01040115 INO
CIBUILDINGDsOIVIIN PERMIT CONTRACTOR INFORMATION:
UILDING ADDRESS: PERMIT NO.
owclmPq1Ppn Rn i PIATINUM ROOFINGI C 0104011.5
OW NEWS NAME.. APPLICATION SUB DATE
Ail 11 1—16 A SERRA APARTMPNTq 1 A-9.3 IS 7TH ST04/23/2001
I(1NE: SANITARY NO, CONTROL NO.
—c
SeARCHITECT/ENGINEER: - BUILDING PERMIT INFO
_ BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z y 1hereh art" I Bas I am licensed under f Chapter 9(commrrin Job Description
o z-❑ r provisions Prole° p e
F,F" 'wdn secson 70um)ar Droi.mn9°nne ata,ine.,dna yrare.p,ians cal na-r„y license in Fill d,ae dad e0 /0/3
5S,2a< Liwnseclax. 1—r Lia.n REROOF r�����D
ad 911- nate Cnmmemr .art n -�, '
ARCHITEC used asCLA ATI N MAY 1' 0 2001
C O 1 nnder,mnd n,y'lair.boll he used as public records
Scor
ac,O Licenwd Prnfesxioml _
�J o�y OWNER-BUILDER DECLARATION
Iherby affithat I am exemptfloor theG I I License 1 for the
(; = fall g Selina](1115 8 IP f: Code Ary 'ry Dairy - BUILDING
O wh n q l :' P II t I II p J I'h pa 'ry.lructure �vv�
m pnnotol itstonee,al,braeoure.,,heiripli,an,l uhp mirl to II v hoed:m,emem
(hat he licensed p . t to the Provisions of the Centimeters License Law(Chapter 9 'Sq. Ft. Floor Area Valuation
(coronation tg with Section 7000)or Division 9 of the Business and Profesi ons code) -' -
or he is exempt th.rcfrom and,he basis for the alleged L.cueion.Any violation -
of Section 70315 by any applicant for a permit subjects maapplicmi to a civil penahy 11 P 14
error mare than five hundred dooms($AHn. _APN Number Occupancy Type
❑L as owner°f me pmpeny,or my employees with wage,as Mair sole annperoxion. O -
will do she work,amt flato
dor...is ma Intender ,,offered for sere(See.ID44. �Re aired Inspections'
Basin...and 1'mfea,inn,Code The Connector's License Law Dues nor apply to on q p - .
o.`ibr of property Who builds or improves thereon,and who Jous such work hinbelf -
rangh nix awa anipmyce..provided Iron such improvements an,net intender or - 305 — FRAME” -
offered for sale.If,however,the building or improvement proveent is sold within one year of
anapma°n,lieowne,laildera;Bdid.,.,
ror 307 — INSULATION
improve err parpmtof,era.). -
°I.as owner of the property,ams.auxivfy, contracting with licensed conlatemoro 601 — ROOF TEAR.' OFF -
,nshro
uct the project(See.70,14:Business and Profession.Code:)The Commads 602 — ROOF PLYWOOD NAIL
License Law does not appy to an owner arpropedy who baildv or improve,thereon, - -
and who contracts for such Forces with a coulmemres) licensed pursuant to the 603 - ROOF BATTENS
Contractors License Law. - -
°Iamexemp,under Sce. .B&PCfro"h.re..on 60.4 — ROOF IN—PROGRESS -
Owner Data
W'ORKER'S COMPLNSA[ON DECLARATION x
I hcrehy atfinn under larmlty of perjury'une of the following deal...lion,
I have and will maintain a C.ndicate or consent mself-Insum for Worker', -
Compensation, as provided fur by Section 9700 of he Luber Code, for the '
performance ofth,work for which this permit is issued.
❑1 have and will maintain Worker',Con,pcusa,ion Insurance,as required by Section
3700 of the labor Code,for the parfornbnce of the work for which this'corn,i.
issued.My Woorker' Compensation Insurance carrier and Paperrumberaao, Q _
Comic, q T+ DPolicy No. /p 3
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tlassornma aced not be r mplawd if the permit ix far no hundred dollar,
($100)to less)
I certify that in the performance of the work tor which this pmao(is issued,1
shall no,cold,any person in any number so as to become subject to the Workers
Compevsotlon Laws of GJirornin.Data
Applicant
NOTICE'TO APPLICANT:If,chill making his Cer,ificute or Exemption,you should
became subject m not Work,,s Compenxminn pmvlsiorvx of the labor Code
K,ya must
Q 0 firmwin'an ndy with such pow i.iorv.on,this perms shall be deemed revoked.
z ,
FCONSTRUCT ION LENDING AGENCY
l - -
a ' 1 ,omby affirm that there i.n construction lending agency lot performance -
W of the work fur which this permit is,r,oad(So..3099,Civ.C.) 1
Lender's Naim
z Lender's Address -
V C 1 ramify that I htwo rend ihix application rmd.,are that the above information is _ -
W Ey correct.I agree u,comply with all city and county ordinances and state laws relming '
0 [) to building roosamealon,and hcrehy vuWnriee eposaenm,ivos ofihis eiayon enter upon -
iy r� the abovo-mentioned properly for Inspection p rlawo.
{. Qr (We)ngree 1. as,.indemnify and Karp h anlass the Cityof Cnpenino noon,,
Fr tn' liabilities,judgments,costs and expenses which may in any way accrue ngaiasr said
V ti City in consequence of the germing of this permit.
APPLICANT ON TAND. UWILL COMPLY WITH ALL NON-POINT
soultce RP L TI s y a3 Issued by:, Date a
Signamrenf aI/Coanaeno Dam Re-roots -
H"tiRDOUS leATERIALS DISCLOSURE.
W91oto arpnecnt m coma building ca,amen store o,handle ba:atd w,material Type of Roof ,
us defined by the Cupanim,Municipal Code,Chapter9.12,and the Health and Safety _ -
Code,Section 25532(rp? r
°Ye, �N. All roofs shall be inspected prior to any roofing material being installed.
cora nark ophii.ant or nrinr'.odditis occaPan,uxu egldprn.n,ar devices wore, If a roof is installed without first obtaining an inspection, I agree to remove
at Ibmnloas vis contaminator,u,it me I by the Bay Are,Air Quality Mmagenent
i.trmrr all new materials for inspection. Applicant understands and will comply with
"° all non-point source regulations.
I have d the < J :materialsy ts tinder Chapter 6.95 of the
C:df H Am&S I tyC I ly have
f 'imm,t5 tits ,a ,a,m4.1 I.mi dthal T
if the b 'IJ',Kd t of. abet ,Irl t: y- p ofa a nal,of
Interioribs rad cos alae m...t he mel prior I.issuanceola Cundwum of
°c °pa°`r _.�3 •Signature of Applicant Date ^
ownaor,tua, agmn Dere All roof coverings to be Class "B^'or better
OFFICE