011100969
OFFICE
OF
CITY
e
DING DIVISION
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT N0,
10351 N PORTAL AV
WOODS ROOFING
01110096
OWNER'S NAME:
APPLICATION SUB DATE
MCMANUS MARCELLA M
1020 HICKORY CT
11/20/2001
PHONE:
SANITARY NO. CONTROL NO.
(831)637-5576
O O
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
B ELECT PLUMB MACH
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LICENSED CONTRACT'OR'S DECLARATION
Job Deseripti ❑
I hereby uR�w that I am licensed under provisions of Chapter 9lcommencingQ.
with Section]IIf10)of Division3of the Business end Prolcssions Cale. end myliccnse
TEAR OFF TAR/GRAVEL, ADD 30# FELT W/35 YE
av
is in full forts an R
ucepjcl� 9J CLiuorm
DOUBLE LAYER MODIFIED BITUMIN 9#
LLO _r
5 DECaur
—T ARCHITECPS OECLARA N
y �
1 understand my plans shall be used os public records
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Licemed Professional
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OWNER -exempt RDECLARATION
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T hereby a07w 1 exempt from the Comms Lew I.co the
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on 1. Coe : Any c
]031.5, Business and Professions h, or Any city or county
following lemoa Permit conswn, alter, improve, demolish,
which requires o permit or repair any snucsurt
re t
titans 1 issuance. also q theapplicantf such 1laice
stananantChapter9
PER" .o .
Thal heist ed wit puffsan the n At fNeC mnsinsLnd Pr law(Chapter9
seLaw
(commencinge ss Code)
with Sectionium the J f Irk
)�4�"� •1 , r r, ; •,r . sa - Valuation
li and the basis
or he f e a alleged
alleged exlmpoon Any
mp ion. Any vi
Zany
1,,
31.5 b it subjects
anHor a pcwil svbjctts the applicant a civil penalty
applicant
p
]031.3 by any hundred
l Penalty -of not
of not mole than Ave hundred dollars (SSW).
m i Occupancy Type
° I, as owner of the property, or my employees with wages as their sole compensation,
.!])'do the work; and Ne structure is not intended or .Rercd for sale (Sec. ]0oa,'
Business and Professions Cala: The Canwctar'a License Lew d«s nm apply man
3 0 - INSULAT plQlre nspeetions 1, ^'
owner of property Who builds or improves thereon, and who does such work himself
or throeggh his awn e.play,.. provided that such improvemems arc nut intended or
601 - TEAR OFF
offing 61 sale: IL however, the building or improsxmcn, is sold within ore year of
., ., - -ROOF - - _._-_.- _ __
602 - 'ROOF PLYWOOD NAIL' `
completion, the owncr-builder will have the burden of proving that he did not build or
improve fur purposeofsala.I.
603 - ROOF BATTENS
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°Lmowner the property. am exclusivelycontractingCoanatsto
- .._. .. .. _. _ —
604 - ROOF IN -PROGRESS (' -'"-
- -
consumer the 7
Sec. ]Doan Owners and Profusions The Conuaaofa
ills or
does who builds
License Low does not apply m an owner of improves Hereon,
-
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a contr ser
avd whv.mnwcus.for_such.projms with a mntmnm(sj licensed purwem to the
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Contractor,
_
pt under Sec.
111 em exempt send& Sec.B g P C for Chia reason
I. , 1
Owner' Date -
WORKER'S COMPENSATION DECLARATION
,
1 hereby aft w under Penalty of perjury one of the following declarations:
❑ 1 have end will maimain a Cenlflcnte of Consent to self -insure for Worked
Compensation. es provided for by Section 3700 of the Labor Code. for At.
-
performance of the work for which this pewit is issued.
have and will maintain Workers Compensation Insurance. as required by Section
-
00 of the Labor Cade, for Aha performance of the work for which this pewit is
issued, es'Coompstuation Insurance carrier and Policy number arc:
pMyyr{g
v'PolicY S-aw I�IG
Carticis:iG;: /`^�. No.: Le
' i '. CERTIFICATION OF EXEMPTION FROM WORKERS"
COMPENSATION INSURANCE ''
iidnlon neat nm4completed iflhe pewit is (or one hundred dollen
I' `li;l n,t l.?_ l'�',2 I,
(SIM) or
or) lcseJ t
.. - hi �.
. Icenlfy than n Irk of the dr1 for which This pewit
Worker I
.. i .. r... .. ..a ,. .. ....... .I ...... .., i. _... ,.. ....
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n in any mann.
shelf not employ any person in any manner so as to become subject m the Workers
a
: H f
Compensation Laws of CeliPornie. Data
Applicant
after Ceninso of iod,you should
NOTICE TO APPLeWork
'
Z
nes
b,cumesu Wof.rkers
the Workers Compensation
Compensation Labor
of the Labor Caked. must
m
� 0
Permit
forthwith comply with such provisions or this pewit shell be domed revoked.
amply
rn
-
'o" CONSLENDING AGENCY
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fr
I hereby efBw Natt AM. Nere'iis a91a construction lending agency for Ahe perfowame
of Ne work for which Nis pewit is issued fSec. 709], Civ. C.)
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Leiber's theme"'-"' •• -.: _ .. ..... .. .._
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Lenders Address
,
1 cenify Nm I have read this application and slate that the above infowetion is
,
corrin: I agree m comply with all, city add county ordinances and state laws relating
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to building emostruction,and hereby authonte representatives ofthis city to enter upon
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the above-mentioned property for inspection purposes.
(We) agree to save: indemnify and keep haindesa the City of Cupenino against
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liabilities, judgments, cosi and expenses which may in nay ways accrue against said
City in consia,"am a of Ne gra "g of Nis permit.'
APPLICANT UNDIlRSTA 8 VD WILL MPLY WITH'ALL N .f-POI/t.',�(
50URCE'REGULATR92' '' 1; s /%'6/ -�
Issued by: Date `
Signmure of Applicam/C.Atooiar—;iD'me
Re -roofs
DISCLOSURE
„,
Willpp 8
illthe;Cu�nnoMu
Type of Roof
udefi cWilCgcusah�tnarewhandlehauMonsmaterial
y pe Municipal epser 9. 12, and the Health and Safety
`:.;+ r -
Cod,. Section 233321! . ;.,.. �, ,r :..
0YC5 �° ^ `
•' 1 i .. s
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All roofs shall.be inspected prior to any. roofing.material.being.installed. .
Will the applicant orfumm building occupam use equipment or devices which
If a roof is installed l without first obtaining an inspection; I agree to'remove
emit heedous air contemmants es de0ded by the Bay Arca Air Quality Management
Distinct ]Air -
all new materials for inspection. Applicant understands and will comply.with
°Y°
all non -point source regulations,
1 have reed the hdaerd ere materials rtqu remrnts under Chapter fi 95 of the
Califon a Health At Safety Code Sa6finmv 25505 25533 end 25534 1 undenuend that
if the bit Id ng does not curtently h c a tenant shot ins my responsibility to notify the
oceupam
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-�T�--�
of the requirements. In moss be met prior io nsuonce of d C:vdic a of
Occupancy," 9
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Signature of A plicant Dale
All roof coverings to be Class "B” or better
owner.g, t Data
OFFICE