01040044CITYNO
I BUDIGovsoILINltN ' PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
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PERMITNO.
,20800 HOMESTEAD RD # R
CRE
01040044
OWNER'S NAME:
APPLICATION SUB DATE
BANKAMERICA REALTY INV17STORS
0411.1/2001
PHONE: _
SANITARY NO. CONTROL NO, '
ZQ-ARCHTI'F.CTILNGINEEIi:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH ,
to
1=1 • .LJ .O =1
a LICENSED CONTRACTOR'S DECLARATION
, Job Description
❑ 1 hereby afrtrm that 1 an licensed under provisions or Chapar 9 (cotthnenemg
witI section 7000) of Division 3nfmo Bosinessand Professions Code,u,dmy license
< i`in fall force and In e t
berveClass G 39 uc.a 7 O
REROOF.
yDate /.o "armc
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so ARCHITECr'S ITEC ARA ION -
<
I undenlnd my plansahall be tncdas public reand,
I ad Pelfic,iciandlc
OWNER -BUILDER 4
1 later, rf 1 pt r m ,h C , s
hiDECConce, Law
oat
sp e: county
< fall g n.(4eT 90315 Business -dPrP CN Any city nrwunty
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❑ wh tvt, n u pwm't t)construct, al¢r,'mmave, nal ren, or repair any,mmmn
ce prion(itscensed e,uBareprints the
r 1 forsuch
h I
Sq. Ft. Floor Area
V uation
- that neislice the p ainavnt
the Connmmr'sl.,to Law (an,
(commencing an Section fDivision
Sectien 91X)0) of Division? of the Business Lind ProfPoCode)
vi Code)
_
air Any
Any violation
or that he 7 rxempt therefrom end the basis for the cts
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the applicant to
appllcmn EG apenn'usubjectsthe upplicam n,ncivil penalty
of Section70315fee
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nrhot moremanrvel„ttmraddol ,tn155otn.
APNNtimber
- Occupancy Type
❑ T. as owner of t6o propmy, or my employees all wagon as their sale eompensmioo,
will Ju the work, and the structure is not intended or offered for sale (Sec. 7fUL
Business and'Proles:ions C,de:'I he Contractor's License Law does not apply to an
Required Inspections
w r pm
of peny Who bond,,), impnwes,herean, and who does such work himself
n rough
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or 1,19 two employee [fiat ,at such improverl am not intended or
'305-. — FRAME. -
trared for sale If, howcvcr, tn, banding or improvement is sold within one year or
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completion, the ow ner-huilder will hove mf p
e burden oarving than he did an, build nr
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,';07 — INSULATION
improve for impose-
601- — ROOF,TEAR. OFF
ol,asawnmol,ne t.atnexdnrivel t�aedtt
,. it, lo,io ed c arm ter, to
imam, aeon announcing licensed
estrum the protect folic, Bn and noucin,otxa Code:)
.602 _ ROOF PLYWOOD NAIL,. '
ueenseLawdoesnotapplymanownerofpropertywhohwld,orimprovestherron
and woo te
contracts for each projee•with a cnnnanmtls) Initiated protean, ,, ma
.603 — ROOF BATTENS
Connector' License Law.
❑ I am estain under see. ,B& P C for this moan,
604 — ROOF IN—PROGRESS '
Owner' Date.
WORKER'S COMPENSATION DECLARATION
1 hereby affirm thither penalty of perjury one of the following declmutions:
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'❑ I have and will mainutin a Curlmcne of Consent to sellbimure for Worker's
Compensation, as politicalfar by Section 3700 or the Lahor Code, for the
porarrance of the work f r which dusErman is issued,
1111 have and will mountain Worker's Compervoion Insutchat, as real by Section
3700 of the Labor Code• for the perlimnunce of the work for which tris pemnit v
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sved. My Worker's Compeneminn JohnsnmcliccrkhAr
had Policy nme.
ter: 4j-4 "A Policy Na.: 1 ► 3 69 R
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CURT IFICATION OF EXF:MPTIONFROMWORK
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COMPENSA9'ION INSURANCE
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(This section lead no, be completed if the permit is for one hundred dollars
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($10O ar It,,.)
t '
I ernify that in (m performance of the work for whlch this permit is Issued, 1
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'shall not employ any person in any manner so as to reactor, lancet to the Workers'
Continuation Laws ill'C.10choja. Dale
.Applicant
NCU CE TO APPLICANT: If, after making this Certificate of Exemption, you should
became subject It the WorHer'a Compensation pmv siare of the Labor Code, you must
forthwith could, with such provisions of this permit xhall be carried mvokerl.
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CONST RUCTION LEN DING AGENCY
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1 hereby atfimo that there Is a constructina lending agency for the performance
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of the work for which this pt. 11 is island ISea 3097, Civ. C.)
,
i Lender's Nass¢
Lender's Addrcke
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1 canny that 1 have read this application and state that the above information is
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correct 1 g therapy, with all city anti county onfinninces and state laws relating
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to haildi ng construction, andhereby authorize representativesof this typs enter upon
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a the ho t J OmEnrly bur inspectionpurposes
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(W)agree t save. nl ify andikeeph the City ofCaparfina against
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liabilities, ] dg lbturns and cloture, villath may in aaY way aricamesig r t said
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City in consequence (if the granfing ofth permit
' APPLICANT UNDERSTANDS AN WlL,.L IM GY WITH ALL NON -POINT
"Issued
SOURCEREGULATIOpYf�� ( ! (/
IT Date
Slgnamre of AppliamVC,Clntrudor Date
Re -roofs t
HAZARDOUS MATERIALS DISCLOSURE
Will the apprcnhorfnntmbuilding eceapantcomorhandle nn.,fdou,muerml
Type of Roof '• .
to refined hype Cnperu no Munldpa JenChapter. 9.12, and the Health and Safety
o
CodnSection255321a1'!
”
0 Yes No
All roofs shall be inspected prior to any roofing material being installed.'
Will the appbcari or future build goccupant use equipment ordevices which
If'a roof is installed without first obtaining an inspection, I agree to remove
emit hmardaus air conmminanu as <ed by not Bay Area Air Quality Management District! JJJJJJ
all new materials for inspection. Applicant understands and will comply with
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all non�' -point source regulations.
Ila math broader, (neral: q' d Ch p, 6.95 of the
CaliforniaHealth & Safety C de S f: 2551525533 and 25534understand that
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flueh dlgr hot currentlyh thount, that it I ) p bItytt tfythe
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outland of be mature, iwhvutht prior o issuance of a Cenifcua of
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"h"orty'
D,'
/Sg—nature of Applicant ate
All roof coverings to be Class "B" or better
g
Owner or cul mnzed agora Dane
OFFICE