01030107 CITYIOFNG DIVISSIIONNO CONTRACTOR INFORMATION:
" ' PERMIT
BUILDING AOGRESS'. PERMIT NO,
7570 ERIN WY
OWNER'S NAME: APPLICATION SUB DATE.
PHONE: SANITARY NO. � ,CONq'ROI.NQ
41 -0222
O ZO ARCHI'TEC'T/ENGINEER: - ' BUILDING PERMIT INFO
w E _ BLD ELECT PLUMB MECH
y�.i - ,• —I fel r= C=1
LICENSED CONTRAC'TOR'S DECLARAq'10
ZO x=0 I hereby aflirn,thin 1 atm licensed under prevision rirmmendng Job Description,
w with Section IlNHD it 3of IM1c Buain 4th Pro ns a] license
Q� w 'ia in full for�eun�IR`cirv '
if l.1cen lass Lic.q
3� D;,teJf .3 cnnlracmr REROOF/SHRKE TO DURALITE
m ARCHITECT'S UECLAR 5l
I understood my pions shall bd
used a,public accords -
oO Licensed Pndesainnal -
s�o� . OWNER-Rscrate ft DECLARATION -
I Item.. d act o nl I.m exempt from the CmraarProfessions
Co License Law for fine
m,
F Z G fallowing femnn.[Section TUI,5,construct,alter. and Professions Coda'.Any city of county
f ❑ which acquiresapermitt.itram, eaper,improve,or sudemolish,ora a siranymmeute
�r3+� pat t t .. ¢ I q thp[,I'c of hpartial t fig d irmem '
dmtn h1earicalp a l p fu ❑n L I i 1 1 fen Coda) Sq. Ft. Floor Area 3 Wluat
or -g 'mpt me "ain n f e b 3 the Business J P_( : 'Code)
ar tna he mr,s exenpl th f om and Inc hu :for the alleged Lxenpl rn.a ry l Penalty
of Sacuon e thin.
5 r any applmvnl for o permit subjects Inc applicant to a civil frailty
arnat fanr.man Bve hl,nerm nmmm(ssan. - APN Number " Occup c
❑1,as owner of the property,,,my cmployeas with wage%as their sole compensation,
will do IM1c wok,and IM1e 1...are Ix nm intended or offered for sale(Sea.70.14,
Barings and Pr,fia,mns Cade:The Cnnmaemr's License Law lows ran apply or a+ egnlred Inspections
o,net of property Whir builds or Improves thereon,and who does such work himself .
r through his own amployeea,provided that such imp...emems are noUmended or
Offered for sole,It,noweva;n+e budding or improvonem ir..d within one year or 305 FRAME
icompilerorlhenwncr,build,,will have the nmdenof pillions that re did net build nr 307 — INSULAT'I C7N
mprove pur,oco _ -
❑I,aa rofthe property,amexclusively commctingwlmrcensedcontractors no 601 — ROOF TEAR OFF. -
owner
icemel he pr aa..(sea.7044,low,iet of arta Pridproperty
visor e code:)Thr.ventheror, 602 — ROOF PLYWOOD NAIL
I_
License Law does nm apply m nn owner of property who bu lice or seimproves thereon, - '
one wan rsLicets for.man prJee,with a..m aatirrc.)licensed narsaant t.n+r 60,3 — ROOF BATTENS
\ C.nvaa.r'x License Law. � .d -
❑Iameaeonto der See ,B&PC larthis.,,)a 604 — ROOF IN—PROGRESS '
Owner Date
WOR K Ell COMPENSATION DECLARATION - -
1 hereby affirm Imdur finally of perjury one of the following declaration:
❑ 1 have and will maintain a Cenifcam of Consent In self-insure for Wil - -
Compensation, as provided'for by Section 390l1 of the Labor Code, for fire -
perbmmence at the walk far which this pennil is issued.
111 have and will maintain Worker's Compenmtion Insurance,ns required by Section
3900 of lac Labor Cade,for Ih wrfnrmanm nl the work for which this permit is _
issued.My maker's Compan' o Imumncecarieraglillicynumber mmD a
Currier: Pavey Nu: (y 7 �l/{ - -
CERTIFICAHO PEXEMPTIO FROMWORKERS'
COMPENSATION INSURANCE -
(I his vaea n n ul a"'he completed if the permit is for one hundred dollars
($100).,lea.) .. _
1 unify that In IM1e performance of the work far which this permit is issued,1 '
shall not employ any person in any manner so as to beconm subject m the Worker,' "
Compea,mfinn Laws of C.Iif.mia.Date
Applicant
NOTICE TO APPLICANT:If,rias making this Cer ifcam of Exemption,you should -
b onar,subject m the Worker'.,Compensation pue ,ions of he Lab orCode,you in
'
Q O farhwith comply with such p oirions or this pennil shall he deemed residual. + -
Z ►
CONSTRUCTION LENDING AGENCY
+� 1 hereby af0m,that them is it construction lending agency for the perf.rmunce
W nr,he work for which this permit is isaal(See.3097,Ci,C.)
I,endcrk Name
Z Lendccs Aridrexs -
U 1 certify that I have read this uppGcatlon and state that IM1e above mbo amnion is
Gr. Bey correct.I'....a 1.comply with all city and coumry ordinance,and same laws relating
Q U to building fenuuction,road hereby:afhoriurepre,mulawd,orthis eque coma upon
[� the ah i dpnpe ly for unificationpup. :.
ry y
(We)agree 1()save,hadcaludy antikeep h I :s the Clry or Clpen'no against "
F Z) liabilities,jUdglarearS,costs J cosperses which may in any way neva a against.and
U Z cop' fol g g rthislcn n't.
rat APPLIC NT NDP.RSTA AND WILL COMPLY WITH ALL NON-POINT'
ouRc�R - ca � Issued by: Date
St I
n .. G Dem Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE
Will roe appliwn,or rambudding dding oecapam store or handle na:ama.,material 'Type of Roof +
as defined by the Cuprrion Municipal C.da,Clmptet 9.12,amd the Health and Safety
Code,Seolinn 255321x)' - I '
El W, El No.
" All roofs shall be inspected prior to any roofing material being installed.
Will the trip]
lcandorfranc huiIdling oecapantuse .deviceswhich If a roof is installed without first obtainingab on,inspection, I agree to remove
mi,hazardou,at,came forms as defined by the Be,Arco Air Qualify Management p
oi.friell? ❑iv. all new materials ffr inspection. Applicant understands and will comply with
Dyesall no pont so r gut, tions.
1 have read the lazardnur materials regairculars Imdue Chaffer 6,95 of he -
CaliforniaHelth&Safely Code.S Miens25505,25533 and 25534.l undcrdand that '
if the bund, ,times of amount] hI- atenam,tflat it ,by responsibility to notify the
....pant of Im rc acrouna, I I mast he fall Prior to ismonee irf a certiraatd al'
Occupancybe
a ure of Applica t Date -
Owneraae I Date All roof coverings to be Class `B'+ or better
OFFICE