmmdod that such immmvemenn are not intended or -
offered for sale.It,however,the building or impmvanced Is sold within one year of 303 — ROUGH. MECHANICAL
completion,the axmar-builder will have the burden threateing that he did nor build or
ia,pmva mr pam,se,rsalea. 304 — ROUGH ELECTRICAL -
❑1.LLS ownerafanenr,pdty,arinmcwsivelye,armamgwilde nsda,mmm,r,m 505 — FINAL ELECTRICAL
canshaa the poster(Sec.704.Hu,iiness and Pmrexsiens Care:)The Contractor's s
License Law does net apply oras none,of I+mpery who builds a,bnpmves werean. 507 — FINAL PLUMBING .
andwho wrtvne¢for such pmjcets with a am0earbud licensed enchant to the
C,mmcor's license Lau., 508 — FINAL'.MECHANICAL
L3,am exandander See. .B&P C fon this reason 514 :'FINAL PUBLIC 'WORVS .
Owner Date
W'ORKER'S COMPENSATION DECLARATION '
I healthy affirm under penalty of perjury one of the following declamtimss:
7 I have and will maintain u Certificate of Consent mself-insure for Wnrkv,s ,
Cempemmlon, os provided for by Section 3700 of the Lubar Code, for the
Performance of the walk for which this permit is issued
El Chase and will maintain Worker's Conspenmtion Insurance,its requited by Section r -
3700 of the Labor Cafe,for the performance of the work for which this permit is
issued.M Worker's Cam/p�eI l Insurance rnrd//$$//yppygqd,,P�ssonlicy mu I`]O -
Carricc � /'- •P,Iicy,Nrv/�V w/O•��/�/�
CERTIFICATION'OF EKt�I'TI a PROM WORKERS' '
COMPENSATION INSURANCE ,
(This section need urn be comelered if we permit is for one hundred dollars
($100),,less) -
i certify that In the porformartce.of the work far which this permit is sarral,I
shall not employ any Person in any mminncr tons m belled,subJae,lo we Waders' -
CompensationLnwsafColifornlu.Date ,
Appeeam
NOTICN Tipea m e W..11L Coma,rorr this
ovisio s of of [.shot io d,you mind
hea,me subject m the Workers Cisions vtlan permit shall the timed rare,you tuns
Z
Q fanhwith annPly with dell provisions or this permit shall he deemed munke,i:
F r�i CONSTRUCTION LENDING AGENCY
a 7 1 hereby affirm that there Is a commotion lacing agency for
tha parfnrmance
L>a of the work for which this vrout is issued(Sec 3097,Cie C.)
LLQ Lender's Name
Q z Lender's Address
V I certify that I have madtn:application date that h information is
. ;iW E. corrovel.I agree comply eith all vity and 6mly ordinances ard state law,rel ring - -
O toholding constraction.had herebynulho p hive. ttM1:city in colorupon
the adowainectioned property f i nopechon purposes.
'
aJAPylii`l
W) g t indemnify J keep h I.,.the City f C_penin ug n.w '
W jIg, t d p hell y many y rcug nst.ait
scqu aice fw y nungoftb print.4NTON D, STANDS AND WILL COMPLY WITHAL NoIry
Issued by: Date
gnamre ,f AP011mn onmmar alta Re-roofs
HAZARDOUS MATERIALS DISCLOSURE "
w rb PPI' l future b tu g p t,l r handle"hrEnd a minimal Type of Roof ,
ns line by tier' ls.n' Mnl pl Ch pt 912 Ith Health aniStety -
Code SelfSelach 25532(1) -
E)Yes All roofs shall be inspected prior to any roofing material being installed. '
W11 It pmI l ��e(Uabaldl pat deeq,m t d vire, nim If a roof is installed without first obtaining an inspection, I agree to remove
to rear." colt t do al by(he B,Area Air Creel ty Management
i.t l all new materials for inspection. Applicant understands and will,comply with
°yet, No all non point source regulations.
1 have read the cianrder,material,mchrarml,under Chapter 695 of the '
Culifam Health&Safety Code,Stations25505,25533 and 25534.1 rude.sland that
ifiha but Iing Oxxm -early havcatenont,that it is my muponsibilll'm n" the
occupant f the req nems which must be nret prior m1 issuance of n 'enifnr of
Con°"°` / -� Signature of Applicant , Date
ra ipeaagcnt D.161— All roof covering's to be Class "B" or better