03080096 CITY OF CUP '°
BUILDING DIVISION PERMIT CQNTRA.CTORINFORMA.TI,ONE';.
n
BUILDING ADDRESS: MARTINEZ-OJEDA CONST. PERMIT N903080096
�a �� -
nrnnTn rat
RS NAME: 326 STAPLES AVE PERM17155UEDATE
n ,mFV r qg/19/9nn3
NE: (408) 259-5171 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
3C`p LICENSED CONTRACTOR'S DECLARATION
I�Fp I Isere4y�(firm Thu 1 em licensed under provisions of Chapter 9(commencing Job Description
U with ScIt..�pU)of Division rlhol 1 end Profcssiuns enclosed my bcense i+
' In fait forte adE cf `, ✓ - REVISION--ROOF RAFTER
j41Z L'amse Cl Cunuu
ARCHOE F'Da` RAT ON ' NO NEW PERMIT ISSUED/ORIG. #03080034
I S ^ I understand my plans+hill he used u public records
766
e -
Licensed Professional I
,rt5 OWNER-BUILDER DECLARATION
e F I bemhy iron that I am exempt from the Comracmr+License Law for the
❑O following me son.(Si 7131.5,Business and Pmfeasiou Code:Any city 0,county
3$ which requires a permit to construct.alter,impmw,demnllsh.or repair any structure
in prior to its issuance.also requires the applicant for each permit at Ole asigned statement
so +Liccnw Valua 000 Nat he is licensedpubodtotheProvisions ofthcContrumr u
�H (commencing with Section 7000)of Division 3 o the Business and Profusion Code)or
ti $ Nat be is exempt therefrom and the bass for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to•Civil penalty of 32'3181i3'0 4:rO0 Occupancy Type
on mart Nan Om hundred dollars(5500).
0 I,a owner of the property,or my employees with wages as their sale compensation,
will do the work.and she swcatre is net intended or offered for sle(Sec.]D14,Business
and Professions Code:The Coruscates License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and whodauuch work himelfor Nmugh his 305 - FRAME
awn employees,provided that uch improvements are not intended rro @red for ale,If. 307 - INSULATION
however,the building or improvement Is sold within one year of completion,the owner.
builder will have the burden of proving Nu be did not build or improve for puryoe of 601 - ROOF TEAR OFF
.1c'1' 602 - ROOF PLYWOOD NAIL
C]1. Onerefthep.C.70 ,B Business contesting Cral licensed C.om ui to 603 - ROOF BATTENS with C]1.as Ne project(Sec.Wad,Busmen and Professions CodeO ene d contr ear 10
cane law does not apply to an owner of property who Wild&or improves theeon,and
G 604 - ROOF IN-PROGRESS
who La s for such projcN with a crmnaor(e)licensed pursuant to the Contractor's
License Law.
❑I em exempt under Sec. .B 6 P C far this reason
Data
WORKER'S COMPENSATION DECLARATION
1 hereby aM.under penalty or perjury one of the following decimation:
1 have and will maintain aCemf¢ote of Conant to sel6lnsum for Worker'+Compem
ration,as provided for by Section 3700 of the Labor Code,for the Performance of IM
wants for which Nis permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as mquimd by Section
3700 of On lobar Code,for the performance of the work for which this Permit is Issued,
myrtWOrker C m nsallon lnsu�d Policy n�umMnm:
C(. / C TIFICATE OF E%EMPf10NYFNQbtWORKERS'
COMPENSATION INSURANCE
(Tilesecureneednot becompleted HIM 1 i+for one hundred dollars(SIM)
or lass.)
1 certify Net In to performa oc of the work for which this permit u issued,I shall not
employ any person in any mannersu as In become subject to Ibe Worker'Compensation
Law s of Cehfomn.Oil,Applies-
NOTICE r0 APPLICANT:If.after making this CeruOcam of Exemption.you should
become Subject in the WorkeM1 Compendiums provisions of the Iahnr Code.you mm
JO foMwith comply with such provisions or Nis Permit shall be deemed meoked.
Z .yN. CONSTRUCTION LENDING AGENCY
[-i I hereby affirm that them is.construction lending gency lot dx performance of
lYi> the work for which ON permit is Wood(Sec.3097,Co.C.)
151 Q Undoes Name
LudefYAddm"
U Q I eemfy Nu 1 ban mad this application and sue that the above informulun is
14 f" correct I agmc to comply with all city and county ordinances and+se laws relating to
O U budding convection,and hereby authonm mpreaemstives of the city to enter area the
fda abevnscoua ccO the granting fogof thiuoomnil. sea (rJ��
(We)agree to save,indemnify and keep baronies the City of Cupenina against
aj liabilities judgments,cola and expenses which may In any way aceme against aid City
U z in consequence UNDERSTANDS of this petmil.
APPLICANT UNDERSTANDS ANO WILL COMPLY wl' i�'NONPOINT Issued by: Date
SO GULATIONS. / _
Re-roofs Q
gig a Applmanu on Sur Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant atom or Medic hanNuus material
defined by the Cameron.Municipal Code.Chapter 9,12.sad the Health and Safety
1-1 yes 23532(x)+ ,,yy All roofs shall be inspected prior to any roofing material being installed.
1-1 yes No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
II hamrdnW air conuommans as cortical by the Bay Area Air Qualify Management all new materials for inspection.
nrict7
- ❑Yes 6Nn �.
I have read the haxordous materials requirements undo-Chaptet695 ofthe Cabral. ,g�/// a--s
rise HCalth,k SNCfyCodc,Sccdons 255115.25373 wJ 25334.1 undcrnnd thnlfthc holNngrhl O-WWs/�/ 1 / r�- 1 q� �S
dos not cu nlly hero a mnen4 Net it Is my reaponsi ley nnWy the occupmf of Or 7777 ll�P' JJJ ///VVVyyy,,,
mq n n menmastxmel ritsriniaati. 1.7.0 lesto ofOccupancy, Signaureof pplicant Date
a 9- 117- 03,
own, r auNOrimJ agent Dam All roof coverings to be Class "B" or better