02090009 CITY ILDING DIpERON PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22998 STANDING OAK CT APACHE ROOFING 02090009
APPLICATION UB DATE
5696 bOUG ET AL 5829 EL DORI DR 0904 2002
PHONE: (408) 363-0205 SANITARY NO. CONTROL NO.
p m Z ARCHITEC(ENGINEER: BUILDING PERMIT INFO
WOO BLDG ELECT PLUMB MECH
1 u u u
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v_ LICENSED CONTRACTOR'S DECLARATION
I hcteby elBnn thmlam licensed undo provisions of Chap¢r9(commencing REROOF Job Description
F`3tw with SCCdon]0001 of Divisiun3of the Business and Professions Codc.and my license
a�6is in full tome en t A p a1ll n t�
Liccnu
7 Lc
inum
3 a Dme 5 DECeIARATION
u g I understand my plans shall be used as public records SEP L P 0 4 2002
�6E
i❑O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby a(fimt that 1 am1. exempt from the CoCock:
License Law
y. fa me BUILDING $6500
f Z r following reason.(Semon 7031.5.Business andimprove.
deProfessions h.or Any city or county
E�p which req pe t t construct.^Iter.' tp demolish.or repair tiny swmvrc
u� pno t t Is 9 m pPlc tf bra uo Blcavgrcdatamtmm- _....-_.._.._... _....
d3- mat rte al "6sedp tya Imtnt pron ^^ rthec ucetors Lmcnu Tnw(Chapter9 34b Stp�jlporea�1,5 + r Valuation
cont cna wIbSmlon]WO of Diels n3mfm Bus neasad Profess nns Code? t ,. a
or that rte is
csempnhcrcfrom addle has
is for the allijN ucmpheri Any violation ��s.�1 .l s,'.;-0.[. . i).[;
of Station 9W 1.5 by any applicant for a permit subjects the applicant m n civil penalty
Int ant mare man live nanercd emiars(ss(loz
3 0 5 ARN Pkpift 'rl::. 'I;' Occupancy Type
0 L as owner ofthe Property,of my employees with wages so their sole compensation. 307 - INSULATION
-will do me work,and'the'mmcrum rr not,mended a,offered for.La(Sea']BaL" 601 - ROOF TEAS (y�j Inspections N •1'�'•1`-
f Busmess and Professions CMe no Contractor s Ltccuec Law does not apply to an q p
..at of property Who Wild,.,improvesdiereon,and who does such work himself 602 - ROOF PLYWOOD NAIL
or through his own employees.provided that such improvements are not intended or -
Rcord fur sale.-If huwevei,me biddingens it sold within one car of -'--' - --- ------ ---------- ----- --
completion,me owner-WOEerwill have eburdnofpmvingthat hedid not Wild or 603 - ROOF-BATTENS s•'.u ;,:'.I, ,�Irn,r .',
improve to,p.",c ofsale.l. 604 - ROOF IN-PROGRESS
Ell.u owner of the property,al.Business a contracting with licensed Thi,Cmurach's I"1-. i.;
_ ;answer me tieproject(Sec.]000,Business and Professions Cls or The Cos there i. r;�,,. t-. p ,�,I;r s.i.11
License Law docs not apply mon owner of pmpcny woo builds or improves thereon,
and who.contruu.for.such projects with a.cunuadur(s)Iiar,seJ Pursuant.m.the. ._..___.. . .___...._.___...._._..__.._--__._.__-___.__-__._.-.___....._.-__.—__..__.._._.___............._-
Commemrs License Law..
C
❑lamexcmptunder Sec. r �'''\' " ! `� Br&PCfor this rwson I^•% ' `
_ _
Ilium .,.., ..
WORKER'S COMPENSATION DECLARATION
_ I herchy aRrm und<r perulty of perjury one of the.following declarations:
=iO 1 heve'Aod will'maintairi o'CeniO<am`of Consenttosilt-insure for Worker's
I c_. Compensation;as provided for by Section 37M of the Lahr Cade, for the
pert ti ce of the work f which mis Fn 't
rod .
1- d will mai t Wok 's Coml,cr t n I . nee req and by Section
J� ]IXI f the-IaMr Code,for thepe fomu tt of the ork'for-which this permi�.is
ssu d MY W -k r C pe 1 Insur c c pad Pnl y tc m.., _- -�r•r, .,
.. ! ..�t 'a .....-_ _
Camir \ 'Pot yN .LOO
•" ,,r ICERTIFICATIONOFE%EMPTIONFROM.WQRKERS',
t ., COMPENSATION INSURANCE'' _- --______ _-_-.___.__ -�._.._ _ .. ._ -____ __-_.__
��"' � (This section need-tit Wct'nplcied jibe perms is for one hundred dollars "si � I ''.R ' 1 . ,\.( CJI :S' I)j'�
r1•' 1 en'fY thm n rM1 parturitionabfine' d,f hi orb pe' t s I...
W I
•stiall not a nploy any peron n any manner so as in become Subject to the Wo kers
Compo t Le iefC f a,Dme; .,
_Applicant - :. .--._ . ....._._ _ .._......._ _. _. .____. .._ .-_.. ..._. . _ _
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
' �'
z bane subject to the M ker's CompensationiProvisions or th-Labor Cale you"must,
wa tiah th d ply - permit shall be dee lied imitated. _
p m
v� o, ' P t t CONSTRUCTION LENDING AGENCY
a.; of 1 hemby aBl tht,w t t lending agency f theFee nn ¢e
Q.Q m k f which m pc . tied(S J09] Cr,C 1 _.. _.
Lender Name"
C ..�• ' „ .,..' - _.._... .. ._ -_. ._ __.______ ._ ._ ..
.Tz Tender s Address 'vl` Is✓a0
U O
1 amity tha 1 have read this application and sma thatthe above information is
- coriecr.1 agree It comptywim all city and county ordinances and state laws relating
�,(, mWilding comwaion.and hortby omhonie ieprcammivesor'mucity mernerupon
the above-mentione-d property for inspersion purposes.
A.. (We)agree tunas;,indemnify and keep harmless he city of Ct]erumo'ugainst
F'(n liabilities,judgments,costs and atlases,which may in any way attme agdnst said i-s
City incouseerporicicId the jort,ir,alms parnut.'
APPLICANT.UNDERSTAND AND COMPLY s�ITH ALL 6QQQN' I T Issued b Date
SOURCE REGULATIONS $ �/0 z y
Signhwrc�ol Appl,canUCuntruaor, : .may Date "'t Re-IOOf$
HAZARDOUS MATERIALS DISCLOSURE
Wljl'jju�a,licant hir future Wilding tsocu,xiiii tare orhandle incautious ouramil Type of Roof.. ,. t
aed fn JbY th Cupen M ;pal Cudp CA Pt 912, dth He lm ands ftY r.s, 5 � ,r V-, ��s- H -'- � - ♦ - -
Code Sect 4$ 3211 I i s
ori, r:� tie All-roofs shall be inspected prior-to any.roofing.material.being installed._.
.t to llm apphcant orf ulure Wild gmeapa t . co, t rile icer nm. If a roof is installed without first obtammg an-inspection;I agrec�to.remove
cr t hazed s air contaminants u defined by the Bay Arent A Quality M nagem nt
D mitt �� all new,materials,for inspection.,,Applicant understands.and will-comply,with.
aye all non-point source regulations.
"S,I have rendahe haxardnus mmenal5 o quirements under CT,aper.6.95 of the
c.lifnmia Health&Safety Code.Sccdon,25505,25533 and 25530.I understand mat' -
'i(mb Wildingdoes notcunemly livea¢nant,_thm it is my oci,mibilityus nmify the
motion,oI re ¢which tan W met m issuance of a Cenificme of,
9u P
•• Puri r I - Signature of Applica Date
.. _ _Q 5102. . .. - — _'- - --..
Owner liraadwr¢ ag pt, 1. All roof coverings to be Class "B" or better
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_.. _ .. .--OFFICE