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CITY OF CUPF.R'IINO
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CONTRACTOR INFORMATION:
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;L BUILDING DIVISION PERMIT' ,
BUILDING ADDRESS
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PERMILNO.
120 If
'OWNER'S NAME: a
ALPINE DR
ANTHONY ROOF SERVICE
APPEICATIOMID 13020 {.
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' PHONE: /' ,,- �'
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SANITARY TiSir '3/ 20Y.r00
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JOHPIS,, DRV IA
ARCHITECT /ENGINEER Y _
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rf BUILDING PERMIT INFO t
:.BLDG F.CF.CT,' PLUMB MF.CH
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LICENSED CONTRACTORS DECLARATION
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- Job Description - '•
I leads, affird, th.tl aid licensed order provisions of Chapter 9 (em nth g
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wr0 S t ]WO) ID s inflfyJBI 'n(d jProftsd C l anBnyl
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N D'a1 AacHIrECT'SDECLAR /, N ..
r 'I REMOVE � INSTALL 1 /c '„ CDX- PLY
a 1 unention l my Ilan sold be used as ptbl nrecoob; _
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• •SHAKES
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RND DIMEhIS:TOgIAI_. FIDERBL_ASS, SHINGLES
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' OWNER - BUILDER DECLARATION
at I hereby a0trn that 1 am An opt to.. the C trod s L ease Law far the
4 pollonvinj n (Section 70315; "Btsine and l f sconsC d Ally city or emay
❑ which y'c.a Per I, to el,nmored, 11 dicarolish, or repai y structure,
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pr I'I " I. q' the "'Ificard it a "nall file ad,and,enmere
but le, '. licensed p t to tit p onsof the 0 tract Lucrative L (Chapter 9
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USl. dProfession, Code)
(e nonungw mScetan9W07 of D'vi nn3af he B a
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,Valuation
of that he Is exempt therefrom and the nasas rat We alleged exompaan. Any violation
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ofA'I 7UL5 by any .ppl' tI nit ) bjec{s Om alTre n a civil p ly
or not n man fire tumbled talks 0500), _ - ,�
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" APN Number -
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.' Occupancy Type ,
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flh ,p Pr te ply Ili .g . I 1- p
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Re aired ID- S c t1- 0 DS
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I f d ih n I I d d ❑ d f I (S 0 44
Battle 1 C d The C L' L d r py i
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a and o nu l
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w f p rY Who builds P es thuum and who d h k h If
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m through his p Y: P tied that such improvements p t a d d or
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al ed far .In If, ho cue, the bti d iri in...orement sld .,thin one yar of
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completion, the owoenhullder will have the burden of proving that he diA not indoor
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Iriprodl for p p : f I)
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O1 , n fin property, ty, meollet ly I 6 I I 1 I. r I
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a nh prj I(See 7044 Ravim I Pope . cd:1_Tn c t t
— TNSULATTON
[Across, l p veslh m
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and I contracts to, rich r;eel, wall accepts) I ount he
E01 – ROOF- OFF
Cl narrators License Lai,
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❑, p. nnel'sff. .i &'PC far this at
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_ 602 : – ROOF PLYWOOD NAJl_ "
Owner ' Data
",603 - ROOF BATTENS
- WORKERS COMPENSATION DECLARATION
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604--. ROOF', 'IN— PROGRESS
rcny.rrrm de pe uv tip 1 > ed following 1 l is
r' ❑I have II ri intair, it Cnififimen 1' n tit Eft :uof W k
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Coup f p E to, by Section 3 900 Penn,
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pet ftl kf h h,Cm permit '., J
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- Ili J 'II' I or k'.0 p i I required ' byS
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3 1 Ili Labor Code, I the K p f the k f which this pe t
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"red, My Workers Compensation Insurance camer and Pol y nu nber are
Correr.11 /l'r Ic /'�r.(,^V yNoO io 6 aa� sal
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' CERTIFICATION OF EXEMPTION FROM WORKERS'
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. COMPENSATION INSURANCE
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(This idr teed rot be earn pleud.if the perm I is for one hundred dallory
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' I certify that in the perfommuce of [IN work for which this penm't is issued, I
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shill nod employ any person in any manner so avla become subject to the Warce s'.
Compensation Laws of Calif ..n e, Date
Applicant ' . ..- V:,
NOricP 90 APPLICANT ICANT: IL after Halley this Certificate at Exempi on you should.
i, became object l,heW k , Cmu,ni pritoromis of ine Labor Cade, mandiral
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forthwith comply with such provisions o this permit shall be deemed revoked.
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n r CONSTRUCTION LENDING AGENCY
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I KImb,offulmdand,co, is a constraction landiagagency for the performance
yof the k for which this partial is issuld (See 3097
Leader', Name
r l.endfrx Address_ _
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r I ol, ... I, that I havemad lh'.ppl I Icold sure flmn base ( atolls
ico cr I agree ho comply still all city and county containers and'yeal, laws relating
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acluddngconxm eta dl by II pe I.I esof this city to en,rrupan_
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the alboverimentioned pieced, p n' purposes.
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I., OVOaCen I e ndenndy and k ph I stheCity fCr,dbnar,,ad,,
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0 lialolifics,judgirwas. costs and expense may .inany way sector, .gntnt'ud
City consequence of the gram tg trlh .
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APPLICEN U DEROSNSNDS ) W /y1, OMPLY WITH ALL NON POINT
Issuedrby: -Date
9-71 -M.
` Slgnmare or Apphcamicantrantnr' - i Date-
•'Re- roofs,
HAZARDOUS MATERIALS DISCLOSIIRF .
wiBmeappfe r f t b lTg p. t'l alr II k=. d imcdal
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Type Of Roof •. p. - _ ,. " r
r del ned by the Ct lari no Municipal Code Chnprar 9.12, s ul the 1{wlth vnd Snfety
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• Code, 25532(x) ^
❑ Yes . El No - .-
All roofs shall be inspected prior t'o any roofing material being installed=
' Will he apdacant or Evil do, truildir,ole,o,cont me equ pm t dr,c,c, wlad
If a roof is installed without first obiaming an inspection, I agree to remove - t
cord wd not am s defined by the B.yArcuA Q M
Quality .nnymctf
DI tr t , '
all new materials for inspection. •Applicant understands andW_,ill'coan with
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all non point source re ulat '
I have read me brifirdar, bereanals requirements under Ch pit 6,95arf the
Cnlf Ii hh &SftyCd Sections 25505th and 25.534, E understand lh(
ifihbuilding de t euytr letter, lht t'. nynp hlgl tfyl
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p t ih 9 r ha)!''y'st b t prix m s t o Cert ..... f
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of Applicant a r ' Date
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.,Sig ature ,•_ __ -
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All roof coverings tri be Class "B" or'better'
ow oranntori eagem a Date
OFFICE,