04100012 D NCITUGDOo
BUILDING DIVISION PERM !.GOO N R CTOR�NFO MA
BUILDING ADDRESS: FIVE STAR WINDOWS PERMITNOys4100012
T)WT(ITC PT,
OWNER'S NAME: PERMIT ISSUE DATE
SANITARY 0. CONTROL NO,
OS) 370-33-31 1
ARCHTTECTMNGINEER
7 -
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Oct, LICENSED CONTRACTOR'S DECLARATION _ - -
FF �I henreby affirm that 1 am littnscd under Pr�o�vp'ions of Chapter 9(commencing �'ffrff1f����A���` npI1 J//AAnn�yoas�`b Description
uz with 4MTh 7000) fl) Sof NCBusincss antrYofcuiona Code.and myliccmcis "' 1hae ®
in fol and cf /• YY- �5 REMODEL--"WINDFI 'H$`s—
j�i Liccmc - ---
u Dau CITECrSD ser m2
___ ____._ . . _-
I understand my plans shell be used u public rte rds NOV -I?- 2004
;�G LiccnuJ Pnsfcuional - - -
OWNER-BUILDERexemptDECLARATION 1r
1 hcmM1y.(Them that 1 1. exempt(tete the Contecmod License law for the D
p O following mama.(Section IID str Business and w.demob Code:My city or=aunty --
K m
which rcyuires a permit to construct,slur,impmw,dcmnlisA m repair any xtmnum
yzILCHNr
i prior to its issuance,also requires the applicant for such Permit file aligned statement
< that he is licensed pursuant to the pmvisionsofthe Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
XI-M (commencing with Section 7")of Division 3 of the B usineu and Professions Code)or
y _ that he u exempt thesefmm and the basis for the elleg=d exemption.Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant m a civil penalty of 3 5\Hy1`M&(bCr0 O Occupancy Type
not mom Nan rive hundred della.(S500).
❑I,as owner of the property,in my employccs with wages as their solo compensation,
will do the work.and theslrucwm is not intended or offered for sale(Sec.]BAA,Business
and Professions Cade:The Conuuctor's License Law does not apply to an owner of Required Inspections -
property he builds orimprmes thereon.and whodoea such work himself or through his _
own employees.provided Nm such impmmmeno ere not hammed m.ff od relish.If.
however.Ne building or improvement is mid within one)car of completion,the owrter-
builder will haw the burden of proving that W did not Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively convecting with licensed contractors to
construct the project(Sec.]BAA.Business and Professions Cmc:)The Cantracter's Li-
mine Law does not apply to an owner of progeny who Wilds or improves thereon.and
who contents for such projects with a conummr(9 Remixed Putmanno the Conttxeto_Ys
LKens law,
❑ I am exempt under See. .B&PC for this=men
OwnerDECLARDate
WORKER'S COMPENSATION ATION
G 1 hereby affpm under penalty of perjury one of the following declarations:
I mon
and will maintain a Cmermine of Consento self-insum for WorkcYs Compete -
ation,u provided for by Section 3708 of the labor Cmc,for the performance of the
work for which this permit is issued.ai
I have and will mnoin Worker's Compensation Insurance,as required by Section _
3780 of the labor Code.for the performance of the work for which this permit is issued
My Workek - C`om� a(Idaon/Insuence comm and Polign mWr am:
aPolicytlF .Z(Q�
CERTIFICATEOFEXEMPTION WORK RS'
COMPENSATION INS AN,
f]hH section treed not W completed if de permit is forotc hundred dollars($100)
or Lc..)
1..fy that in the perforromec of the work for which this permit is issued,1 mal not "
employ any person in any crooner u to be=omc subject o the Workers'Compenution
Laws of California.Da¢
Applicant _
NOTICE TO APPLICANT:If,after making this Comficam of Exemption,you should
become Subject to the Worker's Compenation previsions of the Labor Cmc,you most
.JZ forthwith comply with such Noviauxui or this permit shall W deemed ranked.
z O
CONSTRUCTION LENDING AGENCY
',.. I hereby affirm that them is a convention lending agenry for the performance of
D.a
to work for which this permit is issued(Sec.3047,Civ.C.)
[k1 Q Under's Name
a Lcmim's Address
U 0 1..it,than 1 have read this application and sort that the show,information is
IL F correct 1 agree to comply with all city and county ordinances and sum laws elating to
DU aboyc-meding ntioned ion,ond for
mthon.mpresenutivrs of this city to enter upon the
r W shove-mentioned property for inspection purposes.
O. (We)agree to eve,indemnify a d keep harmless the City of Cupen o against
liabilisia,judgmenu.eosu and cape w heti may in any way accrue against said City
U z in consequence of to graining of is pc L
APPL ANT�1NDE N A If \ LL COMPLY WITH ALL N N- 01 Issued by: - Date
. IN '�
Re-roofs
ig tort Can C"m o S MATERIALS DISCIX1Stl E Dam Type of Roof
rilthcapp'amorfu building occupant tore cr handle hanumus material
as fin d by the Cu onto Municipal Cmc.Chapter 9.1],and the Hcahb and Safety
ode.Se on255 all. All roofs shall be inspected prior to any roofing material being installed...-
0 e
Will the an(dinan nr Suter=building occupant use equipment or nevi==s wmnn 'If a roof is installed without firs[obtaining an inspection,I agree to remove
r h000dous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
ismin]
❑Yea /fyt pin -
&lffiSd.1
ha>.eMnusm Ismquitcmcnu under Chapurrr.95ofdm Califor
rde,Secuurue58 SJJ and25534.1unders�nd thatifthe building t
at' my rcaponsillity to notify tnce�.pent of the�" rwiuuaettea certifin�or n p =b Signature of Applicant Dale
agent Y�/1 Dam All roof coverings to be Class"B" or better