00090079 CI TY G P
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DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS IPERMIT NO.
ALL SEASONS ROOFINI 00090079
OWNER'S NAME: - APPLICATION SUR DATE
MIDDLEFIELD RI 09/14/2000
HONE: SANITARY NO. CONTROL NO.
P. V5 ARCHITECT/ENGINEER: 6 - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
s < LUI CI 1=1 =7
Z z r�ir E I ncrchy affiro man I malicensed ONTRACTd R'S DECLARAmof TION
9(con r ing Job Description
F4ce wan Section 700(b of Divitien 3 nithc Basin.,,and Prof n.io,'u,"anduty license
g.< IicenselCflaa"ndeBr—_7d Li N90 TEAR—OFF WODD SHAKE 0 COMP
3 u,to Date RC l S DECLARATION 3
F tS O G ARCHITECT"S IlEC1.ARAT1(1N /vppyq
nco3 IuJ -, Jmy pl shut no used phl Is /
ek
ra re C O Licensed c,,bProfessional
/
OWNER BUR DER DECLARATION C//
X� 72L
WW Ih M1y.Brat thin a.vsentsI hfive
e CEz< I Lc Low,far
g (Sect 7(HLS Business
l :' , I Any 1y scotntywhi"h rcy prms, , , aI,,,improve,d did, rcparey we,urc
as
a
prim to its issuance,also requires the applicant for such Permit o file a signed statement
that he is licemed pursuant to the provisnow ohne contractor.License Low(Chapter 9 Sq. Ft. Floor Area Va u
(emnmcnu in,with Sc,i..1 7001)al'Division 3 of the Bnsincst and I I•ssiom CmIs) n
.r he ie exempt thcrefnege)rm and the hasis for the allexemption.Any violation $6I4r�00
of Sdrat ection 7031.5 by any applicant for a Moro objects the applicant in a civil Malty
of rim more than five hundred dollars la500f APN Number Occupancy Type
❑I,ns owner ul the pnrpeny,nnny employees wish wages usdsirsolb cumpeinminrr,
n 1p . (7101
will do the work,and the moodone is no,intended or offered for sale(See.70,14. 3411,
Business and Professions Cash:Tete Conuacmr',License Ino does not apply to an Required Inspections
.wocr of pmpeny,Who builds m improves there..,and who dues such work himself
.r mmngli hi,uwo emplo,ce,provided mat such improscumnts arc not mtended.r 305 .— FRAME
offered for tat..If,ow,,rr,me hoild.g.r impr.vnnen,Is sold within on,year nr 307 — INSULATION
completion,the owner-budder will have,he burden of proving that he did no,build.r
improve for purpose of miss).
El 1. cowmmoffar I.antescrosivel 601 — ROOF TEAR OFF
thepmpnr ydmnadmswimrcemThe,mlaymrsm 602 — ROOF PLYWOOD NAIL
manse Law does
(sec.Zola,Business and ertyPlolwhona Code)The vemmreon,
iadwhLawdMsn"arsuch,apply oan.ones.fpmpenyxhubuud."riporaattote 603 — ROOF BATTENS
Co who
Contractors License for such pmjccts with u ntmrunos(M license)punuam m the
El[���`e`xemptmd`,�Sec. ,0&PC for his re.mn 604 — ROOF IN—PROGRESS
Owner Data
WORKER'S COMPENSATION DECLARNTION
I ticat alTb,a order penalty of perjury one tithe billowing declarations, -
I bare and will maintain a Cenircme of Comm m self-imine for worker's `
Compensation, as provided for by Section 3700 of ,he Labor Calc, for ,he
perfurnanec of,b"work for which mis permit is issued.
❑1 have and will maintain Work,,',Compensation Insurance,as required by Section
37W of the Labor Cale,it),the performance of the work for which this permit is '
issued My W/ft/eefs�Coo ufcmation Insurance carrier and rsPolicy n/ryumbbseer�r aagrre/e:.yr '
L-arier�(Jl7-4N-V ' Policy No,: �1✓��
(;EDIFICATION OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
0111,sed on need not be completed it permit is fir ane hundred dollars -
(i100)orI...I
I vanity that in the performance of the work for which,his permit is issued,1
shall not employ any penin in any manner sa m tu become s.hjcc,,o the Workers' -
Cmnp road.,d.aws of Culifontia.Date -
Applicant
NOTICE TO APPLICANT:IL attar making this Certificate of F.xemptiam you should
become subject to the Workers Compensation provisions of,he Labor Cade,you must
ZO ronhwall"amply with xuah positions or this permit shall he deemed rac k d.
F W CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is.ro..motion lending agency for the performance
W .hhe work for which this permit is issued(Sec.3007,Civ.C.)
Q Lend,,',Name
.ti. z (,ad,,*,Address -
V 0 ..I certify that l have read this application and maethat,he stave information is
W F., correct.I agree to comply with all city and county ordinances and state laws mlalng _
Q [� to building utmwcut and lerehy aur hunue represemallsesof this city m eno,I I
} W ,he abovcmemioned property for mr,chm pmro,o,
F 9L.
(We)agne matte.indemnify and keep harmless the City of Cupsnino against
V] liabilities,judgments,costs and expenses which may in any way accme against.said
V City in cvtn'c"inive of the gamit.
in•of this perm
APPLICANT UNDERSTAND DWII .COMPLY WITH ALL NON-POINT Issued �/ -
SOURCEREGULATIONS. 9-/y-a y. Dale
I
Sill amrcofAPpliem Comme"a Date Re-roofs
HAZAIIDOU' ATERIALS DISCLOSURE
Will tile apprcamtoffin. maga,upamtrate.rIthnddehararamm,mdenal Type of Roof .
as defined by the Coined n M (Cade,Chapter 9.12,and the Health and Safety -
Code.Section 25532(a)7 Cl Yes I ' - All roofs shall be inspected priorto any roofing material being installed.
Will the applicant or future building occupant Use cyuipmem or devices which HE roof is installed without first obtaining an inspection, 1 agree to remove
" hvallous air contaminants as defined by the Bay Arca Air Quality Management
X17 all new materials for inspection. Applicant understands and will comply with
for"x
lX11all non-point source regulations.
1 hall,read,he hazardous minaml,requirements under Chapter 6.95.f the '
California Health&Safc,y Cade.Sections 25505,25533 and 25531.1 understand tha
lithe buildingdoes no,currently have a tenant,mat'.is my responsibility to no,ifyme ���('� 00
cc.pan of the r• auction which our,he mat prior r.ittnarce or.Cenmrrm of
Occupancy. -
G�_(. F—dost Signature o plicant Date
1I
owner nr anmuri=m in ,e All roof coverings to be Class "B"or better
'OFFICE