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01070147 NO CITY DINDII I SN PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO, 22093 BAXLEY CT WESTERN REGION ROOFING 01070147 OWNER'S NAMEAPPLIC TION UB DATE SCOTT BARRY C AND JUDY C 231 N 12TH ST 077302001 PHONE: SANITARY NO. CONTROL NO. (408) 360-9111 �azp ARC[11 BUILDING PERMIT INPO GU L ELECT PLUMB MECH N a i J 1...1 1_I I 8 w Z LICENSED CON'TRACTOR'S DECLARATION lob Descri tion OZ-p I hereby affirm that 1.,it licensed under It...l"ms of Chapter 9(commencing P Tyra, wI'll Section]oBmofDlylslon3ofheBmineeaaadPrnfesnmasCur add my REROOF. �xpa= Int°� "' _ �C{ e(1 TILE REMOVE & REPLACE . C z¢ Llceaa Cm.p n w 3 a N °om Contractor ARCHITECT'S DECLARATION o' 1 and—dind m shall be tired as blit records se ca my public ii p eL Licensed Professional On BUILDER DECLARATION ++ tK'Z--'m mostly reby affirm chat.,I cin exempt from In,r Gurus a Licence Law forthe y C Z G followinguires a permit i ]113 L5.Business and improve, dermli Code Any city orconnty. a,P o which requires o permit tit construct.ober,im forsu dentolal t fi repair any mormene 63,a that heor oslicmm�cgzhion'I-(heres tneapplicummc Contractors LicnseLa (Chaffer _ - mathei:fieenaed Seniorm00)ofDa:oa.nnofill, raetor,,anenarLawon%Crer9 _q, FL Floor Area , Valuation ., hot e.,rwith Section"IBROnof he Sof the Businessolid Prooh.Ad, Crude) , .r mai he is exempt there Goth end the basis For the alleged,lueeninn.Any vlal.try 'enrnqr nn "' r of Section.' me th n v any imputed,dn.t far n p<nait.(chloro me applinant t...mu peawty Occupancy Type 'of nonmore mast Tive hundred dollars rsspol. APN Number Cl L a,ovinertrthpor,i y employees will, -yes asthersale compen.-Minn, 305 FRAME - w II do'th F and(he t t 1 intended or offs cd for site(Sec.7044, -- ❑ d Promotion,C 1 The CroadmiLi ,e Law Joe,ma.,,I,I. a 307 - INSULATIR)34uiredInspections" on r of property Who mildly or improves thereon,andwhoAnes such work hiaoalf or through his p1 y ..porvid,dba,alien improvements t intended or 601 — ROOF TEAR OFF , ger rdenofprovIa m evenror 602­__-ROOF PLYWOOD NAIL m pl compos, b 'lmrwtnhave the baraetofpro�agmmnedid notnnldor 603 - ROOF BATTENS improvef pm r 'I I d Las literal,lifateppty a 'ROOF- IN-PROGRESS­ rise o construct 1h "circ,(S 914 ❑ e d ____ ._.. .... P f Cudc:)'Iho Cormarmal, - License Law does not pae formally I h I I p thereon .end n t c,f hlllicensed p rsuvntto,he. P Je t th ...lith1 s Contractors Liecc,df "'- °I mor coo,ol,pa motherS B&PCfonnie reason WORKIiR SCOMPF.NSATION DECLARATION O/ I hareby affi rill trader pe la,of pi one of the followi ng der fortiori I h p ave and will inainoin a Certificate of Consent to selM1ineme for Worker's - _ Cempensallon, as provided for by Section 3700 of he Labor Code, for the performance of the work for which this permit is issued, 4q+I Irrve a td w ll co t i Worker C p Imsamord,as dyUirCd by Section S]IXI of the Labor Code,for the perform"tce of the work for which thin perm t is start,Say W Worker C p t a Ins. I lid Pot cy lit liber m ���r�, a : 'Ca er�yJ.ylN IXE'Ids! y N41 E 1CAlION l99�pRR IiTIONINSURANCE NSUR WOR ER UNANC 1, COMPS SATION INS (srh'. 'efonwad am be enaplctedf the permit is for ane hundred fit... J'-Lit. (41001 or less-) ' 1rentfythty er,performancefwork- fwhicht' p "t ' issued, shall not employ any pe sen n dry nn s hi became sn bleat m the Workers' Compensation Laws of Califdrnla.Date Applicant - NOTICE uOAPPLICANT It, on"ak mil Cratifc"te'of hsenpfon you should z. barovildecm to he rurker'a Colons or tlod rioniou of me Luhm Code,you'mLLa Q O fo th 'th nply with rush p 'sines n this wrmit shall he 1 ed revoked. F.� 'CONSTRUCTION LENDING AGENCY . . In ehy affirm that hemi,a riashortlenle tdiny egency 6rthe parfunwnce .� locri Ith k C hich th pe is icer ed(Sec.309],Civ.C.7 -' � z Lenders Addksv V0 ,I certify that I have read this application and state that the above information is "g ;� coma:I agm<to comply with an ally and commy rodura was cad chute law,relating C-V m huildingemisouaion.mad herchy authoriiompresenrutivesofthisciiy menterupon t-P, the hu f edp p ty 'pmt p p Fs. iCI0L (W1 't" a fy 'and k ph inad say fCpn,muo,said 6.- LL z Cit 1 d ix. "t d lie h may In nny y gain' acid U �Z City IC y RSTAN tag W ......t �'.3a-0/_ �O/ APPLICA NDERSTANDS AND WILL COMPLYWTTH ALL NON POINT' C Tlon Issued by: Date St UR F 4A �mr. -;Dare Re-roofs _. g Ap IHA RDOUS MATERIALS DISCLOSURE W u ilm apprca t driLturci taliffingoccapaill shom,orhainfli,h`o mutes mamma Type of Roof Ca detSeo Section the Cup n M n'c pal;Code.Ch Pt J.12,a J th H hh add Safety Code seatotzssl'fnl , All roofs sinspected-prior p'N I , hall be to any roofing being installed.._ W IIm appl'c ' ball b Id Imtt : ell par m ' swasch If a roof IS installed'Without first obtaining an inspectlori';'Taome to remove as h d t t lelndby the B'yA aArQ IlyM agement o °i all new materials for inspection. Applicant understands and will comply with Oreo °" H om source regulations: 1_;,•,, - - `sN' .: 1 n r 1 the hoe to te'h. quireHent d Ch pt -n.95 of the ' 'C£IfmiaH 'hl &S,ill,Code.Si,cimar 25505,25533 and 25534,1 miderstandthat p , 1 ifthe thildin,der,netcall h' lervart.L tit : re,somfulitytmoody the eep,nt bf the rlibullands which raos,be met poli r it's eof a Certificate of 1 �f oe Signature ofAk 'cant Date _= owner - Dme All roof coverings to be Class "B" of better OFFICE . . .__