02050178 CITY
I BUILDING DIVISIONNOPERMIT CONTRACTOR INFORMATION:
BWUJINGAA"ft NDY LA PERMIT NO. 02050178
0nX.K rEPANGRLE `d`5` 21ynDab'2
PHONE: SANITARY NO. CONTROL NO.
❑O zO ARCHITEC(ENGINEER: BUILDING PERMIT INTO
P w FF BLDG ELECT PLUMB MECH
S h= LICENSED CONTRACTOR'S DECLARATION lob Description
i z^G I hereby of ion that I sm licensed under provisions of Chapter 9(commencing REROOF
w_Fty with Sect 7000)af Division Jo fib Bp p std Pmfe io Coaa.ad my license
7 Is m ftltgr..and efi y
':Yd a Liccn Close CIF x
'o a. e Corer dr K
E:
0 fn HITECT-S LA A ]ON -
1 and smntl y plant shall be used ns public records
r
i i o O Licensed Professional
OWNER-BUILDER DECLARATION
t1 hereby aRrm that 1 am exempt from the Contractor's License Law for the p?a following town.(Section 7W 1.5,Business and Professions Code:Any city or county $10000
O which requires a permit to consider,alter,improve,demolish,or repair any stmoure
iR poor to its issuance,also quits the applicant for such permit to thea signed statement
Ihethpm3YumuWpuhantwprevisions ofshe ContdcmrsLicense Law(Chapter 9 r a.�+m ii Valuation
oo n n ing th Sen rm,7 lhp)of Divis on 3 of the Busmen and Professions Code).1
t"fx�, x„ I t.f i\ l.'.:'l,'kk $,"Si 1 +
or In.,he is exempt lhercm
fm 'mal the basis for the alleged riempdm.Any violation
-of Section 7031.5 by any applieant for to pimat wbjecu the applicant In.civil penalty
!of nom mom than five hundred dollars(S500). APN REWW m-,%il Occupancy Type
❑I,d owner of the property,and thes or my employees with wages offered
their sole compensation.
307 - INSULATION
will ue th.it Prof ssions Code:The Contractor's
not ctor's d en m Law for sale apply to an - -
'Boni r of and Professions Code:Thc Canimmoro License Law does net apply m olf (t aT�1$t�CtlOns"'' ^'
owner of property Who builds or improves thereon,mpr who does such work himself 602 - ROOF P L 8 LV H1 L
or through his own employee+.provided that such improvements an no,intended or
,apgrca r -sat Irn wader'me nauamg or mpdvemeni is sold w,Nin one year or _ "' "" R-0 --BATTENS
completion,the owner-buildet will havi:the burden of proving that he did not build or 604 - ROOF IN-PROGRESS"�II ,.
improve for pmpose of salt)
pl s owner of the '_. _ow _. . contractors
_._ . ... ... ... .. ..., .__.._...._._.. .._. __._.._ _ ._ - .__...... ...
exclus
ng
property,et m Business
and Professions
C licensed Contracts to
License the project(Sec.]064,Business and Professions Cade:)The Contractor's
, -
..d we Law does not apply to an owner of property who bullas or seimproves thereon,
_and.who contracts for such prnjens.with a-cnnvactor(s)license),pursuant.m.Ne ...�_._. .._.._.. ___._..._.._..__.._..______._............_...__.__.L._..:_.. __._..__..._
01 am ors License Low,
p der Sec - m B&P C f r this mown :s..' .)' (lit
❑lam rotor -t'
J .
> _ .. Owner114 AY s'
W� AL
ORKER S COMPENSATION DECLARATION r
I hereby affirm under p alty of poidur,one ofine following declarm ons ,1UN 1 �I 'Zooe)
❑ 1 have and ill maintain Cenific I f Contain to selfimme for Worker's I+" L
Compensation, as-pr d d for by Section 3700 of the Labor Code,for the
Performance of the work for which this portrait is imace. BUILDING
❑1 have and will maintain Worker's Cpmpenorner Insumnce,'us requited by Sermon
37W'of the Labor'Cmdlel for the performance of the work for which this permit is
n
.atured My Worke's Co it on Insurance c rdr and Policy be d _
COMPENSATION URA , Yat t s
hl . Pal ey
CERTIFICATION OF EXEMPT IO ROM WORKERS L.e la. t.- ! t l: : 4t' (jh\.al{ lit P.4 '
NCE
(Throe wmtondddnutbecompleieIlithe permit is forone hundreddollans J. Clio. r• . .: tl, 1. . .
(SleBj ar 1165.) ,
....,....r. _....m. �-•.•+ 'ems ._ a :...... __
I icarithfy 0 t to performance of the ourk for which this pe m rerissue) 1 1 I`
shal1 l m employ any person any manner so as td'become sub)em to thrWorkeS'
Compc tion Laws o,Cal fo m.Dem: '
'Applicant."! ,^.. :...,.� ..
:.
I NOTIGE TD APPLICANT If Wfrma dulpi Cenificam ofE mpdon,you should „
z bac me b)en mthe Wark 11 Co pcnaal p i ion of theLaborCode you must
0
farthwithomittily with such pdocisimms ar this permit sh II be deemed revoked.
55 -_",.-CONSTRUCTION LENDING AGENCY- z 'r'
"f 1 hereby which that then is p;issued
(Som lend ngg'ueeocy fpr the perfnrmonbe
r LeIh k f which thispermit is issue)(Sec)097,C v.C)
Lena Address
1 cenifY that 1 has is liamicto and state that the d state
a information is
voeiit 1 agree m comply with ty and county ordinances end site laws relating
10 inin6 crosw"Im grid he sty authorize representatives of,hri city tomer upon
the eWve mioned property or' spection purposes. ;:
t.,0:a l agree to save;m em rY and keep hamile a City of Npenino against
''rr-f/J liabilii a judgments osis std nsea which.may o ny way dame against said
U;rz Cit a equence (the m '0
LI! UN STN HALL'N0 N:P INT
OZ Issued by: Date
to ort of mead o ..r.,.:_. f: •' ;: _".;'.i;:; Re-roofs
1,�; YTARDOUSP Code Che DlS91 OSURE- -
w n uppl I or fuwrt bu Id ng occupom note of handle haiardous material Type of Roof.
d fined b Ih C n no M p Z e d the Health e d Safety
ewe OeYes 25t532(el t ons t,a(1 1, f ). r r t 5`c y yd, R a,l z.Y$f 4� a s so
root
Ali roshall be mspecte Ionto any roofing material being Installed.
W11 the erpbca l ret rtWilding upam ux cqu prom tee„«;which If a roofs 'stalled wit ut Irst obtainingan inspection,Pa ree to remove
cm t haze tloua mr conmmmania as def' by the Bay Arcn Air Q ditty Management p g
Direr et all ne m 'rials or i _pe tion. Applicant d_erstands an_d will comply with-
❑Y a S p 'all on-p' int so ceY gu tions.
”' I he rt he hazerJn 'm tilde q t menu uncle Ch pt 695'0(the
Cal forms H' Sa(my C $C 'oro 25505 3553)a 534 1 undemand thst D�
nfth bol gd now yh e a rNatuis spomblty to otify the "
i becupu oft' regoiry i be me ounce of a nit m of
Oce stay '-
1 azureApplicant ate _
erd-agent ,' . ', D All roof coverings to be Class"B" or better
::. r .. .
- :'_' -- .. ._l.. ,..._..... OFFICE._. .. ....... .. .. . . . . ...
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