00090110ct or CUPN:
CONTRACTOR INFORMATION:
BUILDING
nuu,nc nlvlSION slnry PERMIT
BUILDING ADIII(ESS:
PERMIT NO
GWNFR'sNAh+22202 BITTER OAK. ST
T
(IN.RATAW
�IONE: NIELSEN MARY T
SANil 'MBY NO. / I t3 )Nfae.
>. AI1CHITECTIENGINFER,
ICII.IIINO 1 HRooll PINE(
1fl.1 Ki ELN.C'IPIAJMB b1L(JII
I. ] I
d
CONTRACIOR SDFCLARl'N
LICENSED_3_�
Job Description
I herebyfou Wm1an licensed under promnChuPer9(commencing
Section 700(ton Division Jillthe lLninc<add Pro4,iuna Gilaantl my license
is in fu11 ked, late f�
�memrc �..._ Lie.x it B -
hum C, rat
_1.40__do
ARCHI'1'ECI'S UIiCI I mo$
SEM WOOD TO TILE
gI find cn,find my Plan, shell be need ae public reemos
�O Licensed PndeWonal
P., OWNER BUII.O?R DECLARATIl1N
1 hereby anion that 1 am exempt front the Conine or's License Law for the
fnllmving renam. (Emden 7031.5. Bm'inee, Lind Proressim s Code: Any city oreuunly
O which relu'un, it permit in eonmmml, alien unprt.ve, de:nolitlt, or epmr any amcnre
prim to its hsuuncc, al,n ntlttlm, Ihua,Pbe:ml for nndt armed, ,, Nc a signfd art .... cut
Sq. Pt. Floor Aren
Valuation
thin be is nefrnel pmvmrt to me p to.... Qol heComrmerra l.iee.,ee Law (elnrp1ef 1)
fennaneneing with Section WWII) of Division 3 of he Basinesl :tad Pndea„ms Cnde)
or that he is evempl therefrom and the too for the allegnl eacmptlon. Ant vidrfi
of Section 7031.5 by any zppllcem fit, a Permit subjects the applicant ¢t a in, it penalty
APN Number
Occupy
of net mom than five hundred dollars (SNX)),
t'
D 1, as .,net of the pmpe. y, Lir it,, wnployfes with wags, ar III& sole competnaltun.
will do the wank, and due ,warm is not intended or oll'ered fin sale (Sec. 7044
='65
Ilun1ncsa and P ill ,ion, Gslu: 'rhe Cmnwebar, Lireu,f Law tlnart :apply .o inn
04.x.1
32 RLI bred Inspections
caner of property Who builds or 11nnoves theicon, and calm does ani wink un,wll
or rhoumh his own employt provided our etch impmvemm�ta are not inranded tar
ordered for axle. u: hLiwmer, the hooding (or improvement i, sold within one year Lir
,05 — FRAME
i,mplelioq the ownfr-builder will have the burden of proving that he did aol brad or
mprove krpmpteve'If.me).
307 — INSULATION
❑I.y-(owner (it the pmpeny.amexclusively cnmmebtswinolicamedcontractors m
601 — ROOF TEAR OFF
he pout )Seo. 7044. Bee and 'tares a C...')'rhe Cn 1c onlu :r
1.minae,
,u eLawdoes applymnnowner if wl.�lalilN nrmnPnte, holLI''
who,
602 — ROOF PLYWOOD NAIL_
and Cmnruetx for melt pr lana with a umtmn...to Iken.N Pursuant Io rho
Commd,not .iefn.f Law.
603.1 — ROOF BATTENS
01 am eacmpl tinder Ser. . It ad P C for thl, rein....
604 — ROOF IN—PROGRESS
0, her Land
WORKER 'S COSII'1?NSA'1'I(1N DECLARATION
HNS
I hcmny arlinn under pe.ally int p jury enc of the lellowing dcclumfun.s:
0I have and wille I CtlflfiCam AfContent to oif for Woderx
Cil p tion. to, no,ithed tm, by Sot , 3700 of Ih [.;,be, Come. for the
pert f 'he , k Icradia, rl "nut ,I.
01 has, Load voill umnumn W ltCoderme..lion 1r,. umnce. ar; rea,mried by Se,fion
3700 of the Luher Cmle. It the performance of the wink for which this permit is
,sued My Worker'sCompensalin I I mumex carrier al Policy I doe, an,:
Canon Pnlicy Na:
Cf"Ii' 1111 CATION 017 UXn]1YI"ION FROM WORKERS'
CONIPHNSAI'ION INSURANCE
(Thin aeeinn need not Ise completed if Ilse Permit is for Linc hundred dollar,
(S 100) Lir Icy )
I !edit, that In the p<dnmcmcC of the pork fm which tli Anni1 is issued, 1
111,111 not employ may nersnn' y m:nnre , s m ,n,ypynytt to We wmee_d
Gnupcnwdn haws ill Cr.lil Il,ne
yI
nppucalu
Nancev CANT:il.hi(e}4itutkmslnn :eat .e.IvolfPxenWtinn, you should
become suhL in We Wink,, , s Con,penstacur p,,I, or e. of the Loher Coda you neat
forthwith comply with inch provisinm ar this permiuhot be at re, tried.
1 CONS "[RUCTION I.IeNDING AGENCY
I hemby affirm, that there is it cun,mucrinn lending igen y lin the perfom,ance
of the work fm which 1 1a Quite[ is lesurd (Sec. 3097, Cie. C]
p Lender's Name
Lender's Actions,
1 comfy that I have read this application and stale Wal the above infinmatinn in
entree. I agree in c army wim all city and county oNinared, and state laws relating
In building commmnnn, and hereby anhuriot oressemmlw, Lir thi, city to, enter upon
I the It o c-mmaim red property for inapacdnn malaise,.
(We) ugrm oo note, indemnity and keep harmless the Only of Cupcnin' Libelist
1 bibilldn, judgment,, .Li,P Lind eapeme, which .nay in any' way neenn eguimr'old
I City in cometp.cnce if the ginning of this permit.
QQ..
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
ISsIIC(Ib y1 Date
SOURCE REGULATIONS.
Sigma u..c of AppllcanVIComeeno, Dore
Re -roofs
HAZARDOUS bIATERIALS DISCLOSURR
Will Imuppllwmarfrom htdldingoamp,amtatommh I[Qht...thusmternal
Type of Roof
s defined by the Cupeninn Municipal Cndo, Chapter 9,12.:md de, health and safe,
Cliuda. Sedate, 2s571pn7
1:1 Yes ElNo
All rool's shall be inspected prior to any roofing material being installed.
WH We appEemaormor, Aod,lingnfcmpanl rise eloipmem to, deuce, ond,
Ulf root is installed without first obtaining an inspection, I agree to remove
-mil hazardous air fmnmmlnanl, as delinN by the Bay Area Air Quality Mntagutnem
aslrion,
all flew materials for inspection. Applicant undersuutds and will comply with
❑Yin ON.
non- oint sou' e regulations.
I have reed pm hma does u.,1trrials nyuimntenls esu kr Cnrptcr 6.95 of pit
Call I train, k Safety C 1 5 dim 25505,25533L 5531 1 d _rat d that
'fed dll'yl _ nearly I, m. .I WtI'. y .'1'I'yt lfy lho
NNN
uc path fth lir t h'bmu,t he nu preno "auua oft Cen'fnm
Oc up f
d_-
Signature of Applicant Date
All roof coverings to be Class "I3" or better
Owmrnr ammm�rtd ager„ Date
PlR21"