02020037 CITY ILDNwPERONNo PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
t22-Ml a MRnTNA T.N —EESPONSIBLE ROOFING INC 02020037
OWNER'S NAME: APPLICATION SUB DATE
JIM MANSER 2882 SPRING ST 02/11/2002
PHONE: SANITARY NO. CONTROL NO.
(650) 969-6151
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
s. LICENSED CONTRACTOR'S DECLARATION
e o m- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
�y=o
FtJi xitSecrion]1NIOlofDivisian3nfnc�BusinssMndl'rofnsionsCadaandmylinnsc REROOF .
je S Is in full fo¢gmd� _pec -J
x m a Liccnsc Cl+gs c.b J
Say ate - contracm{/ T/0 & DISPOSE OF EXISTING SHAKE ROOF.
o ARCHITET'SDEC�AT t APPLY NEW 40 YR. COMPOS WITH OSB BORARD.
3 aer.rand my plana xhan oma as ubnn rcem f,
x ¢f
i s o LicensedPrnreasional
u OWNER BUILDER DECLARATION
1 hereby serf ni that 1 an,exempt liar the Contractor's License Law for the
following rtamn.(Section 7071.5.Business mrd Professions Code:Any city mommy
E x a which requires a permit to construct.Meer,improve.demolish.or repair any stmnurt
i3= prior to its issuance.also recants me applicant for such permit to file v signcdsmmrent. _ -
I.hems)irens<apaRttantmthe�msarr.ethe Contraim"License Law(Chapter 9 Sq'-Ft. Floore.Area._' Valuation
(tomo!encing.withsection70DOlnrDi.ision3nnhorimineaaandProfessor,Cade) :.e :.•,lA.e ,",ry.:1�;�;%,?i'
or that he i.i exempt th6refrom mrd the basis for the alldgea dchi inti.Any violation ��••Y 1310
-of Section 7031.5 by any applicant for o permit subject the applicant to a civil penalty
of net more man ave hundred dollars($500). APN Number Occupancy Type
❑LaaownerOrmemnxnr.orryempmycexwenwagesaxmefraomeompenvfu¢ 34230007 . 00
--wlll-do be work,and he structureisnot intended or offered for sale(Sec.70a4; - - - - - - - - -
Basincss and Probations Come:The Common,',License Law does not apply m an Required Inspections I` • '•
owner of ptopeny Who builds or improves theteon.Mad who does such work himself 305 - FRAME
or through his own nomcer. provided that such improvement art not intended or 307-.- - Z NSULAT I ON - ----1- - - —-.--...
afRrce'fnr'sale:IL however,the building or improvcmem ix sold within one yjar of - -'
'completion,we owner.boilaer will have the burden of proving that lm did notbaimor 601 - ROOF TEAR OFF
improve for purpose of tale.). .602..-. ROOF-PLYWOOD .NAIL__.__...__.......
_
_..
❑I,as owner of the progeny,am exclusively contracting with licensed.:) he Ciedcmrs to ---
.: :. eonawmtheaw does
(Set. toa,owners oilPrecision,whio b end o:)Thec000-aerra 603 - ROOF BATTENSLicenr .
am
Lwdoean forsuc apply to anown with
promos builds or improves mercthe 604 - ROOF IN-PROGRESSr
Ci who Li,eme Law project wit a comrator(s)licensed Wrsumt.ro me. .
- Conwm9rs License Low.. .. ._ _ _ .. .. ._. _-_ .. -_ .__
❑I am exempt under see. B&P e roe mit mann.
Owner : . Date -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under emally of perjury one of the following declarations:
( ❑ 1 have and will maintain a Cer ifcare of Consent to self-insure for Worker's �O
Compeisation, as provided lin by Section 37M of the Labor Code, for the A■ E®
�.I. performanee of the work for which this permit is issued.
//f�
❑ malaria Worker's Compensaiion Insumnc<,as requite;by Section APR 1 6 2
Z 3 : 3700 of the Labor CMe,for the o formance'of the work for wnich this permi(is 200
1 have and will
.. ed.My Worker's Compensation Inmate ed 'er end Policy number art: L
' �7aa�'Policyf
l CERTIFICATION OF"CM ON FROM W(RKERS'a t-{.I.Nr t - '! i n 1 1.f'1 C n.,r1t
. - .COMPENSATION'INSURANCE'" _BUILDING..._
` This senior need not be complcied if the permit is for one hundred dollars "l ' •"r' 0:r.r
Slw)or less) .
-' I;rimythr inroperfotm,..of, okf -h htarsol o,te issued:1 - 1 fir.p ;f,t•. -
Comen anon L ws of C.on m any marine so o<m become nuhycn to the WnrAeri
Compensation Laws of Calif vale.'Date
.
Applicant ' is _ . . �-
NOTICE comesTO APPLICANT:If,eller making this Certificatesof of Exemption,you should
become h comp y the Workers Compensation provisions of the Labor Code,you must
Q O IbMwirn comply with such provisions or this permit snarl be deemed revoked.
Ff� "'' 'r CONSTRUCTION LENDING AGENCY ' - "I 'I '
'• '�'l hemby affirm that t2m is's conswction lending agency for the performance ,f
of theworkfor which this permit is issued(See 3097,Civ.C)
Lenders Name .
Z LenLer'a Address
f..l Q
I cenify that I have read this application and state that the above information is
W [r correct.I agree to comply wit all city end county ordinances Mnd state laws telating
�Q U to Wilding construction:and herby autodm opresenmoves of this city to come upon
the above.mentionW pmpeny for inspection purposes.„
y t Will agree lu save,mdoo nify and keep hurmlesa the city 6rcr"on.hminst
m liabilities•judgments,costs and expenses which may in any way accrue against said
U.Z City in consequence of me granting of this permit.
AP LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON:POINT I rl v
. . sr RC EGULAnON o Issued by: Da
li
Al um fApplicanJConrvcto,- - "" -,"Dam' Re-roofs
HAZARDOUS MATERIAI S DISCLOSU
ecu the applicant or'r t re bldg occupant sucrei 6er handle arriandmis mar n 1 . .Type of Roof „• .. . -. . . . __
is def ed by Ino Cu pan firm Mu c pal Cod Chapr r 9.13 end to Form and Safety '
Code O Ye 25532(el 6'No 'S 1 t
,,.-All roofs shall be inspected prior to_any,roofing material,being,lnstalled.,,,
'Will the altruism or future Wilding occupant use equipment devices which If a roof is installed without first obtaining an inspeetiorij agree toiremove
.it maturedmis air contiondand,as defined by to Bay Arca Air Quality Mromponem
Dnmieto vet m3( all new materials for inspection. Applicant understands and will comply with
l' all non-point source regulations.
h
r ;re
' ad the hariNo s mammal requirements under.Chapter695 of tyle
, limo naHealth&gamy CWe.Sections25505255JJ and2553a 1 understandrat -
fthebmldgdoesnoterteeyha tenant.that it myresponsibilityr ntfy be
odctipam of the requirements xh6h most be mei poor to rssvance of a Cen mese¢of
°"up°°`r" - Signature of Applicant Date
m;r nr aumoriam armed ', •" Date,„ All roof coverings to be Class"B•'or better
.._ .
: ::i i;'...':,.,;.:,I,. . . •..� ' - - t: 1 OFFICE .