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01100066 CI out Di G 1IMSIioNNO PERMIT CONTRACTOR INFORMATION: BUILDINGADDRESS: 1 PERMIT NO, 10271 LOCKWOOD DR CALIFORNIA SECURITY ROOFING 01100066 OWNER'S NAME: APPLICATION SUB DATE ROSS KEISER 90 UMBARGER RD 10/10/2001 t HONE: SANITARY NO. CONTROL NO. 1/I _ I (408) 363-6400 q s i ARCH[TECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH ori, 1'U I—I L= L7 nay vNi Z LICENSED our,,CONTRACTOR'S DECLARATION I Job Description Z O I hereby ulflrm that 1 am 1 tenseddunder proJm snof Chapter 9(commencing s W✓{ 'Iwith Section]000)af Division Jof the Business and Profex%iom Cody and mylicrnx REROOF. mg7 is in full trete vnde z ' atlua uc.a I REMOVE WOODSHAKEr INSTALL 1/2" r'O De Vm /O—/a+ Ori Contra aor p. gGj ARCHITECT'SDECLA IDN CDA PLYWOOD & 40 YR. DIMENSIONAL COMP. 3. O 1 undenund my plans shall he used as public records ' T i a,p 0 Licensed professional t o , OWNER-BUILDER DECLARATION vihereby am exempt from the Contractor's License Law for the I affirm that 1 t z a 'fallowing reason.(Section]031 to Business aria Profeesio Caae:Any city or county zzO which 9 permit .trot h mva impdemolieM1 orrepair my structure �3$ �pthrid«i ht 't iIlshl m fsahcmitmfbeagnM ou t ld ; _. . _ . _....... __ _ ___ lw(Chrintor) j ationcI S-_CySietO $] 2V u auPrpfassons Code) t� F1P Sq•TC1 t 8 with Division 3 ofthe Buur he nx exempt therefrom end the bass for the alleged eaempt'uv Any violation ' .fSection 703 L.5 by myapplicmt fora permit subjects the applicant m a civil penalty pp�f N of not more than floc hundred dollars(SM, 3 4 2 3 0 0 Ou t b�r0 a Occupancy Type O 1,as owner afire property,us my employees with wages as their ache compensation, will do the work,and Ne structure is not intended or offered for-sale(Sec.]OW, Business and Professions Code:The Comuaor's License law a«x oat apply tom3 0 5 — FRAME 'Required Inspections" - owner of property Who builds«improves thereon,and who does such x.,k himself I or thmuaghh his own employee:.provided that such improvememx.re ret intended or 3 0 7 - - -INSULATION__ _- offered for sale.If.however,the building or improvement is sola within one - r. . _ -_. ..`•,_.._.. ._. _-_. p p proving year a 6 O 1 - ROOF TEAR OFF 7' "' -- ` `'' ---_- - tom lesion,the owner-builder will have the burden of that he did not build« I improve mrpaspoxmf Sale.). t 602 -_. ROOF PLYWOOD_NATL- _._ .. ..._.. Di,svw&�aFihe p,olsrty,nm�xdasi.eiy cammaLng with hcrn%ed camraaorsm 603 — ROOF BATTENS - - - - _ _ f conswn the pmiacs sec.7W,Busirteu and Pmfesiunx Cadc:)The Conuacur's udwhocodulax.f,such an owner wahiscomywho baucensds ed proeextnt theon, 604 — ROOF IN—PROGRESS ' -a Comome ,"License Low,,,protects with a contrb:tI . licensed pursuant.to the _ CoI am exaLicense lrw,,,,, - ❑lameumqundersee: '' 'B@PC f«Nie rtuon It`I„ Ownel':t"- ,,.I: e•: ^'Data :. :c WORKER'S COMPENSATION DECLARATION Ihereby affirmunder pcmlty,ofparjuryp^e of the following declarations: FINALE® 1 huve'and will`�irihtim a Cenifichm or Corsair,to self-insure for Worker,' mmpcnsnion, u provided for by Section 2]00 or the Labor Codc, for the performance of the work ror which,this permit is iuyed" OCT fy a. ElIliod will mai t Wmkcrfa Cerppc t Insummt as requited by Sensori /� b �O 01 2700 of"slit labor Coda f the performance r the work for which Nis permit u ,sued My W rk fa Cna�pe eau Insure and Pol Yy number are:•w Came� '�t'YiNey'fPoLcY ix ell aiR r �y�B�U1L -rte.--. „� 1' I: CERTIFICATION OF EXEMPTION MW RKEILS'l, a tl••.:(tTie�1diosi need ores tie coin lnedifthe rmiuxr, 1r:•- _;, „ ,. , F.__..__._-...__..__-......_-.�__._. COMPENSATION INSIIRAN -. •..t” anentindrteeaBars r,i=\ \�.d.3r��'f ''I"' P Ver • 1 Nfyahet in the pert mcc of Ne wort for which th' permt'i its ed;l P„,a l'1`C Lt', i'"it'll:i ^ t'%Ota shag r pt,,,anY on nanymarmerea Imp�o me stNycr�spA WmRers Compenu't - of Cahfm`a.D e;' `C'✓ ' NOTICET0 ]CL ANT:If:afsermald gthis esof Exemption.you should ' ' '• ` ' o Z ctw Newmr;:ex Compehsationpm snonsofthelabor Code,youmust QQ fdnhwish cmply with ouch provisions or this purest shell be decreed invoked. _ - 7 c mem 'CONSTRUCTION LENDING'AGENCY 7 'I Aeteby alflrm that Mete is v constmetion lending ageiry for the perfoimanm' •' ' -� 0R6e lv«kfor which his permit is issued(Sec.309].Civ.C.) ; Q Lender's Name .i .: .r.y. .. .. ...:... _. __... ..._..-... _.. ^' Lender's Address ""' •. V Q 1 certify Net 1 have read this application and state that she above information is .ra:E., correct.1 agn<a comply with all city and county«alma rcu and%rate laws relating vu to building cousmuhion;and hereby authorise representatives of Nis city to enter upon Ne above-mentioned pmpeny for inspection purposes.,, 0. (we)'agtee tb mve,indemnify and keep harmless the City of Cupenlun against -h liabilities,judgments.costs and expenees which may in any way serve again,said V,� City idemsequencearthegmntingof Nis permit. . - ' ' ' I. _ APPLICANT UNDARSTANDS'AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date SOURCEREGULATIONS,01""" 1, Sig am f Appl'cart controro -' Date - I Re-roofs H RDOUS MATERIALS DISCLOSURE I wtilNe°pohemt ftdrebuld gar pasta arnmNehizvaousmt 1. Type of Roof'. u defrted by the Continuum Municipal Calc Chapter 9.12.and the HnIN and Safety �}� is + t,^'fl , I •flat - r' I Dlit ti) 32( 1 { ; '.b: �C S�{ n'l l%.'[^ , 1 .in Nm.'. ,. 1 vY:, x''•13 1 , Code gets 255 1. ' ❑Y x - .I `�- _.All roofs-shall be.inspected.pnor_to.any_roofing-maternal being.tnstalled _...._.--.__. wtu N applicanta I..holding p,t ax qa p t a pm If a roof is in'stalle'd without first obtammg an tnspectiori, I agree'tol'-move rout h b contaminants adefined by the Bay Area ArQiltyManagement District? all new materials for,inspection. Applicant understands and,will comply with 17Y non- y t i - ❑No t I,. all source regulations:, y, ', ; *,t„ ;,;fl, flout"read he haa.rdous materials req,amens ander Chapter 695 of Ne California HrilNk Sarery Cdda Sections 25505.25533 and 25536.1 undersand that - ;if Nc Dgilding dues not curtetisly ha%<atewnt.Nat it ie mY rtxpmnsibility mnotify the t. 'cilepmt of Lh rtgeirtmants h¢h mast be t p tv id n Y CcnlRcau of �+-��' - °c p f Ignature of Applic nt Date All roof coverings to be Class "B•'or better em sed agcm, ,Date. l OFFICE _ _ . . .