01110026PERTNNO
CI BUOF UDIVISION
CONTRACTOR INFORMATION:
BUILDING OPERMIT
BUILDING ADDRESS:
PERMIT NO.
11911 PLACER SPRING CT
OLD COUNTRY ROOFING
01110026
OWNER'S N ME:
GIULIANO AND ANNA
387 UMBARGER RD #B
APPLICATIONS BDATE
11/06%2001
RAVIQLA
HONE: • :
(408)362-1111
SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm than 1 am licensed udder provisions of Chapmr 9 (commencing
RE ROOF
wilh Section NW I of Division 3 of the Business and Professions Code. and my license
.mmnrara°nd
Line"Liv. a 2'
. -
T/O SHAKES, ADD MONIER
ante _/� Cmmm�or�,
CEDARLITE SHAKE TILE.
I Ns
ARCHll
b, .,so
I understand my pl... M1all be used as public rtcordx
Licensed Profession at
Ot4NER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Commoner's Licenm taw fa the
following reason. Session ]031.5Business and Professions Code: Any city or county
which require, o permit to cunetmch alter, improve, demolish, or mpoir any stricture
.. __.. .. _ ..._ _ _ ELLE_--_______ ______
..priwmimiaxunrce,aloe"arms theapPloard fur such permit m fileosignedstatement.._
t.�^ - T� Sq-Ft,Floor-Ar r11 -f .
l R� �.'s
$150 4uation
that his n,iickmc8 inivirmt to thl pibisions of the Communities License law(Chapter 9
7000) Division 3ufthc Bod Professions Code)
(commencing with Second of mal
or that be is exempt therefrom end the basis for the alle6dl e�lmptwd. An, violation
`_ { i'S '. -r:10 . :. ,t. V r"o)1,.-VI'
roll Section 7031.5 by any applicant for a poorest subjects the applicant to a civil Maltyy
than Eve hundred of
not mhundred dollars (5500).
m
3 6 6 113 910
:r:.t, Occupancy Type
❑1, es own<rof the propcny. nr my employees with wages as their ,ole compensation,
3 0 5 — FRAME fir' :.B v
Required Inspections' -
-w01 damp work{ and the strunare is an.imended -ora tiered for ad, {see. ]Boa'
BusleBs'add Professions Cade: The Contraetor's ueenae law does not apply to an
owner of property who builds or improve, thereon, and who does such work himself
307 - INSULATION
an through his own employees.. provided that such improvements me not imended or
-oRFed'for sole. If however. the buildin _-rTmrosemem a sold within one7-'-----
Na or,
___ _ _ _
- ----' ""--_-"-' `�".--"
601 — ROOF TEAR OFF -----^:.`.hr ,;.. .,. ..';.a,.'. •' "
remolded.., the owner-huimer will have burden of proving thin he did nw build
improve far pugsoznnf aaie.). 1
602 - ROOF PLYWOOD NAIL
--- -- ---- I----,.._-- --..----
awhe toe
f]haa or DrnpenXa xdasi.ely comn<mng with fittnaea comm�orsm
- -- - --
-603- — ROOF--BATTENS—ELLE—.'-"------
'
Code:) The Contmcrom,
who) Ids p thereon.
Lice vn the prosect (Sec. Oto1a. Business and e., who
Litt Is Joe not apply r owner of
6 - - OGR S S !• b" E L 'P
04 ROOF IN PR E � "�
.and who contracts forsuch.projects won.. r torts),I sed imusavirom.thm..__.
a contractors)
Contractor's License W
❑la a ors rider Sec' ' ""t 'r' B&PCfor thin reason
.Icili i}'.°',!I,, o': p/\y
Ovine .. tDm
WORKERS COMPENSATION DECLARATION
' 1 hereby aRrm under penalty of perjury ons of the following declarations:
I have and will maintain o Ccrtificum of Cdnsen, to self,rsure for Worker's
Compensation,- as provided for by Section 37W of the tabor Code, for the
performance of the work fw which this permit is issued.,
`��n vdund will maintain Worker's Campensadhn Iuiwancc, as required by Settlor.
1'100 of the Iabor'Code, for the performance of the,work for which this phmdt is
..used. My Wmieer CompamiWids incur ccomer and PolrcYumbe arc::M1
....__,._...-.._...-_.... _._...._... .... _
Camf ,ei ': s's'Pol yNa. U/e-2¢7859'114.�.t_
t IJ itit'i1!`.•Ll �..+l.ii nc: _.J :t t
'*1. IONFROMWORIy�RS'i n' .:
• SATION INSURA
COMPENSATION
I
_------- ..-
.is, fl 't is for arc hundred dollars
(Thts scaton need nw he eompined,ftM permit
.r • . ':J:_.i. r f ss , - i t . .
pftotally that in the performance critic work for which thin Wool o issued, 1
'i 1(1.1 1,41
ihll not employ apy'pan' n any mann r so s i becom s 63cct to the Wo ken'
,q•• -, sl
I '
C< pc "ch Laws -'C 1 f Dem,
:NOTICE 13 APPLICANT If of(r rnakmg tht Cerf Oare of Exemption, you
'
,hauls
,Come subject to the W'orker's Compcnsmion Drovisions of the labor Cede, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY ` ;,
I''
Ihadssv ffi lendin iv. C cy for the performance
iijd "'1 affirm that t,m tis
•'
Issued Sinn
.kfor which this; perinli isisaucA (Sec. J09], Civ. CJ,
ohne wmk'f u..,......, . •a,a:.
m
Lender i Noine-s' _s..� _.....
a
.
Lcnder'i'Addres, • .• ..' w , .: '. tri :
.. ,, ..
-
s on: information is
and tale that the
I CCN el vC mad thissure
sun
ordinances and shim laws minting
cityd
wish all c o
. c I agree to comply county,
ul dnd cwn
_ . .._ __ _. __ _. __. __.-.__. _._ _._._.....
ere rcieft s
to building �Jh hereby of Itis; city to enter upon
build me to comp an y
theebove-dartioned property for inspection pmpazez._. ,,. ar_,,;;,,,
Bai
Wele'bid'sade; iiWemulf and keep htered the Cit ofN ntnoa nsr
( grt Y D Y
_ ...
m
judgment, cost and zpcnx which may any y cane against said
Ctliabilities, .
City consequence e rids, gm this permit -
,'ARPLfCANT UNDERSTAN M WILL Cf LY WITH ALL ITC NNT
I
- -
- Issued by: 2iDate
saulxcEREcuunoNs
N
.Sign,murcofPplcan✓Contictmt//.. r ,lute n'
"If RS MATERIALS DISCLOSURE
m
Reroofs -..
�O /-
' Will the appliC m or future bu Id ng ore m Pat aroor handle h mat I
_. Type, of Roof - - - - --
'as def ed by the Cullen no Mouripil Cod Chapter 9.12. add the Health nd Safety
255320
..
(; S l �a :- \ ° : •
Code tion u s t 1 a,,•ta vt
�Yei
i v .
be inspected,pnor_to. being. installed.
All roofs.shall any- roofing material ._ __ ......
W ll the appliturn ar noun, hung occupant use isfaiimmat in device, which
If a roof is installed without first obtaining anlinspectidn 'I'agree to "remove
cm r h dons air contrariness as defined by the Bey Ain A r Quantity Management
n.r r
all new materials for inspection.. Applicant understands and will comply with.
i.`�.. ', .: -:,i
all_non-point source regulations',,, ; ;, r ,r .',r f,• -
t^' 1 h -e read the hatadous mammals gmremcmim der Chapter 6.93 of Ne
&Ii .Hoolth&Safety Cod'S to 25505 25531 d255Ja h understand that-
-ifthebald tenant. that fs bllY tonoufyrhe
--
gdoesn t mendyh ee Y p°
oc poor of the ie m a t which must later p to i ante f en' tate of
Oc up y ' `
-
Signatur_e App Date
1 �� p�
of cant _ _. .., _
All roof coverings to be Class `B" or better
Owner or nt ", ' Data
aumamedy ,-
• t `'
- OFFICE