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00110026 CITmLDING DIVISION PERMIT CONTRACTOR INFORMATION: 1 BUILDING AD SSSEDWARE)'. AMI!iIs AND PERMIT NO. I L 1 -' 1- • JWVJ OWNER'S NAME: - 92!5­99905 APPLICATION SUB DATE ONE: • ' SANITARY NO. CONTROL NO. p c z ARCHITECT/ENGINEER BUILDING PERMIT INFO a-,E . •REMOVE EXISTING R r8TO� Nf'r1t0#EA�TM ' <o. Z y i LICENSFD CONTRACTORS DECLARATION lob DeScrlpt n Ifeach,.1firindoill' tl' W 1 p fCh pl 9(omn lig °z r won Scotto 700(U r 3 f n Basin .d Prarac w - J my f n- y 5 Is' r 11 r rc and f ie '•� 7 r/(� 5 N 6 Li Cla e Lim.# L, ' 3 LL Unl _Ct O h ARCHITECT'. F.CLAI os /1anr�e,land,n,plea-bell he use -rem It �/ ' Y ej Licensed Ptnf clonal - ® - L OWNER-BUILDER DECLARATION l 1 marvioumrmaunt stn,Business Bam he Cananeloo e,Anycty. for the ,. $62c4 following i nwn.(Swoon 7031 5,Ba-eme-,nsuitro Ptnfdomels Cala:Any city.,,.only SH ct which reynnes a permit p mw,mcl,alter,improve,demoh-h, file repair nay fhomme amine t 3P� Prior toslissicensed parocaltoThe owsiaaant toe Co puteil tofileasignadxmtemna (that he commescingisit pSewunnolhe pif Usannf the he Business ndP Law(Chnpwr9 S`q. FifS. a �- Valuation I,,tmma,cingwni,$fficam 70(g))(if Dl feesar t the Business PodAnys,Cade) , or teal io is exempt Ihcaflnm,rad the basis forihe alleged exemption.Any violation ar seeliann than 5 v anyalilflwantdap fora permit subjects the applicant m o civil penvhy at not more man oke M1aaareddmmrs(xsa). , . - APh'OrumberFRAME- Occupancy Type ❑I.a..wnaaftheprepenr.armyentployeaswithwogaa,Iheirof,compensadnn, 307 — INSULATTOsl . will do the work,unit the commie is not intended(it ofDrcot for_cele(Sae.90,14. F 01 — ROOPe TiE€bRnEdi ons Business and Professions Code The Contractor's La,i Law does nal apply m an t] 0 oWinrofoppelyWho haikka,i..pro.e=mercon,and whadoes suchwork himself F-102 — ROOF PLYWOOD hIRTL.. mugh his own employees.provided that such l,nprovements are not intended or F-102 - _ offered for-ale.If,naweve.the building or improvement is,sold within one year of I603 — ROOF BATTENS impletion,the ownermaiidec will have the burden of proving that he did not build or ' Completion.the 60/A ROOF IN—PROGRESS ❑I,as owner of the property,arn exclusively contracting wan licensed contractors to - -,income,(he p.,,at(Sec.9044,Business and Profession,Coal The Conaomor's ., License Law docs not apply w on ownerof properly who builds or Improves flounce, - and who eon me,for such prnjrets with a conmmtor(s)licensed pormnm to the - ContmcwVsLi ...Low, ❑I ant exempt under See .B A,PC for,his reason Owner Dote WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty ofperjury auto ofihe following declarations: , I have and will n,ninlaln o Certificate of Consent to self-insure for Worker's Corapenndoq us pravidal far by Section 3700 of the Labor Code, tiff the - pedannince of the.,,,it fi,r which this permil is issued. - ' R- 1 have and will maintain Worker's Compensation Insurance,as required by Section ' 39 1 of the Lunar Code,for the performance of the work for which this peradl is issued.MyCWorkers Com///p$$$���,,,n aaoo Insurance carrier and Policy number are: Carrier.`•+ Policy TION(��11�1-00- Q CERTIFICATION F F.%Eb1PTiON FROM WORKERS' COM ENSATION INSURANCE (This section need not he completed if the pennil is for one hundred dollars - (5100)on Ices.) I comfy the,in the performance of the work 1'ai wh'mh tris pennil is"add I shall not employ any person in any manner so as to become subject to the Workers Compensation Law,of Califinorm.Data Applicant - - NOTICE TO APPLICAN'C It,aOnmaking this Cenlflcum of Exemption,you should _ become-ubject to Ilse Worker's Compensation Prov smis of the Labor Cole,you must Q fanhwithu.reply with such pros-inn,or this per,nitseall be deemed revoked z . E" M CONSTRUCTION LENDING AGENCY a 1 hereby or wBnn that throe Iss cored(Sec. Icnteing agency for the performance W of work for which this pcnnh is issnce(Sec.3047,Civ.CJ Q Leaders Name Lariat's Address U O 1 cwiify that I have read this apprcutinn and eauc that the above mfaif matium is . 4ti [y conduct.1 agree to comply with all city and calmly ordinances and state laws relating C.) to building eansmuc(,omand hereby authorize representatives of this city le enter upon - pWI he ad,we-ancienerelp party f ' .pe( per,ows, „ (W) g e.oor,inderniand,andkeep l I ss the C'tyaf Cupenmo against CO) liabilities, V j dyment' cat,and expenses esh h may in any way accrue against said City to duaw"mone e w"Tion. W APPLICANT,UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issuedb Dat SOURCE REGULATIONS Y•; 01 Squalureaf Applice.07mufaeaa - Date Re-roofs HAZARDOUS MATERIALS DISCLOSURE Wiutheapplicantorfutureladlmogcca;Pam"tarearhandlebrondaismaterial Type of Rho , as defined by the CaTeninn Municipal Code,Chapter 9.12,and the Health suit Sa@ty Code,Section 25592(x)^ C1 Yes ❑rva - All roofs shall be inspected prior to any roofing material being installed.. Will the applicant or futures ingoecup:m,ma, uguarlordwecesisbid, If a roof is installed without first obtaining an inspection, I agree to remove tit h,,u as,air ccomponents as defined by the Bay Area Air Quality Management a-tree - amaterials for inspection. Applicant understands and will comply with °Ya- °N all non-. 'n .ource also 1 have reed fee ba-d!.......am r I adsy i I on Italian' J Cibpt fi.C�.dthm V Y ' I r' O tom v Health A,Safety C J Section,25505 5533 ad 25534 I d Vifiha 'dilg dnasn t n illy ho' et and Ibal'l 1.n(YrcP n.b 1'lytacap.tm the rcgn re rents wheh n t pr nr to i-su:nc_e of Cin _ Occup 1 e o Date 5411 nerd agent Data All roof coverings.to be Class `B'•or better OFFICE