00060135�I InJI DING Divi ONS PERMIT I CONTRACTOR INFORMATION:
HUII.DING ADDRESS:
ARCHITECT/ENGINEER:
LICENSEDCO,NI RACTOR'S DECLARATION
1 hereby 41rm d nt I an, licemal under...... ems ol'Ch ice, 9 (cnmmencing
whln Sectinn 7(XX))n( Dlvisin i 3 ol'the to-mb.a and Prote'sions Cori , and ny lic'u"
is In all force and effxt.
Liccnwclaee Lic.M
Onte Contractor
ARCHIT'ECT'S DECLARN'ION
1 undec,mmu my pontis shall hr used a, public mcnnls -
Licensed Professional-
OWNER-HUILDFR DECLARATION
I herb uutnm ,ha, I am cncmpt into due C, tractor', Limine Law for the
billowing net (Sell inn 7031,5, lousiness and Prom,onnr Cdde: Any city or county
which requites a permit to corm ct, alar, impmve. demolish, or repair any ,uumure
prior to its issuance, also yuims the applicant for such perninn file a signed statement
her he is scored pursuant ,, lie provisions of the Commnors License I.. (Chewer 9
(commencing with Sectinn 7000) 0 Divlsinn 3 or Bieinsc, and P les- Code)
or that he is exempt themlrnce and the basis for the alleged exemption. Any violation
of Section 7031.5 by any applieom for a permit subjects the applicant' it civil penalty
of not more than live hundred dollars (55001.
❑ 1, as ownm,f the Ponti, ..
.. or my cn,ployms w,,it wage, m,hair sole emnlnn,ntion.
will do the work. and the structure is not intended or offered for sale (Sec. 704W.
Business and 1'mfessinns Codc: The Comercmr's License law does not apply to an
owner of property Who build, m impmvm thereon, and who does such work himself
through his own unphrycec provided ,hat such imprn cats n not intended (it
o1mmd for Will. IL however. the budding or hnprnvermot is sale wllhin one yrs, of
completion. the ovmenailder will have the burden of proving lien he did nm build or
improve for purry,u of c le.l
❑ I, ns awns, nl' Ib" pup,crly are exclusively ct am in, wilt licensed contract 10
consumer the project (Sec. 7(94, Bmore,, and Professions Code:) The Civenalm,,
License Law dons not apply to an owner of property who hilus or improves thereon.
and who contracts for such projects with a con,ramup) licensed pumoant n, the
Contractor's License Law.
❑ 1 an, exempt under Sec. . It & P C lin ,his reason
owner ])ate
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pen toy oI penury one of,ne following dcclumdam:
'O 1 have unit will maintain a CeniGcaa sof Conxm m, self -insure for worker's
Cmnpemnlon, us prvided Gm by Section 1701 of the Labor Code, for the
i ... uuncu or ,hc wink in which this print, is issued.
❑ 1 have unit will maintain Worker', Compensation Insurance, as required by Section
37W of the Labor Coda for the performance of the Work for which this permit is
Issued.MyN'o/rks��Cnn/npe�mutiorg l-ncuWy, carrier and Yy,I be
Cartier. �Ir Mer4 rr. _."cy.n. ;9 OY (J
— LtSKl it p_AIIOR OF FXG>BTION FROM WORKERS
COMPENSATION INSURANCE
fl'hls section need not beloniveled il',he permit Is fnr one hundred dollars
(SI00) or less.)
I certify that in the performance of the work for which this permit is issued. 1
shall not nnfloy any Pe's�n 1 any manncr,u�rtJ1"aaWi 1�'1� the Workers'
L'ompansa uwys .ol\C'ulol\CulilI O:te, bac
Applicant � I
NOTicant YP ICA .IL/licr making this Cemfica¢of Exempunn you should
become n..bjecuo the rkard Compensation provisions of the Labor Cola you must
larhwith comply with such provisions or Iii, permit shall he dcuncd revoked,
CONSTRUC`nON LENDING AGENCY
I hereby affirm that there is a constitution lending agency lot the performance
of the wad lin which this permit is issued (Sec. 3097. Civ. C.)
Lender's Nunn
Lender's Address
I slimly Iia 1 ave read this upplintinn and sea that the save information is
corm, I name m comply with u11 city unit county oNlnunec, and sena laws reining
to building conswctidm, and hereby uu0orive mpasen,atives of this city er enter upon
the dame-noentioncd pn,peny for no a mon purpneee.
(We) agree m,avc. indemnify and keep harmless she City of Catania. against
liabilities, judgments costs and expanses %inch may in any way arsine against said
City in cunscynaac i let fiction, of thin is,nmi t.
APPLICANT UNDERSTANDS AND WJLL COMPLY WITH ALI. NON -POINT
SO EREGULATIONS.
Sic
nuunvor App l VContruc - Dale
HAZAR US MA'1'17RIAI S DISCLOSURE
Will Ne applicant or from budding «..pant sure nr handle ha'rurdom mammal
as debn"d by the Cupeninu Municipal Cale. Chapter 9.12, and the (Health and Sal cry
Cole. Section 25532(x)"
C1 Yes Vo
Will she applicant or lcourt building occupant use c4uipmcnt or lemic", whir,
n t hamNnur, air contaminants as defined by the Bay Arta Air Quality Management
n Y",
1 have mad the halandous material, icyuimmems under Chapter 6.95 of the
California th alth & surety Code. Sections 25505, 25533 and 25534. 1 umkrmmnd that
it the be ki n, docs en currently hast, a tenon• tin it is my responsihil ity to notify ,he
wceD t of one requi mmers wbicn oma ("on, Io son nee of a ernircme of
! �� a
?
Owned or anh.dad ent "%6 -,T4
VERMrr No.
1711Tnen 7 .+S
APPLICATION SUI: DATE
ITi�0 a
SANI'rARI'NU, COSTCONI'RONOL NO.
BUILDING PERMIT INTO
IILDG ELECT PLUMB MECH
Job Description
RE—ROOF
t
10.E
Sq. Ft. Floor Area
Issued by:
Re -roofs
Type of Roof
Number
Inspections
305 — FRAME
307 - INSULATION
601 -
ROOF
TEAR OFF
602'-
ROOF
PLYWOOD NAIL
603 -
ROOF
BATTENS
604 -
ROOF
IN -PROGRESS
Dille
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
Signature of Applicant Date
All roof coverings to be Class "B" or better