02020071 OF
CI BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME APPLICATION SUB DATE
ALTMAN RICK AND REBECCA 5554 HARVARD DR 02/21/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 269-2025
❑po ARCHITF.CTIENGINEEW BUILDING PERMIT INFO
O
g' BLDG ELECT PLUMB MF.CH
�¢tti�P LJ LJ LJ LJ
a 5 w LICENSED CONTRACTOR'S DECLARATION Job Description
D a_C 1 hereby affirm that I am licensed under provisions of Chspor,9(commencing
„Fvt xsmSecton]000)ofDi 3nnneBull nestmdProfe..im,Code.andmylicttse REROOF.
<m 8
to full room and coca.
Ecp u Dole Class_fCs�3_� uex_2_�+ T/0 SHAKES INSTALL OSB &
Beat Doe 2���O RCHITECT:S DECLARATION r
°'05 1mdersmndmyplmsshallheused a,Public records
25 YR. COMP. SINGLES .
Elle
le
f a o O Licensed Professional
OWNER-BUILDER DECLARATION
=' 1 Imaby affimt Nu,1 ant uempt from the Conoeaor's Liceme Low for the
following oa,on.(Section 7031.5.Business and Professinns Code Any city or county
Z SRO which requires a permit cat construct,alter,improve,demolish,or repair any structure
a
32 'prior t tsissuance,alsoyue thepplcunt for such permit w flsigned ,tement. - - -- --- - .__-- -- -- -
Nm lom pus pa atm(1 of i n 3 of the tractor., an ons C erg S FillFloor,flrea� Valuation
ammo mdg with Section]an) ret ron3onnmBaamma, gQvm., oacndq t"�,'t.,' 'i2.ieq'ir_iN e..v_-v+�,fb? :��ii'i �• $8500
or Nat hes exempt the'rcr nnand the bulk for the alleged esamphroh Any,'nlai m
-of Smion 7031.5 M any applicant for a permit subjorts the applicant to a civil penalty-
:ornot more than five hundred dollars(anoo). APN Number r . t - .t. Occupancy Type
°I.as owner of them n'.or my colo ees with xa Ncirsok compensation, 31633098 . 00 )
p P< > P Y r offered
p<nsa
imf do thew k d th t t : of intended or offered for sale(Sec ]0w,' -- - - -- -- - - - - - — -- - - -
mer.: d P ofc. 'en. Code:The C °errors I.aerie Law does vet apply to an Required Inspections
oil
r of progeny Wire builds or tmpmvn therton,and is ho docs such work himself 305 - FRAME
or through his 'n employees.provided that such improvements sent intended or
oared foor il 'If.tree Neb ltlngo lcap c. ts: Id ' n' - y r. ._ -307---- -INSULATION-- -- -- - -
c mplef n
do,cosm,lWilde,willhaethe harder.of poncia,hrotheJd no,Mild or 601 - ROOF TEAR OFF
improveto"iml r le).
602. -_.ROOF..PLYWOOD .NAIL-._
O1 f,M1 p pent 1 IY , , g lh I' red , emrsi
construct the project(Sec.]OYi Business andP f eta Cos )Thf,Common,s 603 - ROOF BATTENS
License Low does tsnot forart
such. fp pent boldimprovesNeo=nn, 604 - ROOF IN-PROGRESS 2J�
cad who contracts for h polars,xtN onvanor(s)1 c d p rs ,to th<. _ _ .. . . _. ... .. _. _ ....
Contractor's rrL License Law. /^
❑lamcxcmpt undo Sc ",B&PCfor msren.on
Owner Dulc' .
_ WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penulty of perjury one of the following deductions:
F) 1 bare end will mi a Cmifcate of Conium to self-insure for Worker's
Compcnsaion,-os pnwldcd it,, by Scaion 3700 of the Labor Code, for Nc
performance of the work for which this permit is issued.,,
El 1 have and will'maininin Worker's Compensation Wurbnce,as required bj Section
_
3700 of the Lului'Code,for the performance of the work for which this pemiiiis
.sued MyW k 's Competition Insurance camel and Policy number am.
C"L. I .Iiit.0CERTIF9Iz., OF Policy o.:
1Z•O%SZ��L�� ar_!I�•. .Il tl`-J tJ)< k.°i] ���l,S..S.'Inu l',.•.y.,. v ••• '
.. ....,COMPENSATION
OF EltEINSU FROM --
�x'
FI
s It (This se do;ri need no,be completed if,he permu's for one hundred dollars "' TC.
($100)or less.)
. I n fy N f the Performance of the k for which this perm t iS issued,I
'shall I pl Saype. ymang , h cal t th W k
cnmpe , { w:or I f D 2x2.�
.NOTICC('SAI PLIC N If ft '11 fli Crfcatc fE ,a 'yu.hold •
tiecome subticno, 'orkcfs Com,lemtlon provisions of the Labor Code,you most
Q Oforthwith" - comply with provisions or perms ked.
. ..... ..._. .. .. . . . _ . _._ _ . .. ... _.. _ __: _._ . I.. .. ..
c m 1 t sac this ,shall dimmed rto
0 :.t'' �''j�" �^°' CONSTRUCTION LENDING AGENCY" 11 � '
C � I thereby a(bim that there is a construction lending agency for the performance
r of Ne work for whi,lidis permit is issued(See 3097.Civ.C.1
Q -lander'.,Name. e
].z Leader's Addrea '..�: . .- .. ...
U O
I I agree that 1 have read this application and stem rha,hand late
information is
0 1.building
uil1 agree in comply with all city and representatives
and.,city laws relating
'Q U the al,tingonedconstruction,antl h<rcbyaumonmrepose ratives of,his city 1.cruet upon
C6 the abo(We)ag.16 goperyfor iospmnion kepurperolei,., ,.
y ec.pdgmemsave:indemnifyand seswhiep hamayinan wayfrmeaainstsaid �J"� �
C") liabilities,jadgmenu,emu and expenses which may in any way accrue against said
" l/
U,Z City inT ND of Ne A of Nis permit'-
SOP RIANCCE EiULA, ANDS
ANDWI ,C LY WITH ALL POINT Issued by: Date
Sign tum fApphe U , for - Dam'; .
Re-roofs
ZARDOUS ATERIALS DISCLQSURL'
Will da ppllcant future Wildingcommit tore or handle haurdems mac ed Type of Roof
as dmf ca by the CuNnino Municipal Cd Chapter 9.12.and the Health and Safety _
Code Seection 25`3Aa ) No" .3 - il ic`� Pt t '+"jl slty5
All_roofs shall be inspected-prlor_[o any roofing material being Installed.,_
W 1fli ppllun,or boom pa tuseequipm iorae.a.,wnfce: If a roof is installed without firs[obtaining an inspection; I'agree to remove
emit h d a coma a as defined by Ne Bay Area Am Quality Management
Dietnet9 all new materials for inspection. Applicant understands and will comply with
°Y all rion-point source regulations._, , ;1
1 h to Testi the A zardous.m renals q r n' rc;and Chapter 6.95 of the
Califomia Heehh&Safety Code.Seniors 25505.25533 and 25534.1 under and that
if me building does no,curtcndY have n]n,,,,anari,ismy ospomibiliry to notilY the"rlat rat of 1 c require u x,hicA met prior,io iaivance'id a Cenificare of
... 7 Orcupanc - .,.
r a�� Signature of Applicant Date
oxo Noriuda' ,, : Dam All roof coverings to be Class `B" of better
OFFICE- ... . . . . ..._ . .. _ ._ ._ ... .