02060047 OF
CITY
I B I DI G DIIVISiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10128 RIDGEWAY DR FOUR SEASONS ROOFING 02060047
` OWNER'S NAME: APPLICATION SUB DATE
CANNON WENDY 645 HORNING ST 06/10/2002
PHONE: SANITARY NO. CONTROL NO.
{ (408) 278-0330
q 0 o ARCHITEC IFNGINEER: BUILDING PERMIT INFO
kC w_ BLDG ELECT PLUMB MECH
C —1 u
dad
Z y z LICENSED CONTRACTOR'S DECLARATION Job Description
0Z_G 1 hereby mm,that 1 am licensed under provisions of Chapter 9(commencing
F_tw with Secm 7 fomi,i 3ormxR.,me.oa:dP ,Coia.andm license REROOF
Q Y E J ii in full�farrJ�T/middi r�q /A� O
z < License sFas. J ( Lic N ✓ ess / y
%0 a,u Date tactor 1 QU
F a,.t4 ARCHITE S DECLARATI N
g understand my plans mall be used as public records
odLicensed Professional
e a
z es 0 OWNER-BUILDER DECLARATION
m so 1 hemb,sM .that I or
exempt from the Contractor's License Law for the
t?< following resort.(Section 703 LS Business and Professions Code:Any city or county- $8000
.�C which aspiresPermit t tm Iter improve de nrEm repair ny stiuuure
a 3°O Pnr t a ss ante.rets req m pplieam fonuch pemuno filaasignited sutmem -- - -
—
thattliq itilvermiodparathat totle.pre ionsof line Contractors LicenseLa (chapser9Ft. oprpC�d ,- Valuation
mat {
(eo tang d,Srsto7 ) f1X0o iron Sof me llmincu d Prufessiom Code)
t, 13'1'i X34'L¢1.OF�4`:;O<!f tit �_�a��.11.t; ;
or Fels 31.5 b thnrerrom anJ the bans for the alleged exemptions ci violation
-of vany applicantforapermit subjttnthe applicant macivil Penalty
rr nrt mire mon Eve nrtarea emiar,astwl. 3 0 5}1PN ,IJh]I$� Occupancy Type
the
or ;and he mr my is
or es wim wage fared for
alk
(S e 7 inn, P t(.FL�l
wusine'she work:end that manure is Contractor's
License
Law docs no (Sec. to an -
owner
'Business and property
Who
Calc:The Cnntanoro License Law does not apply m an 601 - ROOF TEF 94 'Inspections""" -'
owner of h his ow Who biles or improves at such improvementsand who does such work intended
or
lf
o mmngh his Own employees. Wildea mss such ementissolire not inrendep or -.. _._ 602_.— . ROOF.-..PLYWOOD -NAIL
-
offered for sale If,howevere the bo ave t"or improvement of
ng that
he did one Year ofcompletion,me owner-winter will have me burden rf proving mat lie sire not brim or 603 — ROOF BATTENS
improve far parpouofale.). 604 - ROOF_ IN—PROGRESS.
_ _ -- —cID onsumer
es er lief onhe p(See 7(am e.cwsmey contracting with licensedcontractorsContractor',m "
ocenset the project(Sec. to
owner o andpro erty whon.CWo:)Thc improves
taaoh
License Law doe not apply to an owner th papally who builds nor eimprove thereat.
and who's Ideen.fLowvh.pmjects with.0 crntiamar(s) li<enseJ.pursusnt.m the
C maaols License Law.
❑l am exempt under Sec t t :B&P C for this resort
_ Ownei 'Dme '-
-' WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of me following decimations:
1• ❑ 1 have mad willmaintaina Certificate of Consent to selfure for Worker', LED
t Compensation, as provided for by Section O7W of the Labor Code, for the
.1 performance of Jin work for which this permit is issued. .
❑I have dad will maintain Worker's Compensation Inami as mqg imd by Section J JUL"L 0 f/1,^ 2002
3700 of the Labor Caller,for
ytlhe performance of te hwork for which this Permit is
Csed.
Mattu.1✓�'I'r lP'VtPolicYwC2 T•m7�0/ 6�
"!:,CERTIFICATION OF EXF,MHnON FROM WORKERS.'. a., J'y ? Cf f.Li
COMPENSA'1'IONINSURANCLi- " ' -._ .___-_............
.—_.�_____ _ ___. ..................,,_
ui•
(This%cation need nil be completed if the Permit is for one hundred dollars 'i - t .� 'J,i'• " "
T'"I iendy that n the Performa uc•of lbc work fUr which this fiction
icrm t ,tssucd,l
"shall not employ any person in any manner m as to become oubject m the Workeri
Compensmmn Lows of Calimia Dam'
Applicant. _ -_ - -_ - -.._.. _ ... ._. .. ... . ...--- _.. .. .... ._
NOT TO APPLICANT making nuking this Ccnilcatc or Exemption.you shoulJ "
z O - ubjeamme W'orkees Co.tunitirnpmcider,of the Le Er C6le.you must
c fanh onarply with inch provisions ri this permit shall be deemed revoked. _
b� Ms
._. _ -
NSTRUCTION LENDING AGENCY " 1 ,
E" y t -' g agency for me performance
I hereby which that there as construction Sec.
]ending '
Leader's
work me which this perms is tsuiN(Sec.J09],Civ.C.)- _ _ -
y.0 Led Name
' G DF., 1 jn fy that I h mixpl w and
t to he boinfomei is
;T+- coned 1 agree to comply tut and county ordinances and state laws raising
0U11, u lJ 8costncttn rheebymm nil auvs rfthsntymenterupon
i d t nen ppenyfnspct o urooms,
owl (W) g on,x,ul indemnify
expenses
keeph lee the Cly IC pe ogmrgafnn
V1 liabilities.judgments.costs and i pof which may in tiny y ogain.t zaiJ
U Z City c nq pcc of th g amir, pc t 0-10 --
o'APPLICANT GDERSfA1D5ANDWILLCO}1PLYW'ITHALL.' POINT Issued by: Date
SO CE UI A S y'
G-/a
Stgn
Appl cant)c nta m - Date Re-roofs
_
HAZARDOUS MATERIALS
_ ' Mt.DISCLOSURE
Wl �Plihmbdingcopaiommor ;handle
V aI amnal Type.of ,
a def er by theCaperon.Mu 'Pal Coot.Chapter 9 12.and h Health adSafety 1, s, �_
Civil, Set 23g33(m) YY 1.
- - - •
t. t, ht
} ;L.
❑Y a it I _ All roofs shall be inspected prior_to any roofing material being installed.,-
1 w ll me applicant t Wilding occupant use eq pt t dace which, If a roof is installed'without first obtaining an inspection,'I'agree to remove
n h t J cot t d lin J by the Bay Art.A Quality Mrnagemem
District? r all new materias for inspection. Applicant understands and will comply_with
all non-poi rce regulations.
1 h read he nazallot s materials q u undo Chaps 6 st of the ,r
Cali(orri Health&Safcy C e Sectio s 25505 35513 and 25531, understand that
if the building Jrcx not n sly nsv<a tenantthat it is my responsibility to notify the'
accupant of do,mquiri s which mt W met prior in souraince of a Certificate of
°"°°'b`y" Signature of Applicant - Date _
7.
errr.am^ria agent ,. - All roof coverings to be Class"B"or better
._ .� ... .. ... . . . . OFFICE ' ., . .. . . .