00120072 (2) CITY OF CUPEWI'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AI)Itill Ll_`12 SCENIC CL rl:Rmrr Na 001.20072
OW NEWS NAME APPLICA'T'ION SUIT DAT li
MA, CAROLINE_ 12/12/2000
[ONE ' SANITARY NO. CONTROL NO.
BUILDING PERMIT INTO
ARCkI1 ff:C'1IIiNGINIiIiR: III .UMI MECH
W❑
FEW I: 1 L 1 L- t=1
S N E-b"NSED CON'TRACTOR'S DECLARATION Job Descrlpl Il
CG_pp I hereby allinn OM1 I 1 am IicemeJ under prm'ixinm nl Chaptcr9(tttmnencing
F,:ty with Sect ion 7000)of Divi,ion J of the Tbwinpv and Notes%ions Cole.and my limn,
LBATH REMODEL (2) -
aa ' in full force and elllwd.
a O a.U ice w Clay Lic,b -
a. Uatcn. s DECILor
AHCHI'I'f.C'1"S UIiCLARAl10N
u O 5 1 underso it any pbms shall be"red;is public rimed,
ce p'O taintr ed Professional -
OWNER-BUILDER DECLARATION
d ;n I hereby allirm that 1 am exempt from the Conlrnnor'x Licemc law rnr the
following (Scetion 7031.5,petite, J P fesion,C I A , it,or count,
5dISG ishawh onTaire, pinnal to t ft prov,d I.I I' Yt Core
6 � '1 11111t I. II IPI Ill I I 'u IIsigned,I tet
'- mat he is licensed pea,man 1.the P I IT,C t I L (Chapter 1) Sq. Ft. Floor Area Va ua tQ
(commenting sea It Section 7adI of revision J of the Business unit Proessom,Code) rEO
ter that he i,c,empt Ihemfrom and the bait,for the alleged e,emption.Any violmion
of Section 7031.5 by any applicant for a rennin subjects the applicant to a civil penalty
of no,more man fine handred dollars 1S51101. APN Number Occupancy Type
C1.as owner of the pntpcny,,,my amployors with wage,as Mm
Meir vole cnpro
cadoq 35707010. 00
will Jo due work.Taal the amcturo h non Intended or olle,ed Ibr sale(Sec.7044,
m
uo, p,and Profcv,io"r C«m:'rne Crmrllmr,Licen,e Law doer not apply to on Re aired Inspections
etw rof ,,,,,,IyWt haild,ormtprove,hereon.and�nimyedo�e,,,u8,11 uLhl"^ell 101 — FOUNDHTION
through his own however t prodded Ona,Deb semI Jllt6l0"U ® 102 — PIERS
ortcerd for Wile. t employe the building or imsh our t 1 -
completion,the owner-milder will have the heeded of proving that he did not build lir
inputs efor purpose ofsale.). n�ST qn 103 — UFER
01,a, of he pmla.my,am exeluxivelr a unlacing widQ 6d�ILL2V l 1 04- — REBA R
n,rano the project(See.7044,Rosiness Lind Prob—o Is Code'.I Cie Confraemr',
i'.icen e Law do, rot lymlymonuwoerol progeny weo'mdmxo,hnpm,c,thereoo, 1.05 — ANCHOR BOLTS
and who conow,I for xncn projm,will a no mems,)li I I
Cummnne,Liecna�law SUILDffV a 106 — SEIJER & WATER
014' "`mm ImPro
cR,rthna,"" 202 — UNDERFLOOR PLUMBING
�2 /,` �1
woR K COM1[NSATION )ECLzhRA1(ON 203 — UNDERFLOOR MECHANICAL.
Iherehyomnouoderpeuaeyofpapoyooaothe emowil�ydccmmdn 204 — UNDERFLQOR FRAME
1 have snit will m:dnuen a Cenireate of Con,cut In wIl-in,arc p,r Worker's 205 — UNDERFLOOR INSULATION
m
pe",adon. provided for by section 3700 of the taloa Code. Thr me 301 — ROUGH PLUMBING
snce of the wort.for which his permit in issued.
01 have and w ill maintain Worker's Compensation Insurance,In required by Section -302 — TIJB x OR SHOUTER '
3710 of he LaW,Cule.for me pe,I once of be work for which this reran is 303 — ROUGH MECHANICAL
,Zr
is,"cd,My wmlo,',Lbmpcasation 1"en"mce carder and polo a numer ore:
Cnrriee Pulley I IO
304 — ROUGH ELECTP,ICAI,
GI1{'I'II'ICA'I'ION UNSAIiAli"INSURANCE W(IHKIiHS' .305 — FRAME
COMI'FNSAI'ION INSURANL'B -
306 — HOI_DOWRIS
Ilhi,section nccJ two M annplmcJ fife parotin is for One hundred dollars
Isnwlmle\s.l 307 — INSULATION
Icoolly that inthe of the wurk for which his pemdnisi,med.1 308 — SHEF-,TROCR
shall non employ airy pen n a any ma r nn us to hunm
ce robject ,,she Worker,' ,
Coopen,au Lues,ofCallfirm,Dale'I 309 — EXTERIOR LATH
AlmiNOTIC"' 310 — INTERIOR LATH
NOTICE,TO AI'1'LICAN'T:It,alter,taking this Cenifica¢ol laentptinn.you should u
Leuome,abject tothe worker,Cumpen,adua prw'i,im,nfine T.ahnr Code.you main X
Q O forthwith comply with such provision,or Iiia permit shall be dmG,11 — SCRATCH COATee
ed revoked.
y CONSTRUCTION LENDING AGENCY 313 — ROOF NAII_
a lending
501. — FINAL ELECTRICAL. ENERGY
of the work Iia which Iii,,tenet is imnst Six.land.Civ.enc
a o Le"der,Nam' 502 — FINIAL PLUMBING ENERGY
finance,,Adders,
U O 1 teray that I love read hisappnemim ads.Icthat the abuse information is 503 — FINAL MECHANICAL ENERGY
a p Correct.I agree to comply with all city and county ordinances and state laws relaing 51 4 — I_ BlJ I I_ .I NIG ENERGY
Q V to building construction.and hereby anhorirs representative%of his city no enter upon
�. W he.1w,'e-,eproftemy,for inspection purpose, 50 — FIN ,L ELE. T R I CRI_
r D+
(We)agree to vast. keep harmleus the City of Cabefflar mit
m nabilfle..irdgmwtls,nt,ts and cnpemrc,which n ay In Cory Willy"coma ngain,l,aid . 5 for '-' (-
GA. 1-EST /
uz S'bj'urtli1c^cnwulmcgmnmtgul'min fat nal.
lssuedby: 507 — F _U GING Date -0O
APP NT IT I' NOS ANT)WILL CO
S NEC i..l/I Z a LCOfl —
eanVConnmemr L— e J \ 1 11..H
Re-roofs 9 — FINAL GRADE
IIIV.AR000S MA'IiRIA1S DISCLOSURE 50
Will the applicant or future Wilding tecupam store or handle h:vadou"amriel Type of Roof
t,defect by hcCuperbno Mmdeip:d Codes Chapner 9.12,red me nenitn:md Safety 51. '. — FINAL PLANNING
Code.Scenion r-5532(4),
D Ye" C No All roofs shallcE4 ihspectEdTpTl toQhM- Jtl"ng W3tBliflibeing installed.
VAR the applicant orfuture Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection. I agree to remove
emit havardous air contaminants a,defined by the Iia,Area Air Quality Management
,ixhcr. all new materials for inspection. Applicant understands and will comply with
D Y`x 0 N all non-point source regulations.
I haverend he Ianatho,maltual. .....i end under Chapter 6,95 of the
C411f rniu Hicalh se Sulmy Cod ,Suniun,25505.25533 and25"4.I umler,und that ,
it IIIc huilJing Jap not currnnly �nc�tcmm�.Ihm in it myleywnrihilitym sonify the
or, am of the gdeem,at,, ch uma be nth prior m isxuana of a Cenifcum nl
O uponcv
ld�/L Signature of Applicant Date
owner or a"moria<dasc ane All roof coverings to be Class "B•' or better
OFFICE