01100150 CI
BUILLDIN
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10542 E ESTATES DR ARMSTRONG INSTALLATION 01100150
` OWNER'S NAME: APPLICATION SUB DATE
LEE SUSANNA W AND LO DANIEL 774 HARRISON ST 10/29/2001
PHONE: (415) 777-1234 SANITARY NO. CONTROL NO.
on 0 ARCHITEC rENGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
vay I--1 O CJ C7
y i LICEN ,D CON CfOR'S DECLARATION Job Description
=�=0 (hereby affirm 1 liccn e<r provisiom of Chap¢r9(commencing
IQ is: witnseaean7llro)ar .ion-on )1 014. dm nems. REROOF.
[yE� is in f ecfon7an
.oar uaetoclaw /4ca 2 T/0 ROOFS, APPLY 1/2 " PLYWOOD, CDX.
;BLLF Date _ Contra<tar _ APPLY 30 LB FELT, INSTALL 25 YR. COMP.
RC TECrs DECL A
- O I undcmmne my plans zhall be used as pu Ile rtcordz
2�o2
o n a O Licensed Professional
OWNER-BUILDER DECLARATION
w,_1 1 hereby eRrm that I am exempt from Inc Contmnor's License law far the
!' < following reason.(Section 7031.5.Business and Professions Cade:Any city or county
4 s D which requites a permit to construct.alter,irritative.demolish,or¢pair any structure
i3m ..prwrrom kaut.1.1,orequiraatheapplicam fim,uch permitto file.aili sumernem -- .. _ _ ..____.___. _. _ _ .......
that he i3,limnsid p,usuini id Mh ro sions or Ne Conuactots License law(Ch,tat,9S h: Hoot•Are -- -
(commencing with Section,7000)of Division3 o(Nc Bu;immaM Professions Code) (:C:•1."t'E2,:k9` %_ i\ INE111�Z;N:IATIC1,1 $123b*ation
or Nai he id cxcmpt tbamfinni'end the basis for Ne alleged eaemytion.Any violation j
of Section 7031.5 by any applicant for a pamut subjects the applicant to a civil penalty
.of not mare Nan five hundred doll.(5500), 3 6 9021N?JvP!t60 r•: Occupancy Type
O I;as owner of the property,or my employees with wages as their sole compensation,
will do the work,and fire structure is not intended or offered'for sale(Sec.7(11,1 3 0 5 - FRAME ,
,will
aid Professions Coda The Contractor's License law does not apply to an Required Inspections
owner of property Who Wilds or improves thereon,and who does such work himself 307 - INSULATION
or da gh his own employees.provided Nat such improvements are not intended or
.agema ror sale:Knowe.er d e Wilding or impro ement is sold within one you orcoumdi . 6 01 - ROOF TEAR OFF
improve
Ne own«-builder will have the Wrdcn or forming mm be ala not WJe or 602 - ROOF PLYWOOD NAIL
improvefor purpum r- uilde
❑Lasowner'If (Secny04m4,BmalavlynProfeision,CW.:)
.:)noContrarcto _ . 603 = ROOF BATTENS-_
- - anmroet the pros«t(see,Tau,Bameofdna property
h. iloder)The Carrtmnamr. 604 - ROOF IN-PROGRESS
License oaw docs rot apply man owner of progeny who) lids s improves thno the " + - •
• andCin who contracts for-such projects,wiN a.<onwemrtx)licensed pursuant ro the
_.. ConuazmrsLt..it taw.
❑lam exempt untlor Sec.' ,B&PCfonhis mason
Dwn«, r., r .,:Dee FANAL.ED
_ - - WORKER'S COMPENSATION DECLARATION
(hereby offirm under penalty oft'arjury one of the following declarations:
❑ 1 have and will maintain t.Ccnificme of Consent to self-nsare for Worker's JAN 2 2 2002
Compcnaatim,as provided for by section 37M of the Labor Code, for the
peri a ftn .turl,for Illichithi,permt di BUILDING
❑1 h d II" ei ran No k Compel..wo
iad by Section
- 3700 of the labor Code,for the perfi mmnce oh this Permit is
,,.ad My Wok C pn '1ui 'e carCarvk t . 3..:.(PDI YN 1 y yq nr, , ICERTInCAT10N OF E%GMPTIOS 1", 1 t o f .�.t, l l ll 1. t,}'�- }P�1'y,.4B ,i. `.Irt
COMPENSATION INSURANCE
{! L (Th lea n cd nm be bomplcteJ drM1e perm( sfa one hundnJ Jolters - t • ' '- -I - -_---_---
,
k ..
Ic rtfy iht rhe pcf hh kf hhth ermi •. ...._ .�. - •• • .- .. .'-.. .•
.mel 1 .... - •• "
shall t employ
any
k y mann io Wcame b)n t the Wo k rs
n
ComDale
-APP1Pcantm on Laws of California.Cal forma, i„I _
NOTICE TO APPLICANT If, ftmaking N this n'f t 'fE pi y -- _
n le
Z bio me bol a the Wok C pc t pro ns of, Lam,Code.'y u l '^
zQ forth th I th such s N
.. th .,t. .•y d'(Sea.3097 C; gC)y f the rrorm .. . ... . - .-. ... .__ ..._..._. ....
PY p K t hllb d d ked.
'CONSTRUCTION LENDINGAGENCY -
� > Ihe'byhi 'bar t ran led p
bfN kf r h hN
yf� Lenders Name .. .. •,' "t., .. .. _ . ...
z7. .. _.: .. .. .— ..
V . I comfy that 1 have read this application and state that the above information is
counter I agree to comply with all city and county ordinances and state laws relating
to building conmtiction;and hereby num iae reprtsentatives of this city to enter upon
,}t(ra the above-mentioned property for inspection purposes
F.,-.0+ (W) greeters ndem ify and keep h ksire Cty fCpeu oegainm
h
liabilities, dg nts.costs d expenses which may,n any way accrue alpinst.said
U"Z City n req "e of th grant g of this perms.„
'••� APPLICANT,UNDERSTAND$AND L'CONPLY WITH rNONPOINT'"
SOURCE REGUCATW' Issued by: Dale
Z,urnature ofAppl antic - Dat Re roofs
HAZARDOUS MATERIALSDISCLOSURE -
7 j't. Will the appl t or f tore Wilding capon(store handle WuNous mat nal Type of Roof- �
is dented bYN Cpen noM rdp lCode Ch pt 911 cid th N Ith and yA
Cod S u n 25532of - t -s• 'n
❑Yes. nU�IllpNot71, 1t fats '11i �;•. tl, SDI ) i
All roofs.shall.be Inspected prior-to.any roofingmaterial being installed.
Willtheair cmaturnim mrc blueing by the nt Bay Aida equipment or Marta which If a roof is installed:without first obtaining an inspection;I'agiee.[o'remove
emit WVNous eu contaminants as defined by the Ray Arza'Av Quality ManSgcmem
Di;�mova `� .,Otic" _ all new materials for inspection. Applicant understands and will comply with
"` "' - -+ ^. r .• �.' I all non-point source regulations,,.�t,;...,,
I ba,' red the h ardou minimills -
q come is under Chapter 695'61f the
'
California in it&Safety Cad s ions 25505 t it
d 25S3i I understand that
fete Wilding tloes not c dy M1 (Count.that l Y responsibility to notify the
Ocupa t f the requite e which um W t pno t suanc 'ofd Ceti fate of
oc<apa y
��= l22� Signature df Applicant Date
- - �vmmr III°w!eAco
se�t Date.. All roof coverings to be Class`B" or better
OFFICE - . --