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02010083 OF • CI BUILDING DII ISSIIONNOPERMIT CONTRACTOR INFORMATION: Bul RARE S: PERMIT NO. X63-8' ELDERWOOD CT R-M YOUNG 02010083 OWNER'S NAME: APPLICATION SUB DATE GALLIVAN JAMES J JR AND MARI A 14549 S BASCOM AVE . 01/22/2002 '1 PHONE: SANITARY NO. CONTROL NO. (408) 358-6977 0 O O ARCHITECT/ENGINEER. BUILDING PERMIT INFO z BLDG ELECT PLUMB MECH a d I_J _I L_1 L_J y Z LICENSED CONTRAC OR'S DECLARATION Job Description i z_� 1 affirm hereby arm that 1 am Iicen xd under provisions of Chapter (commencing „�t< with:err°n7")ofDivisi°n3 of the Business and Professions Code.and myhaense REROOF. izwaLicense CI fique" LLiica.a�7L�Z G�-- O n U Dora -.1 ntranor ILL ta G pIAaPRCHITECT'S DECLARATION ucontraband O 4 1 my 1s shgllfic of a. Ins records ;E00 Licensed Profess osood 1 �, OWNERBUIL R DECLARATION 1 hereby offimt that 1.am exempt from the C.ntiacon,License Law for the t-z fallowing reason.(section]031.5.Business cad Professions Code:Any city or county $9800 E x e which requires a permit m connwn,alter,improve.demolish,or Mair any muaure i3� ...prom t '. also req rt theapplicant for such potato fl 'grcdstamment that Tet ficerviod Irrsdaa to the Provisions of the Contractor's License La (Chapter9 1, 1S FI- FIOOr'Area y Valuation commencing 0S t 1]fgN)) fDi,.mn3 tithe Bus nes DP fc..ions Coda $ ( i� t '\..,iQ'i •f... f. r „,til'k. or that he is exempt Therefrom and the basis for the allegM,&_mPt on.Any violation of Section]031:5 by any applteam for a permit subjects the applicant to a civil penalty or not inure than five hundred dollar,S500). 3 0 4PN P Y yP Occu ane T e ❑I,as owner of Me property,Lir and,employees with loges as their sole compensation, _ will do the work,and the xuunure'is no,marchedor.Rnvd for role(Scot 704y' Businds r aod Propositions Code:The nt Coact.,.License Law door,a.,apply or as 601 - ROOF TEPAin kiRHhspections'"`,,t -_a/, I„ owner of property Who Wild.%or improves rheraon,and who does sum work himself 602 - ROOF PLYWOOD NAIL or through his own employcez.provided that such improvenomms arc not intended or -.Rad for sale 1[howeva:the Wiltlin u is sold within one - - f - - - - ---"'-- "-'---' - g°"mPro"`m`" "'° 603 - ROOF BATTENS completion,the owner-bonder will have the baided of proving Nat he did not Wild or improve forpurps of sake). 604 - ROOF IN-PROGRESS ❑1:as.wnepr0e property,am exclusivelyc.mronirig-withoakr) do Coazwrsm h'1r b."di continua the project(S¢.7U44,Business and property who ildc:)The improves tmaam i License Low dos not apply m an owner of property who builds a improves Thereon. .and who convaense Law.., projecu with a conuactor(s).licensd.purtuanl.m.las _ .. Commamors License law... 1. ,t ... ._._ .-_.......__..-_.... ._.._.._ .... ._..__....... ..... . .. ........ ___.__.. ...--.._.__._._.. ❑lam exempt to Sec. ,0&PC for this maven .O;I Ise:':f'�lifa: Owner•. ., Ddlo,.. „ WORKER'S COMPENSATION DECLARATION I hereby affirm under,penalty of perjury one of the following declamations: C j•O 1 to aye'anniOonse d will maintain''Cecahe or Cnt to self-inure for Worker's r NALED Compensatir,n. as pr.vided for by Section 37W of the labor Civil. far the FEB Performance of the work for which this permit is issued O O p 002 ElI have and will maintain Worker s Compns eation Insurance,as scghired by Section 3700 of the lab. Code f the perfo - Formit in amd MY .ins .0 po . into . ..BUIL-DING a Car kir which n mie e d Policy bn Cpducl l CERTIFICATION OF E%EMPf1ON FROM.WORKERS a asst}A ( 19i lit k?ig's, - _..„,c„,,.:.,;. ....,. ENSATION,INSURANCE'... 1• ., flirt wniori need COMP.. ,. .. .:',n.__.r,...:.. ... ...._......___._- .� �.. :1 J,�o �. •'1.,.. ;. .. I% ,. hat be'compind if the permit is Interim hundred dollars -- --+-.�--_--•--' �- � t -_-- -_- (EIW)nrlcssJ ' 1cant,fyihat .the pert n< /th kfor xM,h th pe;-i ed,l i t ,I:' 1 :".t t!)h, � Y ,v'Y,•• ' �` - as any me b as id, is Cam ut O e,OTIC us tO Upyday a Cklpf C �ekia tP roiv.Ac ll be dcemedtrc.okea. must. shelf c a t her a b)a I the W kers of 5affial ter ari P you should ons of the Labor Cod O f.nnwith coat with such r o ons uh half _.. . �,h •t - t70NSTRUC ION LENDING AGENCY a 1 h iebY ff uh t Itie onsliuc( d g agency for the performs ce „ W Or of the work for which This perm t is issued(Sec.3097,Civ.C.) ,.. .Address r..) O 1 certifythat 1 have read this application and turn,last the above informmioa is .gree 1. 0 comply_with all city and county ordinances and stem laws relating O f) m building construction.and hereby authorize isItac unitives of this city.m enter upon ube a arm-m rommd property for inspection purposes. F.r L (w)agreeto sevindemnify ad keep h rmle L lha City f Cu peri .against m liabilities.judgments.cot d expo xs which mayin any way occurs,ag m;t said U Z Cityimquence aide goading opthisperni s�SP��P)1 DE A SANDWILL COMPLYWITHA LNO lllf ` b'N}'RGF �I. - Z W u Issued by: tate S✓ig�natureyf ApplicanJComra "" -_, Vit^ •pate''L If O MATE L DISCLOSURE ''” Re-roofs Will Ne appl'ani orformer b 'ld' g c tstem handle hazard :mammal Type Of Roof. os tlefnd by the Cpen Mue 'p IC Pte 911 dm Health and Safety yP _ _ -'-d""- -T"' : -' .. .-- CWe OYe 25532(') ®N • F } I rit ..All roofs shall be inspected prior to any roofing.material being installed. _ •” tan th ircontaminants t ants b fdim,inedoccupant-yAequipment d :v.•meh If a roof Is installed without first obtaining an inspection; I'agre6,to remove emit M1 Will a c u m t. refined by far Bay use A Quality M s mem D.td O all new materials for inspection Applicant understands and will coat I with _ all non-point source regulations- P y' ` - - .t a'tfar, !,r 1 h - d fl h za d mrials iegmrtmems undo CM1 'mr 6.95 of the v r ,_ California Health&Safety Cede.Sections 25505 25533 and 25534.1 understand that if the Wldng does not command,hamnatlhat it is ms.vuane f Cniotify h`- - -- .- - ., .,, .- _ , Deco tMuh're Yaspo siblu t motif t tkcu qu em m h ch imslbe m t p'?m of .. .� 22 Signature of Applicant Dale Oxmcr.r.mnmiad'gem , Dam All roof coverings to be Class "B"or better' ... _.... . .OFFICE.