00090109 ci uu.OF G DIV SIONNo PERMIT , CONTRACTOR INFORMATION:
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BUILDING ADDRLSS: - - . 'is,IJ PERMII's }. "p
OWNER'S NAft1tIZ�L� tl
PE — APPLICA'I'10 -
PHON&' ' WU PABLA G, AND DIANA
.a SANiURYN - ).
OxZ ARCHI'IF-C'DENOINE[R: — - , NUILUINOPERMIT INFO -
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LICENSED CONTRACade, S DECLARATION ° Job Description
Oz4"tom 11 bit nand tit of d' J P fCh pt -91 ons.
1E S ( 7000)of D' 3nrthe Pu IP rc C Je mJ ny l' nse -
xa Dtrre1� ' lel c "ado. OVERLAY °(2) COMP ROOFS' W/40 YR GAF COMP
W O y ARCHITEC3'S DECLARA ION
F-- '� 1 d .n J' YPI hIIMused aspuhre Cenedi
Y
pLicensed P'ofess oral -
0WNFIiBIIIIUIRIIIC1AI2A1'ION
el"' Ihereby 0 that I an, x,nmer do,C fewon,i Law for the PC or `
fall g .(S,Cnmi 7031.5,Business d PmaussamoCade Any city orcounty
. z�M Q win q notion u erasures II p di h L y structure
prior to ts iALamirc,also equinesth pplt t for suchfount ttile a signedttement a a .
thnh licensed tt t t.p of the C t t L' L (Chpter9 Sq, Ft. FloorAreA Valuation
(Counimencingwth Seclen7000)(if Division 3 of the Business and Pmfe'sions Cade ,•L-, �'
or that h pit wo,finre undhe basis For he d1,,al d Any vmitr on
fs It areman5n rnydpalnalm is rs p) I, bi len,e nit Pr II 'ivupe pally APN Number
_ - "Occupy
°I,as owner of Property,ormywri.yecc with wages as heireme cmhpanammun, f .
,,It do the k.and the tractuseis o t tad.,offered r - Ie S,C.7044. .. '3301. 1
Bu" dprofession,Cd 'H•Contractors L"a I' d t'poly ,,or' a 31.6
. •s :wired Inspections
own f Property Whon Id tp tin d does h k it 11 ' -
or through his ply p rid that...b Capture CutsI inumded or ..
.Fired for:l .If 'he n"Id" g s,r" p t m'ithin ace Yen or, 305 — FRAME`` -
ramplf nmc ownerh ld 'llban.Il bu ileo fpry ng that lmdirk,ot hn'IJ or .. ,.
mp r pa asenr l7 307 — INSLILATION
.to 601 — ROOF TEAR_ OFF: .
construct tin project IS 7(94 B d f I. Cad,:)TI C t can s
License Ln at early no fproperty n n I1: hereon 602 —
ROOF -PIIYWOOD NAIL
and who contracts for such projects with ,mrtnarts) : Torment to the
CmnraunsL°enseLaw 603 -- ROOF BATTENS:
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I an escape under.Seo B&PCfor this remen
Owner Date _ ` .604 —. ROOF IN—PROGRE9$
. .WORKER'S COMPENSATION DECLARATION i
• I herby off Car CodesPC. f p 1 Y to-f d f 11 g l 'f il
n
° I bact,unit"willjoraininnCertificate o1 3 Consent I f Wo
Compensation, president d t by Section 3700 of [h Labor
an Code, r the 1 the
wificrourno,ofItworkI' hlh'. permit is issund.
I h 1 ll maintain Worker-'Comp, t Insurance, I I by Secs ' t -
r
00 rtin L nor Cod f II p f t tik f h l the P r'u d My Wo els C p t n incur vre ' d i nit y nunhcr arerriu''.-��!� .,Iicy No..
CERTIFICATION OF EXEMPTION FROM WORKERS' n.
e. COMPENSA'f]ON INSURANCE ..
(This section vCCdi?Ihacno,lemdd the permit is forene handreddnllam '
.($IIHI)Of less) .
I eerily that in the performance of the work for which this permit is issued I
slmll ed ineploy any perx.n in any manner s.'ias n'hem.on eobject In the W..kcrs' '
Gnnperedion Laws of Callfomin.Dote
' Applicanl
NOTICE 10 APPIICAN9'.11"afer makingd" Crit 't fl pt ) -:h Id -
hec subject I the W k :C p t p f t Labor C d y' :I • 4> I .
. Q forth t Ih comply with such Previsions or tit s permit sort he deemed revoked, -
F C4i. CONSTRUCTION[.ENDING AGENCY
hereby afror that there t 'I lendng agency fc)�r the perfamtaace'
W .fine work for winch ln'p rrnis issued(S 3097,Cl,C.) - -
1t Q .Lender's smane
UZ Len 1 Add e.. v
I cen'fy that I rose Creditsup,linitro,and late h t in,oba,c, Instruction its„
W ji. col t I agree to Comply with in c'ry and ' ty oofirrource,rad'tat";'w. hung
67 mn 'll' , xmicuo (hereby carni' mpraett luesflhs city to emernpnt
r y W
duclowe-ruenitored property t " 'pet 1Parsee, e x
ray y (We)".t rdtannif,endLee,harel...the City of Capetian reln.t v
liabilities,judgments. t 1 ue:which may in m>way arecric against end
.ii.ii Z City' -consequence of the gaining tit this Pc- t. , - Old'`,
APPLICANT UNDERSTANOf ILLCOMP WITH ALL NO POI Issued b �� Date /.[}-Z/ V ,
SOURCE REGULATIONS 4 � Y•
sig tSig t dador - ( D t -Re-roofs r • '
HAZARDOUS ATERIALS DISCLOSURE - t
Will the ep,Ecn t fine louldingococal larr rlnordl,l `mi4 r'al, 'Iypf;Of Roof
as'demed ny the Ctmwlina Mnm6pel Cale Chapter 9.12,and the flet inn and Safety
Code,Section 25532007 'p
°Yc` C"'r .All roofs shall be.inspected prior to any.roofing material being installed.
WB h ,Rica I r to n 'Idiny rapt .'c eqa p t nt I e`.when If a roof is installed without first obtaining an_inspection, I agree to remove
etnul r cam dr l: JRnul nyth B'YArwA Q I'ry Managcmem .
District'°Y � all new.matenals for inspection. Applicant understands and will comply with
all'non point.source regulations.
I face and tire helmori m I " I,requirements unde,Chat 695 ,f the
C.1homin Health&ne so eCode,lSection,25505,it is and 25534 I t I i' d Ihm
'[tin art of
J t fly have tenant,lb l t is myresponsibilityofaC catify lna
. na pit fah I 'm t which muxlh tp'.r m'xs corn Certificate of
Oc` p j Signature of'Appl Cant n Date
�f ' o� All roof coverin s to be Class "B"or better
Ow hal zed n w. - ` ..