00110028 crry OF curHCONTRACTOR INFORMATION:
nun.nmc DIVISION
sul" PERMIT
BUILDING ADDRESS: PERMIT NO.
COSMOS ROOFING 00.110028
j..)WNIN SA, r,: APPLICATION SUIT DATE
SO SAN ANTONIO RD 1.1/06/2000
PFIONIS: SANITARY NO. CONTROLNO.
49,3-6373
BUILDING TERM] INTO
O ARCH["f1i6Tl1iNGINEIiR: ILD ELFC1' PLUMB - MECH
a i E L J CI O IU
G«
I,Ic1:NSEDa>Nr11nCIOR'S DIscLARAnDN Job Descripti n
0 w I bcmhy alum,Ih n I am licensed under pn visin.,nl Chapter 9(commencing
M2F H I-ty with section]IXXp of Uivisinn 3011.B.Anes.and Poor..too,Code.and on,beano,
isle Hill run and cnt�.��—
C�2 Data's // a_ f_� _ T/0 $' S ADD TR G 4PL Y ROOF SYSTEM
c u U.nc__ #(, Y ,,DECLARATION-
0
EL
0 fin v ARCHII'Ihe o. DECLARATION -
=�� I undcrvhnJ n,y Alam.hull M uscA uv puM1lic records
Licensed 1'mfessional
anal /
OWNER-BUILDER IIECIw\RATION
4X1^m I hereby atlinn tint I ran cscn."I'n)oi the Con,ra,lo,,Llceme Law he the
C Z< following reason.(Sectio1703 I.S.Im,inco,and Profession,Cele:Any city or eomn, /
$$S soh ch retinues apcmri,I I n It,,improve demolish. p. y t amic
a3� prion t Ise 1 dppl'^: ,1 hp silt II g dart nen,
Ihulh 1 11 a, It tile1 Wo-of Conorwor,L, Low(Charter 9 Sq. Ft. Floor Area Valuation
(commencing With Section 7(I h of Division 3 of the Business and Protessioa Cede)
or that he iv exempt therefrom and the basis for the alleged exemption.Any violation
of Soot uu703 5by any applicant for a permit suhjcns meapplicant to n civil pcnalry
of not more than rive hundred dollars($Sa))a A PN Number Occupancy Type
❑I...sawncnd,he Pro,fy.ormy emplo,rc,With wages as'heir sole annper,anion, e-]C
Will do the wink, all the swcome is not intended ,,ofteted Ort safe(Sec.7044 - - -- '
Biomass and Professions Core: Comment,',License law does no,apply h,an Required Inspections
net of properly Who builds or improves thereon,and who does.such work himself
or It h his own employers.provided,hat.telt in,pool, an,are nal intended or 305 — FRAME
offered Inn sale.It.however,the Wilding or Impnocamm is sold within one year of
icompletion,the osvnertaaildensill have the haden of proving that he did not build or 307 — INSLII'_ATION
mprove Ior p„Tose oranm.).
❑1.asowner nfthe prn ny.amexclasi,eycontractiingwimHcensedcontractors In 601. — ROOF TEAR OFF
constrict the project(see.70,14.Hames,and Prof csion,Code:)The Contmctory 602 ROOF' PLYWOOD NAIL
.iecn a law docs nal apply ,,t owner of ptopeoy W ho hndds or improves thereon,
and who ommnz to,.nett projects will,a cm,lmctorv) lteenycd pursuant I. he 60:, — ROOF BATTENS
Contractors License Law.
❑Itint exempt under Sec. .H A,P C for this reason 604 — ROOF IN—PROGRESS
Owner Dane
WOR KHR'S COM PF,NSAI[ON DECLARATION
I herehy adlirm undw,moult,of pa,jt,iy one ollhe billowing deelarniom:
❑ I have and will maintain a Cenifinre of Consent to self-insure for worker's
Co:ape astaion, u, pmvidud lot by Station 3700 of the LeMa Code, In ,hc
pemmoamee of the wad Ior which this pemtit is issued,
tI have anti will meimair Worker's Contpensntion Insurance,as required by Section
_]1X1 of m,labor Coale,for the performance of the work ftor which this permit is
is,eurreiJsucaieuicy :
C : T"I S�I Q0—II
e N .: '
CERTIFICA)ION Op EX12NI17ION PROM WORKERS'
COMPENSATION INSURANCE -
frhi,mcdon need nn,Iso con,la,ol it To permit Is lar one hundred dollars _
(311X11 or less)
I certify the,Ir the peHit n,mar of the work fur whleh his Penni is issued,I
shall in employ any Person In:my manner eo as n,bean...object it,the worker,
Cme'ro ilm lass of Calihania.Data
Applicant
NOI"ICI:TO APPLICANT':IL alar naAing mi,Ccnifica e of EsIntp,ion,you,halal
becomewbject to We Wd
oer'y Compctsution provisions of the Labor Cafe,you most
0 foohwi ll complyn,tac
wih m
Provisions or this .it shall he desired revoked.
>Q ,
CONS'I141JC'I'ION IAN DING AG17 SCY
> 1 herehy M.that there is a construction lending agency for the pedomtance
f11
file work fin which this permit is issued(Sec.310,Civ.C.)
0. Q I.cndn's Nano
7 Lender's Address
U Q�+ 1 calmly that I hale read this application and state that the above infornntion is
I;, ro carrell.1 agree it,anmply with all city and canny oolinances and sem laws relating
Q U mWilding construction.and hereby authorize Mnewmatives of this city to enter uµ,n
y tall the alloe atentimed property to,impeai m Prologs.
(✓ y
(We)ngtce w save,Iednmtilyurd keep harm less the Cllyol Cuperiroallmalt
V1 liabilines.jedgmems,costs and expenses which may in any way tmcmu against said
U J City in canseyuence of the starting of Tis prnnit. rr--SSp /1(
APPLICANT UNDER"NIAI
ANDPLY WI"I'IT ALL N``1N-PAINT Issued by: oe_ �N7k ,11WA_ -Ci Date
SOURCE RHCULAI'I �Sign:nure of nppficwlDmc RB-rOOfS
IIAISCLOSURE
Will In,apprcam m home betiding oc,iipmn store...handle hmadon,anoretic 'type of Roof
as defined by the Cu,mm,Mam,ipal Code.Chapter 9.12,aad the Health aad safety
Code.Section 1553200" Il .
All roofs shall be inspected prior to any rooting material being installed.
Will the...icnm Lir fntre Wilding«apam uw equipment or do,ices which If a roof is installed without first obtaining an inspection, 1 agree to remove
rah hvardnux to,contantia.,ol as detined bythe(lay Arca Air Ouulhy Management
>lthat? all new materials for inspection. Applicant understands and will comply with
Li Ye, all non-point source regulations.
have rind the Side,lacCodes m:ucris 2 505.2 533 a under 4,1 mi er,a of rho .
Calan I hveahad l Gctc.Saminns35505,25ocot, do,C1und695 if but I, 1
tribe
building does not currently have a tenant,that it is my msrymsibildy to notify the 6/
.spam of the requimmerrs whim mast W muom
Fort prier ,rance of u Cin;lige n1
ixetn,apg 6D Signature ofApplica t Date
Uwner`1rinlh�,rir tnen� L— Doe All roof coverings to be Class"B" or better
OFFICE