01080056 Ci cuof GDIVISION
t PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
6339/6351 BOLLINGER RD 01080056
OWNER'S NAME: APPLICATION SUB DATE
HO ARTHUR AND VIRGINIA TRUSTE 08/09/2001
PHONE: SANITARY NO. CONTROL NO.
C O O ARCHITECTIENGINEER: BUILDING PERMIT INTO
z w- L ELECT PLUMB MECH
y< _1 I"—I C=1 L.-I
z�J y 2 I thereby RLICENSIEDmONT eCfOR'S DECLARATION Job Descrip On
O Z-o y a prvwi,m s of Chapter 9(commencing
amF wil eclion]000)of Division 3ofthe Business add Pred � ^� ny REROOF.
,WZ n full face andefe,-� 7YL Cl�i<• %en T/0, 4 GNC.
m ec¢ ase Class Lie.a z(� .11
w 3 u O Ia¢n Contractor
ARCHITECT'S DECLARATION
1 understand my plata shall he used as public records
�r
w 6 tip 0 Licenced Professional
OWNER-BUILDER DECLARATION
I 1 hereby affirm ba,1 am exempt from,he Contracmr's License Law for the
F following reamer(Section 7031.5.Business and Pmfc,o...Cade:Any city or mimtin,y,
F which requires a pert to common.alter,improve,demolish,or repair any swcwrt
n 3 z prim ,ol rte alw q <''h far stailt,o,nair file a,i,acd stammem. --
thatlhcitlicenudvun116d,epmvisionof,hcCon=toesLLaw(CMpter9, , aut(om c g with StRi ]Y ) f Division 3 f theBusinessd professions Code) .s 9.sFoorArea ion
or that he is exempt therefrom and the basis for me alleged aeniplxmn Any violation
-of section]031:5 by any appramn for a amm,s.bjcc,s,he apprc m,o a civil pamlty 365
Occupancy Type
1 of no,more than five hundred dollars(55001. be u
rd .:"
0 h as owner of the property,or my employees with wages as their site compensation,
will do,he work;and,he structure is not intended or offered for sale(Sec.7044,- ME
V:-
t Business and Professions Cole:The Commerm's License Law does not apply,o an 307 - INSULATlP§Anired Inspections''
owner of property Who builds or improves,hereon,and who does such work himself
or through his awn employers. _
gv :dm that win improvements arc no, ne ycar r _ _ ROOF.TEAR OFF.
'compleffeled for saF Ir,erhowever,-,A l have t or improvement is sold hed id one yes'of - - A -- -- --- -- -- ..._.._...
d
dmplaion.,he ow ta'b 'le will have,heburdenof proving that heddnm,build or 602 ROOF PLYWOOD NAIli'r ;
lmpmwforpurposeof`al`), 603 - ROOF BATTENS
olaaowner Orme property ' I an -mm g ',Cm,:)Thu Canr,nn, 604 — ROOF IN—PROGRESS
cont nM1 P l h (S ]1.a Business- d P f '.ons CW I Th Can s
Livad s W d f puck o rte of p pe tY ha hu'Ic. s pro t tooth. ' '
o h con, as(o RP,.,.t,.with , t qs)licensed pursuant m,rte _...__ _ ._. _
Contractors Lc .cls "
01 ,todelS ',B&PCf ,his reason :i, I,
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pe..try of perjury,one of the following declarations'.
0 1 hove'end will maintain a Cenificam of Consent M self-insure for Woller's
Compensation, as,provided for by Section 3]00 of ,he, Labor Code. for the
_ performance of the work for which this permit is issued.
- ❑1 have and will maintain Wodter's Compensation Insuremce,as required by Semi
on
'39ID of,he labor Code.for the peiformance of dm work for which this permit is
is d My Worker's C - ,e . , Tasman nd Pol'y be
Cam hey
N..:'
'CERTIFICATION F EXEMPTION FROM.WOR KERS
C . 1 }
y ,,.. .. ..,...__ OMP.NSATIOY INSURANCE'
URANCE'_ ' '• .` .•
.-..-.- .. ... ., .: ... ..,. . _._...._.__ _._._.__..._...._.._...
" (This'chitin aced no,Is,e'mlenl ir,he -__ "-- 1°"'!- •. .1 rn:
o p permit t:for one hundred uouars
0100)or less.) ' '
t: 1 ecrucy,that inm ferformance
...of[he work for which this permitisswee I ...._...,_..... ..., .. .., ,.. ._ .... .._._»,.__. ..
Cian t all Y s,f y as m become pita to coq Workers
n :
Apmpe i laws of C f r Dam -
pplicant-
YNOrICETO'APPLICANT If ager making thisC nificme afE rmp,nn you should, f "-
z 'becomesubjectcony the Worker's Compensation provisions of,he Labor Code,yo:fmusti
Q '(mrthwi,n comply with such provisions or his penin shall he deemed mvoked.
Z __.
'F ^ � `CONSTRUCTIlIONLENDING AGENCY
�i1 h by firm this the cone i nding leagency for me performance
.�.:.., Leta ork( which this permit . issued(Sec 3097Cis.CI _, -
.a-Q 'Le,ndel v Name' _.'•... -•° :•, a. •
..Q.Z liodera Addrus... 'i i 1•4!' :
V 0I certify that I have mad,his application add state that the above information is
'torr"'.I agree in cranny with all vol and county ordinances and state laws relating
Or •to buildiagcons,rvtion.and hereby authorize representatives of this city,,.emerupun
'the above�mentioned property far im"im m........
(We)egree to save.Indent;fyand keep harmless die Cityof Cupenim.,iast
h liabilities,judgment.rAA.ts an expenses which may in any way accrue agalnel said.
`'V-Z Cif ine sequence to egret agofthispermit-
'A LIC. UNDER❑\ND. ND WILL'COMPLY'WITHALLNON- 1 r' [sued by: ate
OUNCE 11 L TI [ '„i' '+
1 Sign ppl' V o vac, .. Date Re-roofs
HAZARDOUS RIALS DISCLOSURE' - 1 '
'" venin -ppr tis (t¢b 'Id-ngac p tstdreo-n al bas'+^n material T of Roof , .
defncd by,rte Cupert M p 1 Code Ch p, 9 12 d m He hh d Safetyype
Coe SOY 2551 fn1
❑h '
All roofs shall be inspected.prior_to.any.roofing.material being installed.. .....
Will he ppr mo more building pa, ea p , devicesmi m If a roof is installed'without first obtaining an inspection,•4'aaree t6.remove
emit h d u onmm ,. eel and by m Bay Area i Qpsl ry gemem
District!o Ye Cl Nis t Inewterial or in Pecuon., Applicantunderstands and willcomply with
of so r e re lauons1 h J the h Cw maseral req m m.' d Ch pt 6sh of,heulifur Hmm&Safety Cafes Ionssrogt25533 dderCI rl6tend mm,doe.no, nI h 'ten i, t . p dldy, nify the -'-di require , hichbe e,p i ism - Ce nam of -of Applicant.
Dwn �noa,:e Darr_ All to
c Brings to be Class "B"or better
OFFICE