02050174 /CITYr obi c upviRONNO CONTRACTOR INFORMATION:
PERMIT
L
ILDING ADDRESS. PERMIT NO.
1412 ELM CT PETERSEN-DEAN INC 2 4
NER'S NAME: APPLICATION SUB DATE
UNT JAMES E AND MARY JO TRUS 7980 ENTERPRISE DR 05/28/2002
'PHONE SANITARY NO. CONTROL NO.
(510) 494-9982
IR!
ARCHITECTIENGINEER: _ BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
>01 C.D f---'I LLJ
Z LICENSEDCONTRACIOR'SDECLARATION Job Description
O I hereby affirm that 1 am licensed under provisions or chupter 9(commencing
wimsection]0W)ofDivision3oftheBusinessandPmfessionsCode.andmylicense REROOF
li:_ u«�°yep"n.,` q_ u<.a I T/0 SHAKE, RESHEET 1/2"CDX
O n r,_Bmxe Commaor
M it ll 6 � ARCHffECT'S DECLARA ADD 50 YR CELOTEX COMP SHINGLES
C'='O g I undenimad my plans shall he used as public records
}E
C O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby o(Grn on 1 I.S.exempt from the Gonias is License Law for the
r Z a following reason.(Semon]oJ LB.almar and Professions Code:Any city o....nty
4 p which requires a permit to ronswn,altee improve,demolish,or repair any arvnum
�m Pn t t ' y me PPI' tf hP iuo file asrgnw sw¢mem .ra .. __....
aa-"math gf« xepyuarytoticp,o'.io rm c tr thLicertuLaw(Chaptcr9 S FLF r-Area Valuation
or
me n8 ph Sthref]IXp)ol Divi 3ofm Q s= and Profuaons Codc) g,4 J:1i � 1a','�<q'1 _I ,..',t L.a+'.1i,?f.t!i�v: $6200
or that he rs exempi therefrom end the bass for the all ged exemptlaiiAny violation
1
-of not mom than
v any dred dol ars(SS rmit subjecu the applieant ro a civil penelry qL'{pfy���
'of not more man five hundred dollars(SSW). 362 V1V Nllmgea r,.... Occupancy Type
❑I,as owner of me property.or my employees with wages as their sole compensation, �j )
-will clothe work,end me'swctme is not intended or offered for sale(Sec.7041, - -' - - r - - --- -
Business and Professions Code:The Comtmctor's License Law does not apply to an 305 — FRAME Required Inspections -
owner of property,Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements are not intended or _ 3.07. - ._INSULATION.__._. _._�_.._.__.__-_. ._.. _ .
comped for sale.owner-builder
will
l have
t or improvement n sola he did nne year of ..I.
'completion,the owner-builder will have the M1UNcn of proving that he did not build or 601 - ROOF TEAR OFF I°'
improve for purprea failei. 602 - ROOF PLYWOOD NAIL
construct the
of the n am exclusive tmetini 'thll<ensedconemetonto --- - -- 603- - - --- ' ---- - - si� - -- — -- `
project(Se= ]w1,Business and Profess ons ewe)The Contractors — ROOF BATTENS
License Law does nota I to an owner of rt who Wilds or rm t
= PPY property pmv=ameraon 604 - ROOF IN-PROGRESS `
_r and,who convects for.such Projects with a contracmKs).1 remand.Pursuant xo.me. .. . .. _. _. ._. .. .... . _._ s...._ _ ....... .. _.. ,
< ' ° Contractor's License law. -- - -
•:,-� ! ❑I im exempt under Sec.'r•tn .t ',✓I: '' .B,&PC.for this reason Lt'' r''7...v..•.t....
_ Owner:. are
WORKER'S COMPENSATION DECLARATION
" Ihereby affirm underpenalty of perjury one of the following declarations F'.,� ar�p E®
(L 111 have and will maintain a'Cenif<ate of Consent to self
for Worker's ��V®11 bre
y,. Compcnsatmit;as.provided for by S1.ection 37M of me Labor Cast liar the � 2��2
.. _ perfarmance of the work for which this permit is issued. ��,1 O
have and will maintain Worker's Compensation Insurance,as r=quircd by Section ry
]W cif the Labor Coale Firr�the
Performance oof 1[he�work for which this permit is
ice
rier and
Cmrissum MyWorkers
lL u/ �h"T"""'',nPOIaYNWiS=J-1L Policy be are: 1pt .. .. `` _ .._.BTUIiLDING - - _ ...._..w.�...._.�
•
r!I CERTIFICATION OF EXEMPTION FROM WORKE � ',' u:sl.. � �°L'l. itis[ ..(;Y 3[s: f LI i.y: s• �
.•.s ON INSURANCE• " ' 1. __ - '
(This senior needn,t be completed it the permit is for one hundred dollars
(SIW)or less.)
'I reim'fyaktt the performance ofth work for which this Retain[is issued,I - - -- -- " --
shall not employ any person m any manner sn is m become subject to the Workers' l _
Compemadon Laws of California:Date
._Applicant
t NOTICE TO APPLICANT:Wor es after Compaakmg this Cemfis of the
Exemption ,youmshould
st ..
become subject the Nok fClmpenmt 1p Provisions th lane linked. must
� Q
forthwith 'imply wire. h p 'cions o th' P it shall bed J rc eked.
E'.fir ';'' 'ICONSTRUCf10N LENDING AGENCY i. -- -
;� } I hereby affirm that tiere is a coriswnion lending agency for the Performance •p;
r of the work for which this permit is issued(Sec:309],Civ.C.)
a ❑ Under'a Name .. ..._. i - u..._ ,_.. ._:..._.
'.Z
U10
immir,dualh.,localthis.Prilivirinal and state m t the abovs,informusloon
correct.I agreet comply,with II 't) d county d' d state printing
V obuilding c t ib dherebY the p nd e. rn' tyt t ,no
} W
the W e t' ti p pc ry! Pet ...po 1
nF•t 0. (We)agree t6, dho6ifyond keep moraa,,the City of Cupemno g ant
Vi
liabilities.) dgm consequence
costs d xpenses h h may;n any y ga nn arid v V
V Z City NTUNDeblih gm Fm perms
APPLICAV]UNDERSTAN AV NILL COQ LY WITH ALLM rot
SOURCE REGULATION �" - 3 O Issued by: Date
Si,rsram ofAppncanVC ntmcto - areRe-roofs
HAZARDOUS WTERIALS DISCLOSURE
Will the pplica ror future Wilding accapartaturedrn ndl hLoodon"nonamd .Type.of Roof._.
asdl ed byre Cpenim Mun'c pal Cwe Ch pt 912 44th Halm ds fetY R .y qss er4"1tA L'
Cwe Section 2553 O r t n
OY 1 'B� i'l . tj to t'1 , .( .c V -. t,• E VJ. :
All roofs,shall be inspected.pnor to.any roofing.material being.Installed _
. Bon applicant
ppy t future building p tyr.so equipment or devices
which
h<n
--If a roof is installed without first obtaining an-in1s,pec[lon 1 agr-
ee toxemove
iii,hasaindion, ilematioriamt,ar refined occur RayeqQ Icyevienf
District? all new materials for inspection. Applicant understands and will comply with
(ell nom-point source
, I M1a< h M mmeri I. req us uder Chapter 6.9 egulations.
Colt Heth&Secfry Cade.Sections 25505.25533 and lunderstand hat
ifmbu ldnBthoe, re,ortibJi,minotifyme
-
'Oaapatofm equi t. hoh r be rp- to issuance of of
u
` p"` a fie a
S Z Signa[u of Applic Date
:own= 'ad an,gept .. . „
All roof coverings to be Class `B" or better
OFFICE