00120069 CITUIL 1NGDIViSIO Nc CONTRACTOR INFORMATION:
PERMIT
BUILDING NIDRESS: PERMITNO
21040 HOMESTEAD RD ROYAL ROOFING 001. _00F,9
OWNER'S NAME: APPLICATION SUB DATE
HALL_ TOM L AND ELEANE 1345 VANDER WAY 1.2/ 12/2000
ZONE: (406.) 279-2332 SANITARY NO. CONTROL NO.
O 0 ZQ ARCHITH(.T?:NGINEBR: - - BUILDING PERMIT INFO
s
,do BOG ELECT PLUMB MECH
N' LICENSEDC(INTRACTOR'S DECLARA9lON
Z vat provkav,ofChaI 90ammenpit, JobDescri ti n
O Z t G 1 tion? f rm iso I um alto+B under per e P -
F�tm is infllforelandefnlyishrn7afmpea.mexanJrmre,xianxcaJe. �dlnyfpensp REROOF OF COMM BLDG.
a x g i.5 m mu rm«and+Bea
se a License clay.L,yQ r/�jS ue.«
Data togs cantr.�to�—� .
d,0 rn -•a ARCHITfiCT S DECLARATION
undcrntane my plans shall be used us pnhhe dead,
�N
Licensed 1'ndc,.5ional
�o OLDER DECLARATION
1 hammy affirm I toexempt from mcmr
the Com 's License taw far the
F 2< follaw'ing naaaa.(section
at](D 1.r,BUIL5.Badness and Improve.
dirmm GNe:nor may.,coral,
him. /
Fe xll n I pe u consumer, n Ir I r:n t, }swears
3`� print I I. I :p applicator l am O 11 L d hual,"
Nat he to I t a t s III C I I / l I (Chip aryl S Ft. Floor Area Va�ll �gp�
ten he lg with Sectiondbuto 7000)ofa Divisionof t rbc alleged
n nprofessions Cale) q'
or That he is caembl Therefrom and the hast,lily the alleged ,plical Any vitiation
of not mu a than iv ...ndoiidoll firs($50 inn subjens me appoeam tae,nrJ penally APN Number
nrnm mare mon five nuuared collars rssfx). Occupancy Type
W 1.as nwncrar the n.ornl loco.with we, dtcitr.alc coin lion, 32607034. VIE)
P Ie Y Y employees 6 pens
Bull dr,11h, mk, tire dra,une is a.,untainted f rc l f (Spey]Md,
Buse 5: d1 I . I Core:Ttic eContractor'sLicense 1 Iapply mIto Required Inspections
rn s —a ho con Id. Imp notation, d 'n a . . 1 work himself 305 — FRRME.
n'r through his own emllnyms,provided thnl such improvements arc not imemkd nr
offered for ale.1c however,the building or improvement is stdd,renin one year of 307 — INSULATION
completion,the owner-builder will have the burden or proving the,he did not build or
inlpravp hn purpose 4,11c.). 601 — ROOF TEAR OFF
❑Laxam'nfthe propeo....lnlexclusively camrucrngwithfcensedcontractors to 602 — ROOF PLYWOOD NAIL
Linstruct NWI.e Impact(see.]IBusiness and Professions hale:)The Conlmmol, 60 — ROOF BATTENS
icense Law does not apply to an owner of propcnv who builds of improves thereon,
and who commas for such projects with a commercials)livened pursuant to the F,04 ROOF IN—PROGRESS
Contractor.License law.
4pc,,s..of
1 am e,cnlptunder Se. B h I'C for this reasonSA'1lON IlIiC1.ARA'1'ION
I herahy affirm under Penalty of perjury one of the following declarations1 have and will mniamin a Cenifcale of Consent m self-in,are tar Worker's
ompemmlon, ox provided I'or by Seednn 7A10'of the Labor Code, ror the
rronn:ma:of the work lonvhlch Iispenal it mut al.1 have and will o ur"min Worker's Comryn.wlion Insurance,m required by Section
IDB of the Labor Cade,fns the permnnand,of the work for which this permit iv
My Worker',Compensation Insurance currier and Policy number are:
Cagier: Policy Na:
CIiR'I'I FICATIUN 01 1?SEM PI ON FROM WORKERS'
COMPENSATION INSURANCE
(This seaarm need not he completed if the Permit is for ane hundred dollars
(SINE or Ica)
I ccnify thin in Inc performance of the work for which this permit is issued,1
shall nnr employ any person in any manner wv as ,,fecome xdEccd to the W..Woo'
Com as,l don larw,of Ctdil'uraiw Date )
Applipant
Ncome,I.'1'OAI'PLICANT:11,Compensation
Nie viouicere the
Labor od you should
becomemhjecl Iothe 5s'uch rs,po inions or
permit shall
the Iamr aak you masa
0 O rnnhwith comply with such provisions or Ihia ICm1iI shall be JeemeJ awaked.
Z
F ti CONthereiRUCTION LIcNIn NO AGENCY v
> I hamar wiffiromhich Thin mere is nfamed(See leading agency tar rile Ierfonnunec
nl the work for whine tbi+Pcrmil is issued(Sec 71192 Civ.CJ
L C der's Nmnc
Un '
� z Lender's Address
� 1 comity that I have read Ni,application and state that he above information is
[r a)mcl.I agree to cnlnply with all city and county ordinances and some laws refiling
V Io building a.n....toimo.and It,cloy;w;horize repmnenumiven ar lh is lily m enter upon
the abnvemnm0aned I for Inv I
y W smv, y ke,In.....le
7 on
0. (We)agree Io sine,indemnify one keep h ahoy in the City of true against
st said
Vi City in co sequence taste and expenses which nmy in any way accrue+gains sail
f„7Z Cityinarmeq UNDE fthe granting D WILL
CO
`+ APPLIC UNDERSTANDS AND N'ILL COMPLY WITH ALL NON-POINT
UR Lr<EO LA't10Nrrt� Issued by:-,.—) � /�AJ7i7�(„�/C r —Date Z�l
Tgunl 1 ppf> IIa�� LS Dme URE Re-roofs
HAZARDOUSorfutreMATERIALS DISCLO handl
Will the npplicanl or furore building cecupant awe or handle IwzaNnus numtinl Type of Roof
a defined by the cupenino Afunicipal Cale,CM1aplar 9.12,and the Health and Safny
Code S e25512(xO•�/ '
Wiyt,s )?
- All roofs shall be inspected prior to any roofing material being installed.
Will he at,comm or air,,findubuilding nwup;nv ane Cquipn0nl nr devices welch If a roof is installed without first obtainingan inspection, I agree to remove
emir hnzanlour,air comaminama o.+Jefio«J by lac oily Area Air Quulit}'Management P �r
i"nat!'Ye Q"/ - all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have 1 Ih ha I materials res I. ruJ r Chapter 695 of the
Calif I' 1 aft &SaftyC S i n,2550525511 and 1 Jet diden /f occupant
) k J e: I Ily h" 'len I II II iI I: l y Pon h l)I udienali p• O/��1� ,L . .� // �j QO
s P' I col the requirements ch ma he t P I too
f u C nsficme n(To
rra y' Signature of Applicant Date
r uuNnnzed agent /! Date All roof coverings to be Class "B" or better
' OFFICE