01110117 (2) CIeuo GDIVISION
t PERMIT CONTRACTOR INFORMATION:
BUILDW G ADDRESS: PERMIT NO.
10510 MADERA DR 01110117
OWNER'S NAME: APPLICATION SUB DATE
CRAIK JAMES 11/27/2001
PHONE: SANITARY NO. CONTROL NO,
G ARCHITEC(ENGINEER: BUILDIN RMIT INTO
ad E BLDG ECT PLUMB MECH
L L- IJ I_7
Sy= LICENSED CONTRACTOR'SDECLARATION Job Description
i z= 1 hereby affirm that 1 am licenced undo,provisions of Chapter 9lcommcncing
«fi; 'thSect!un7o(0)ofDivision3offeBusiaessandPnnession,Code, adin,Iaunee RISER REPAIR.
I 2 S 7J=
i s W< i inns Clnaa and
cL O Lic.a
'O aL O Contrnanr_
C v ARCHITECI"S DCCLARA
so 1 undemand my plane shall M1c used as public records
i p Li¢nud Professional
o Oe,I on
DECLARATION
I hcrtby affirm that 11. nempt from Ibc Conions Cis License Law for the
F Z o which ng reams.lemons)o31 5, altessand sae.de o demolish,
Cade:Any ,city or county $1900
ad F O which ts e Perm I I consumer. l t for such
demo)sh p y t cert
L3= Poon I w ce al. requires applicant of
suchpermsu filesignedstatement - - - .. - - ..-.... . _ _ a atio
the he t.beatified p ant!9 the pro i.i ns of the the Bunors L La (Ch pier 9 3 � �,G}�x.p,cgp 4 `�k `. VdIU3I1On
(ton withSeertWi oma)ufD b,cnninf the Busnessand idrnProfessionsvi Cade) : 11r• 0•:110-" e k
or mo Le is b mi,applicant
and the swot for the cus Ee uemtrar d,Any violation
I r!(� �"a r
of not
7031.5 by any dred doll ror a pemat subj«u the applicanno a civil penalty
tnrnmLlbnrt man Eve nnarea aml:as fsscgp304"pN Ti,� ELECTRIAli� '• Occupancy Type
°1,as owner of the pruKr y.or my employees with wages as their sale compensation,
will dome work.and the someone Isom Intended'or offered for sale tree:]oil.- 505 - FINAL EIl?Fi�iYR)a3Lhn Eetions°
Business and Professions Code:The Licensea
Conem•a License Law ds not apply to an
owner
r of proproy Who builds or improves thereon,and who dimes such work himself
or offered
his own employees.provided the such improvements are not intended or _
oRcred cd f forr sale If,howercr,the buildin—sr'im - - tis solJ7vhhin one year f ' _ _
ge proof pro yearns ... .. - - t„•,,-, -
impcompletion,.rfor me rte”of a it.).will have the burden of proving that he did not build or '
mprove for putPose of sale J.
n act
L m owner of the polarity.7 am exclusively consoling with licensedncommmntt to 1 0!a w
License
the all
rte(Seat.]to i Business and Prof whops Wild,
or The Contractor's
Ca am exempt vimcts,under Sue,
proleas_with a contractors)licensed Parsuum.m the
Liccnx Law dxs not apply m an owner of property who builds improve.,thersomr,
01 am exe License Lvue
p �ffiPCfor this reason t• �' ! G
Own e Dat - - /
WORKER'S COMPENSATION DECLARATION
1 thereby norm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self-insure for Worker's
Con-Psmation, as provided for by Section 3700 of the Labor Code, for the
serformarrce offer work for which his permit is issued.
°I have and will maintain Worker',C«npcnsntioo Insurance.as requited by section
3700 o e Labor Code,for the performance of the we for which alis permit is
issueysV k YCompen t 1 ranee courtar
counter and Policy number e
. , 1 (,o. 7777 O/ A
' s '- Policy No. a .`koi f •:'fit. tT `, k, t a .a• a
CERTIFlCA ION OP E TION,N N FRAM WORKERs'1 J t a. 'ri :I't ci D.•..
.COMPENSATION INSURANCE.. . .._..7. _.._._.... . _ ._ _. _.------
12.;-- .""_.. .
lotI
" (This section lived not W completed if the Permit is for one hundred dollars ' 'e v ' ' "• j `
is 00)tor less.)
I ttnPy that inpthe
ion in tce'of the
as f become subject p to issued:
•_._ .• ...._....... .. . . .. . ...,,_... .c- -. . - ....,..,..._..,. ....
.. sued.l
shat not employ Workers
Compensation Laws of Califomm,Date'
-Applicant . - "_. _..".._c._._r . . . . ..". .. .. " . - - ... _ .... __. _.
NOTICE TO APPLICANT:If.afro,making flus Comfiote of Exemplion,you should ' '
Z Cbecome subject to the Worker's Compensation provisions of the Labor Code,you must
fonhdith comply with such provisions or this Permit shill be Jremed revoked.
Zh "' CONST RUCTION LENDING AGENCY. •. "". ._ _.." _ . .. ._ .-" ._ ._— .".___."_. _.._.__._.. - ._. _ t_.. __ _
1 hclnby aftimt mat there ix'i ennsuuction lending agency for the ycrfoimarrce t
Lit nim of the work for which this permit is issued(Site.309];Civ.C.)
Lender's Name,.. . ....: ...�......_...-. . .._..
Ilnder's Address `l
,- 1 certify tom 1 have reed mi,application and nee that the above Information is
tan,-F surreal.I agree to comply with all city and county ordinances and state laws relating
.Q V to building conswedwand hereby authorize representatives ofthis city to enter upon
>. k7 the ala, - ' sed proPcny for inspeed..purposes., ,_
E„s L (W l mm
e or save,ins enify and keep harmless the City of Cdperim.against
Z) liab hlie Judgments,costs and expenses which mayinany way accrue against said
V City in onsequenco of the grams",of this permit.
'•t APP ICANTUN'DERSTANDg WIDCCOMP N
'WITH"ALL 01-POI Issued by:
r- Date
QCE RIiGUCATIO �L 27 Q�
S sown of AprrcanVcnn Lou. Re-roofs
OHAZRU /
wnmelicard or,nine buddingatstore«middle n.atma «am T,sYP`e aof Roof
as defined the
Cpen Municipal Code.
Chapter9.14 and the Health and Safety
Code Smimn.255i2a) it .. '.'[
mN�� •.t, e.;-
--
` ..All roofs shall be inspected prwr.to.any roofing material _. .._ ..._.
Will the applicant or future building occupant use equipment or devices which. If a roof is installed Without first obtaining an inspection, Ilagree to remove
emit haroadmis air contaminants as defined by Iho Bey Arca Air Quality Management
Distrim _ all new materials for inspection. Applicant understands and will comply With•
°Y.,t t.. — `. - all non-point source regulations.
a w 1 he , ad ma howtdou'malerial qts ents'und«Cbaid r'fi.95 d me l
California Health k•Safn Code Scions 2550525533 and 255341maderstand mat
Jtheb does not tl h tenant,that it;m .blit to notify the
axil tnf Werc u fish Yrtnpo Y le 9f
at
usibe met poo to isxuence of e C nifidate
r Occ Panay
•-. L� Signature of Applicant _ Date _
All roof coverings to be Class "B"or better
/: Owner or an nd:ea Dat., g
OFFICE