02070208 OF
CITY
BUILDING my SIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20745 STEVENS CREEK BLVD DAVEY ROOFING INC 02070208
�WNER'S NAME: APPLICATION SUB DATE
ARGET CORP 22390 THUNDERBIRD PL 07/30/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9300
C Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z H Z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z= I hereby.Rrsn shat 1 am I;ceres l under provisions of chapters(eommencing REROOF-�T
with Smion]000)of Division J of the Bmin....nd Professions Code.and m license �/77
<�t9 is in fulllome de 7 T/O SING E FP $
rc rc�< Licenu I s �f tie.. LY MEM RANE E
UD,`
ENFLET
s D u Dote +— DODECLA SIN LE— LY' ME
Licensed
I /I
3 a•Fn ARCHITECT'S DECLARATION (/
O S 1 understsio my plans shell be used u public rtcoNs I,{"""w'� {I
} IL{{JJII flLtyJllp Licensed Profenionel DWNER-
q, BUILDER DECLARATIONvt 1 hereby a0irm Net 1 am exempt from she Convector's License Law for the
following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit ro conCma..Imr,improve,demolish,or repair any structure
$ pdmroiausuwce.aRo requires the applicant for such permit to file a signed saament - -- -------- -
wtn,i.neF ep anentmmp"we' afthecnnta er.L me .w(ewper9 SQ..Ft..FloorArea, Uglua[ion
(commemiog,wiN S&tion 7000)of Division l of she Bus',,...and Pro@cions Code) ii;11• : l:a y_',.r i)tt;v r'�_ I t?'" $10 3 919
or that he is nadpfNemfrom'end Ne basis for the ellaged egemplipo.Any violasian
-of Section]O31.S"..,a11drmfmalxnnit wbjects Ne applicemroarivil petWry- 326�L1J'J e{ V
pfwtmorc Nsn,"amdrm aouars(15001. Ft a''r' Occupancy Type
O 1,as owner of the property,ru my employees with wages ss ed for le 1.(Src compensation.
'the Profession,
Code:
his not intended d e offered for sole(pply 1. n
win d° Required Inspections;,'
'owner of and Professions Code:The Comrmro/s License Law does not apply m w 305 - FRAME 9
owner of progeny Who builds or improves thrown,and who dm such work himself 307 - INSULATION
or through his own employees.provided that s pr improvements are not;mended r
"bdete0for shlef lf'h' - thebuilding rovemeniu 1.1dwithin one em"o('."_.._._ .-..._ .,.. ------
completion,the owner builder will have he burden of proving that he did not build or 601 - ROOF TEAR OFF `^`I . '(
improve for purpose of sale.). 602 - ROOF PLYWOOD NAIL
_..._. .-. _..._._.. ---- - _.. .. - "" --- ------- --
.,in,
t7a.mowncr of aha propertY•nm exduxivelYcomwith licensed contractors to 603 - ROOF BATTENS '�•:r.'' °'+''"' I'f%
construct the project(Sec.7 itt,Business and Professions Code:)The Contractor's , .Ef' -111
License law ones misapply won owner°f ptopeny who wBm m improve.meteon. 604 - ROOF I N-PROGRE S S
Y L:. end whu.contai Pocsuchpmjats.wiN a coousaor(s).Eccased Pursuant to 0¢. -- --------
Constance,exci License L.w.�, _
OlameacmMtt
ptueiS . B'&PCfm this
Owner
W. .'Dnte-
"W�OMPENSATION DECLARATION
' ' I hercb affirm under It f jury one of the following declarations:--
1 hnve'md wlll'inmm am'a Ceniflem,Of Consent to self-insure for Worker's
Compenpationr as provided for by Section 37W oftheLabor Code, for the
_ performance of the work far wAich this permit is issued.:
h ive uadw;ll mmmmn Worker's Compensation insurance,as req iced by Section
9'/00 of thelahor Code for the pedormenm of the work for which h Nu pernut is
issued'MY WW.'rkJJ�g CC iripe, tion 1)�s r ce carrier and Policy number me:
Gerrie moi" +, .�1�lrPoleyN '/3700
A 1!1CERTIFICATION OF P-XEMPI'ION FROM WORKERS -
"' "` CO MPENSATIONINSURANCE-t'" y'""
rr. .. -----------
,,. ..„.
TL"
Oc
(TAis'ssciioa need not be Yompleied if the permit is for one hundred dollar '
fSIW)or lees)
1 nit Nat th rforman
r K. a c fth work for wh¢h Nspenntielauea;l _,� rv,,a•1115} bl -- -
sholl not employ any per on.inn any manner so a:m become subject to the Workers
Compensation Law. f California:Data " ' .. .
-APPlcant. r-.v _.. ._
NOTICE TO APPLICANT.)¢darmabng Nl nyum dof fEa ,Carl , should -
become sabycuo the such pr msortCompensation provamna of the labor Cede,you most
Q 0 fonhw th comply with such provisions or Nn permit shall be domed rtvokM
CONSTRUCTION LENDING AGENCY cl .
lye•' i he by whi-6 Nei Nem C s sued(gconstruction lending agency(er the performance'
u
of she work far which N pcnn i n issued(5 c 3097.Civ C)
.5 Z Lender s Address
U. , :I candy Nat 1 have read this application and sate that the above information is
C. ct:l I. Inca ply it all city and c anl finances and,stamiaw,relating
tubuilding coni ishan;and he'moy maluriidrcprcientudyesofthiscit,wemerupnn
Ds'� the above-mem ibned property for;nspecdo.purposes.,, `
(We)e®rte Co'save,indemnify Ikeephmmleas Ne Cityof Csipeamilaiims
`.� lint,hit,,,jail c tx costs.nil expenses which may in any way accrue against said
U 7�.. City ncan se mac 4 anting of Nis pe h
TAa.,
rAPPLIILILuicpotT Issued b :tOUR
Date
Srgamreic.1' mDate.; Re-roofs
HAZARDOUS ATERIALS DISCLOSURE
t
Will the eppl t or fitime building onds, pansvortor handle haiachHineltaan mnwel ..Type Of Roof — ..-_+^ .-- -Y_-.,,•-••^..•- •-m--.•,.ter
C IsfinculSxc mmJ C penma M n—k/P•I Cod Ch Ps 9 12 and the Hu1N end Safety
-
Cotle OOY n235721a) t1.
All roofs shall be inspected,prtor to any roofing,material being installed,.. _ ...
,1 will he aPPlscanta future builangOccupantusesq mmeata,de is which If a roof is iris[alled without first obtaining an'inspectioit;I'agiee'tolreinove
_ RayAreAir Quality Management
i tics? do rev namtn.nis as defne I hyN
Drsmm .:; ,,,; all new materials for inspection Applicant understands and will comply with _ -
TOYes it t .....
all-❑ob-pomfsoui`ce regulatLons,,.,,:a
I ha e,read iheh md'us,i aatenxls requincovat Mcr Chapter 6.45 of the
Californian
Health'&'Safety Code.Sections 25505,25533 and 25534.I undersand that _
if Ne building does notcurrtnny haYeaavnl Nauus my mponsibiiity to notify arc - - - - - -) __,
mFuPa.,of the mems which et be met pair to Its soca o(a rti0c a of - _ _�
t
P:
Qcupancy. r 7/ny0� SignatureoIApplicant -_ _- - - Date _
owneronmhon agent me All roof coverings to be Class"B"or better .
OFFICE Wx