00060136 CIBuofcDPERONoilt - - -PERMIT ' CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10455 HENEY CREEK PL COSMOS ROOFING 00060136
WNBR'S NAME: "'- APPLICATION SUR DATE.
SMYTH, KEN 450 -SAN ANTONIO RD 06/20/2000
HONE: SANITARY NO. CONTROL NO.
(415) 493-6373
nc4ZARCHITECTAINGINEER: - _ BUILDING PERMIT INFO
O
z m O BLDG •I I-ECT'.. PLUMB MF.CH
LICENSED CONTRACPOR'S DECLARATION
- . . Job Description
OZ- redng1 heronY mon mm I.m licensed andeypmvlstons nl'Chnpter9 , n .•
-
r(,v�F+W with Semi.n 70fp)of Diaisin Sof me Ousinera vnA Prof siansC Je,and my license'
is incetoll lore anJ 4S.
uenfre ltl `i uo.n 71 TEAR OFF SHAKES, RESHEET,' 30# FELT, 40 E
o D01C cOntaCiof COMP REPLACEMENT
3 a,y ARCHITOUT S DECLARATION
C 1 understand my plans shall be used ar public m ,ads - - -
�tilr�
tau d p O Lice n ad Pred"i.nal -
OWNER-BUILDER D17CLARATION
uKi I hereby affirm real 1 con cxcmpt from 0c Conti r'x License Law for the
C a following rearon.(Section 7031.5,Bosinns and Prolession.v Code:Any city or county -
S a wh Iwgt pnntt st t lk p J Irerepair' any.v ewe
da 2 pram t '"care,alk.ac,ainewlet applicant Initial,pctit to I!ia ttment ,
that he Ji liCuordp rs dt (hep of the Contorthes Licefew L (Chapter 9 _ Sq. Ft. Floor Area Valuation `
(cOnnamng with Semon 70001ofDivi i of 3 of n he Bt rites and Profession,Code)
or that he is exempt Iherefnmt and the basis for the alleged exemption:Any vinlation
of Section 7031.5 by any a,]I..,for n permit suncers on,opplicam 1.a civil penalty -
efare noo,far..five hundred dollarsS500). - .. APNNumber 0cc$0•-)W1Ztpe
Cl 1,ov.wner of the Properly,ar my cmplayccs with Wages m molr ao]e compensation.
will do the work,and the.structure is not intended or offered for rale(Sec,7044, �p'1�
- Banners and Professions Code.The Contractors Lifenre Law does not apply m v" 3424E)01.6. Q,t
, 0qulred Inspections
owner of properly Who builds or improves mare').,and who does such work himself
or through his own employees.provided an such imprnvemcntn are not intended or
offered for sale.If,however,the handling or intprovenmm is sold within one year of 305 — FRAME
annpletion,the ownedid
r4Ner will have the burden of proving that he did ad build or ' - '
Improve for Purpnw of -
307 — INSULATION
Cl 1,ar owner.1 the properly,am esdusivdy contract.,with licensed codedoa 1.
- ntstrre,the proecoomrs
jacl(S .70,44.Beand Proressi.ns Code:)The C.nh'armr'r 601- — ROOF TEAROFF -
License Law does carefully bra owner ofPrei who build,or.mpe—them')., '
and Who contracts for inch jwith a connectors) licensed pursuant to me 602 — ROOF_PLYWOOD NAI L
Contraries License Law. r '
❑I tan exmnptanj Sees .BBPCI this reason 603 — ROOF' BATT S '
owner nate 604 — ROOF I OGRESS
WORKER'S COMVENSAI'ION DECLARATION - 1
I hereby offirier tjfinally of pecto,one of the following declarations
-
❑ 1 Ido, and will aj a CeiliEnuile ifContact m. ll nscre far Works,',
Caurpreschar. as p...vichid f by Section 3700 of the Loh Cal, far the
performfnue.I the work for wh'ub this Incranit is issued. m® -
h d 'll v le 0,W k' C p ( I quircd by Seth m "
Ed fuel b''GI f th p flim 0,c fNew rkf h Rte's perm"s "
tsu I.My W r�kcr s�C ]p m n I sur er anJ Pol y bei ore • ,
Carr r�.qy=l�PofyN S�1 99.—//� r � -
CER PIG\TION O SATION INSURANCE NORKERS'
COMPENSATION INSURANCE. - .
(This seat.......d not he completed if the permit is for one hundred delleas
Ib 100)or less.)
t
1 cerlify that in the so nin enee of the work for which this permit is issued,1 -
thin not employ any parson in any harear sa as 0,t become subject In the Workers' t '
Campensi inn laws of California.Data
Applicant '
NOTICE TO APPLICANT:IIL after choking this CeNtleae of E.'a'an.a.yw'f a rid
heatme subject to the Worker's Cmensao')n provisions of me Labor Code,you cons, .
Q npforthwith comply with such provisions or this punch shall allocated revoked. _
y
F CONSTRUCTION LENDING AGENCY -
a ' I hereby Which that there is a construction(See
lending agency I'nr the perfnmmnce;, t
W of bd work for which mi3lrc'rmit Is issmd fgec.309],Co.C.) , -
0 Lutded_i Nance
7. Lender's AJAress -
V 1 cath fy that 1 have read this upplicadoo and see that the above information is
correct.1 agree t.comply whh all city fail county calinunces and state laws including
'Q V to building construction,and hereby fumorize representatives of thi s city to color open
r� he°have-memiondd property for Inspecona purposes. -
[.., (Sr (We)agree to save,inhatiodyand keep Retailers the Cilyof Cocoon.agaimt
4 liabilities,judgments,cost and expenses which mfr in any way accrue against said
V z City in consequence of the granting of this permit.
APPLICANT UNDERSTAN ILL CO 7 LY WITH ALL NON OINT
SOURCE REGULATIorv�r�r G��/OC Issued by: Date ^ �
Signature or App card/C.chn Date/ . Re-roofs
HAZARDOUS MATERIALS DISCLOSURE _
esu me applicant or mere l,uddmg occupant store')rbandle hfzard.us material Type of Roof ..
as
Cede,Search25532(°)^
° �� - - s
Yet .` All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfor tire building.ecupunt use equipeemordevices which If a roof is installed witliout first obtaining an inspection, I agree to remove
•roll orthicon,air contaminants us def Bed by the Pay Arco Alr Quality
nManaim
Diarica _
all new materials for in—spection._
_Applicant understands and.�will comp
ly with all notnteource regulations.
Ihave recd tush b hoist q t' td Crim figs f the
CaltomaHealth&Said,Cd Section, 25533 n125534Iunderstandthat
Rhe Ruddne, carri, hmeanert,Audit : y cp n ihlyn ty the ' /
R p t fme
Occupancy
Signature of/Applicant . Date -
Own d 1�ada I are - All roof coverings to be Class"B" or better so
OFFICE r'• ..