01040065 CITY
BI OF DIVISION
0
PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT No.
20200 LUCILLE AV # 105' 112 ROYAL ROOFING 01.040065
OWNER'S NAME: APPLICAl ON SUIT])At 13
STONIES014 DEVELOPMENT CORP THE 1345 VANDER WAY 04/1.3/2001.
•PHONE: SANITARY NO. CUNI'RO1.NO.
(4 8)27 —'33^c
1p-_1 0 0 ARLI 111 R:1717l' ililt II 1b. NG PERMIT INFO
w IfIAG ;.loci' PLUMB MECH
y j LICENSED CONTRAnOR'S IIECLARA'I'ION
o =❑ 1liereby ol ata mal lam licensed ander pro;,ions of chapter 9 antmneneing Job Description
rr vJ i_w will Seen i700(rof Division 3 al the lfn,im:,cv and Nolev,ions Cn le.and lay llcenne
a is in full fnrcu a cR I
XdX 0.< Urease eyl�se�y, J�� Ue.«Z/p Y3vr6 REMOVE SHAKES INSTALL 1/2" CDX
WSt.t Date—7 / ARCHITEcr'SDECLARxTiON & 30 YR. CERTAINTEED SHINGLE.
C u'to 3 1 understand any plans shall be used as puddle mcoNs
ti p O Licensed Pmfe,,ional
ONER- UII.UI?R DECLARA'NON
X=WHm 1 herem.Bonn Ihul I lint escntpt front the Coalrvena's Gnvt.c Low for the
l-a a follow in,reason.ssidion 7031.5,Ru.ino.send PmGssions Ccde:Any city m county
which rnpdms a Itvrarit w a o,trow,a1mr,improve,liar.obs or recti,any spucmre
prior mils issuance.also requires thcapplicanl for such permit to File a signed.lilemmnl
,last dearicen.dpm,aant to the prowl>inna onusnttlmea,r.Liccowl-,awlcharveri) Sq. Ft. Floor Area Valuation
Ie. Ing with Ste, 700(hol lb,ikikna 3 oft he lhona,,and ProreWorsC«le)
Indian he I,e¢ntpt therefrom and the h-i,Iia the ulle,od nsomplion,Any violation
of Section 7031.5 by any applicant for a peril subjects the applicant to a civil penalty
ofaol nmoe titan rive handful colla.,(s5(k)) APN Number .OccupanT� No
01,as rncr of the property.or any entpinyees with xugcs as their sole cotnllenmdnn.
will Jn Ile work.and the aivelurmis and intended non offered liar vole(Set.7794.
Hume..sal Pmfc,,mons Code:Tire Conarml LIcanm Law due,,not apply m an 31602094MP1ed Inspections
nowner of property Who builds or improves thereon,and who Js such sod himself
on Ihnn.gh his own entpinyees.provatd that,rich Ingvovemmrls arc dol intruded lir
olYereJ for all,II,however,tiro building or intpmvanenl is sold within one yet,or
completion.the nwnewhnllder will have the burden of proving thin he did nal build of 305 — FRAME
inpmvo ter parlm.e H s.kf 307 — INSULATION .
0 L,as owner of the Pntpcnp ran v,11 ively contracting with licensed conpunor.an
tn,btat the p...ml(Sc,.7044,anon....nm1 Isn't cs.ions Code:)'fhe coma"",, 601. — ROOF TEAR OFF
License Ins does nor apply man owner or priori ha
ori who nd,or intpnwe,themnn.
and.vho contract, for such project,with a coatmctoaol named purstant to the 602 — ROOF PLYWOOD NAIL
Connadva',Licen,c Law.
[II ant exempt miler See. .a&PC for this reason 603 — ROOF BATTENS
Owns lime 604 — ROOF IN—PROGRESS
WORKER'S C'OMPENSNI ON DECL\RATION T
I hereby uitirnt under penalty of perjury vol the tollowmg deolarationo.
• 0 I have and will mnintain it Certificate of Consent it,self-insure for worker's
Contpcnsulion, as prided lin by Sec, 1 3700 of the Inbar Code, or the Q/
perfnnmaram of the work for c hich this peril is issued.
have and will muinwin Wader'.Cmnpcnemion lnwrancc.ns aqui rod by Section
.71q of the mbar Cade.for the performance of the work for which this 1Ymtil is
Cued.My Worker's Cnmpensalir Lnenumber
nance carrier and Policy are:
CanlccA_eiy_c Qre"A'{icy No.:
CI?RTI FICAIION OF EXEMPTION FROM WORKERS'
COMI'ENSAOON INSURANCE
f[his w,inn oval not he antplelnl it the .it is for one hundred dollars
is 100)or IasJ
I ceml'y that m Ila,perlinnrmee of the work for which this permit Is issued,1
shall not mnplay any lunar In any manner In m at heroine subject to the Workers
Compcnvali on laws f California.Dam
Applicant
NOTICE l'O APPLICANT:It.after nuking this Cenilicam of Exemption,you should
become subject In the Workers,Compensation provisions of the Labor Code.you neva
O hmhwitl,cn.nply with such provision,or this peril shall be devoted revoked
z _
CONS'rRUCfION LENDING AGENCY
1 herrn,nihnn Jut them is a eanametiun lending agunpy for the perfnrmnnca
of the wort:for which this permit i,issued(Sec.3107.Civ.C.) -
0. Q Leadcr'.Name
= z Ivade, Address
U I eenify that I have mad this application and%rote that the above information is
Fill F. 11111111.1 atia- e,11111 of city' 1 ellool,building bLep CripI.
Ns J state 4elating
I)
bu IJ g I i 11 by M1 p l i f thiscity t I open
the aM liI property Iinspection
(We)ant it Ik 11 I i Cry fC p ', r
Vliabilities,j Jg nCosts d s x h sb nay inany stay acrno against said
City 4 6 (riporb WIL fAPPLICANTlNDER NIWHTO
ce of
IssuedSDURCP NS
Dile
yG Re-roof:S.gn , mmlGmmnum ale
/1
v HAZARDOUS MATERIA.: I.OSURE
Will lire npplie:ml or hnum b.ilJing,terse al worse,handle hamaou,mmedal Type oof
as Joined by the Cuecnino Mmticili Code,Chapter 9.12,anti the Health and Safety
Gds.Section 255321,1'
0 Ye" 11 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfurore bulldingoccupanl use equifjmenl or devices is Bach If a roof is installed without first obtaining an inspection, 1 agree to remove
.harardor,an conounin:na,as delinesl by the Ray Arca Air Quality NEmage icnt
rodnmlrhrr all new materials for inspection. Applicant understands and will comply with
G Yes LINO all non-point source regulations.
I hate read the haurdou,ntatnri,1,requimmmals under Clupmr,695 of the
California Health&Safety Calc.Sections 255115,25537 and 25534.1 understand that
it the haddhng d ,ran.....ally hueca manna.that it is my respomihility to nobly the G
occupant of the mluirenenls which.oust he mal prior at iorance of aCen'lane of
Occllpi L S' ature of Applicant Dae
s ramhnrimdagent Dal Off 25;
gs to be Class "B"or better
OFFICE