00110013 CITY Ne D;V; N
eONo
IL PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PHRMU No,
OWNER'swikT404 RAMONA C1 APPLICATE .o
1101, BADERTSCHER .NED. L AND SAR4 J SANnARY ./027EW161710NO.
-16 ARCHITECOHNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUN115 MECII
S91 I_I =I CI
¢i
Syi
LICENSED CONTRAC`FOR'S DECLARATION Job Description
_o I hereby affirm but I am IicenuA under pnwi,inns of CM1apecr 9(commencing
wide Section 70111)of D,,Wun 3,!IM1e Balmem and Protesaions Cud,and nTy license
is no III laidcite
rc ¢ Jeenu LIc,k_{,o4SOS
Ume )S- Gofer°°I^r SHAKES TO SHINGLES
nRCxfrlicr'5 DECLARAf1ON
I mod enwnd my nlan.r.h:ul he cwd a.public menrdn
W 6 p O Linnsfd Processional
c,LL OWNER-RUB.DER DECLARATION
=m 1 hereby.affirm that l am e,cnepl(Tom the Contractor's License Law for the
F% fnlluwing rcu...I,.(Seed un 70315,Business and 11 reuxintw Code:Any city or,ei my
f 5 a which require,^permit lo,orsma ,ahcr,ilnprnve dcmol h,"r repair any struemm
Ise
e.a I prior „tone.also requires the applicant for p,nniuncilcasigned statement
shut M1a•e,hefa.dperaantln me pmvnism.nr thf ennlm::tnra.ifenm law(Chapter9 S Ft. Floor Area Valuation
(commencing with Section 71)(0o'Division 3 ofthe mnlnesoand Profe,sinns Cale) q' V
of thus he is es,,opt t ...It it and Ile hook for the alleged afro,ion.Any vnotItion
of Setion 7031.5 by roy applicant Ibr a permit subjects the appliaunl to"civil penalty
,if a.,horsthan Bvfhtndrfddmmr(s5B0). APN Number occ ikffic�oupe
C 1.as owner ofthe pro coy,or my ciodo,tmi with wages as their sole co cils,nsatien. --I-
will do the work,std the shuclure i,not inbtded or olfured In,sole(Se.71H4,
Raine„told Pmfc,,imr.Code,The C....mifl„r,License Law does nal apply In an 3570J 082. 0Iquired Inspections
owner of pnepmy Who build,or iinpntves thereon,and who does such work himself
orthroughhis own employes.provided that such improvements are not intended or
offered I'ur site.11:however,the building or impmven s sold within ore year of
mplellon,the owner.bnuder will lnwe the haalfn of pn Ing Beal he did I 305 — FRAME I nada or
e��prnvf
for puri f of.ale.). 307- — I MSUI_AT T ON
❑I.a,owner othe pmpe"y.amexclusively contracting withlicensedcantmc'"r'o 601 — ROOF TEAR OFF
Lmxlono Bea Prnjeet(See.7141.B^,inesx and Profession,Crete:)The Cttlnraemr,
icenseawdoc,mmipyytoane,wmiofproperty whubuilds orttnpmvesmerelin. 602 — ROOF PLYWOOD NAIL
and who contracts for such poill with a n ninsions) licensed pursuant to the
Commetue,Liecnse law. 603 — ROOF BATTENS
❑I am exempt under Se. ,B.@ P C for chi,.,on
Owner. Dale 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARAi'[ON
1 ehereby
ant]affirm under penally of perjury one of the Rellnwing declarations:
Worker
o r:
Cl I nave end will tnuinaed f Che Secti of 370)Ctownt m ne Ladhorrc fie Wotk the
comoccournn, he provided for by Section Jis.. n( the Labor Cenlc Ibr the
performance of IM1e work lin which thi>peemil is i,w H.
1 hove nnJ will con Worker he ',Cnntp rac of
1n,untkf m 1twhmquitedit M1yearilnn
%Uc of y IaWr Codes I'or the pf oo once of the work tier which Ibis pcnnit is
ssneJ.My worker',Cnmpcnsa(/�tian In_2wmm�e comer and Policy number^
Tc:
C'mrie,:/ '-!Se'nlicy Nn.w�q�1-Legg 0 0-1- ww
CHR'FI IICAI'ION Or EKEMIll ION PROM WOR KBRS' 'V
COMPENSAFION INSURANCE
(ibis section need nue he completed if the perom,in for one hundred dollars
[S
100)or he".)
I emly that in the performance of the work for which this cental is issued,I
shall ant employ any person In any nemmer see a,to become whjecl lee the Worker'
Cnmpccs,foa Laws dCaffomia,]late
Apel tont
NOI'ICE esubect it)thCAN e
ni ,wo iti Inas provisionales
of Exemption,you,could become subject y Inc Worker's omoto or this pnwiaons of Ice IaWT rCode,..k you mu.0
Q Q forthwith comply wish such pmvi>ions nr this psmtit,Hall be seemed rcvnkeJ. '
n V_i CONSTRUCT ION LENDING AGENCY
7 1 hereby action chat there is a con.tmelina IendnicI agency lin IM1e perfnnnanec
W of the work for which chi,permit i,i atcd(Sec.3097,Civ.C.)
y Q IsnEcr%Name
7 z Lender's Address
U Q I cenify that I have rend this application and stale chat the aMrv"inllntnction Is
correct.1 agree to comply rich all city and county ordinances and state laws relating
C) iU to Wilding nmariction,and hereby authorize mpmsenmtive,oflink city to enter spm
the ahavoneentloned lnoluny,for impeniot pupeows. -
E,ttit (Wc):Igrec o—or.l"d,init,and kccp 11 less the City If Cupuacn uguiuxc /f
fA liabilities,judgment s,....1,and e,len.ws which may in any any acme aguirsl.said
U Z City in consequence of the gaining of this pemeie.
SOURCIAREGIN AIOTSNDSAN WILLCOMPLYWITHALL (W 1'Q17 Issued by: ti Date
r. SignammofAp tcenlCe IIWOIII Offe Re-roofs
IIALARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding eccuprt store In handle h:tcadous material Type of Roof
w defined by the GIIHCIIIIIII Manleip:d Code,Chapter 9.12,and the Hcilth and S:Jety
Code.Scott I255?21A'l
O Yea All roofs shall be inspected prior to any roofing material being installed.
Will atcapphfainorlattice building occupaeeluse equipment(it desnes shish If a roof is installed without first obtaining an inspection, 1 agree to remove
NiI bvudou,an con,mini is I defined by the It A, Air Quality sh nagoneent
'n'tsrin7 / all new materials for inspection. Applicant understands and will comply with
C Ye, .'Y''e all non-point source regulations.
I Igoe read Die hnrodnux nauerial,eequiecments under Chaffer 6.95 of the
Cnliornia l feulch Ne Sufoty0el ,Seetion,25505,25533 I d25534.l indemmndthat
ifthe M1uildingdot%Bol currcndy h:oa•amngun.that it Moy responsibility to nmily the
nepoat nl the re nireetee ,whish..It be neck prior t"issuance OI ll nihcam nl ^
oenpincy. Signature of Applicant/ Date
Owner erYa>„,c acie,, Date All roof coverings to be Class`Bei or better
OFFICE