02050150 CITY
mvisiouNO CONTRACTOR INFORMATION:
PERMIT
BVL.DINGAntyRE55: TANTAU AVE RICHARD FREEMAN PERMIT No. 02050150
rt! 1111/11 tt55 77 J
°T�i�ffP42D FREEMAN 10189 S TANTAU AVE APCIY 2"3sy82062
Am
(OFHONE: SANITARY NO. CONTROL NO.
kO C ARCHITHCT/ENGINEER: BUILDING PERMIT INFO
U,G BLDG ELECT PLUMB MF,CH
i CJ O C'J I_7
5 N= LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby vflinn mar 1 um licensed under prosininns of Chapter 9lconvnrnu^g REROOF
ly_; with Section]000)of Division 3 of the Business and Pmcssions Cale,and my liana
is in full force and effect,
z sc License Clave Lic.X
O n O Date Contract.,
i LL O G ARCHITECT'S DECLARATION
1 understand on,plans shall he used as public accord,
Y
i i a O Limroed Professional
o a OWNER BUILDER DECLARATION
1 hereby notion that I am exempt from the Contmaoi s License Law!m the
6'Z a following reason.(Section 7031.5,Business and Professions Cale:Any city or county $5500
E is, o which requires a permit to construe,uhe,improve,demolish,ser repair any machme
a 3 g prior tot also req toapplicantf such pe 's m file a signed statement
that he I'<cmeJp rsuau tteP s fill C I ears Leena Law lChaprcr99LP Vfj, Valuation
or h e Iij Seeei n]m o The ilio 3 fthe Bilenear andimri A.,vi
or Ihai he rs aempt therefrom and he basis lar the alleged dempuon.Any violation '
of Section]031.5 iv any applicant u permit mhjecn Ihe vpplicam to a civil pemahy
Of not more mlive e hundred Balm,s(5sett.). PN fEluw Occupancy Type
01,as owner of the property,or toy employees with wages astheir thecompensation. 307 - INSULATION
will do the work,and the structure is not intended or offered for sale(Sec.IDU, —
Businesi and Pmfesvions Cale:The Contractor's License Law doer not apply to an
toter
of propeny won builds or improves oreon.and who does such work himself 602 - ROOF PL �
or through his own employees,provided that such improvementsarenot intended year or 6 03 -- ROOF- 13ATTENS
-'offered far sale.If,however,the building or i,nprovcmem is sold within one year of �- -
im+mpletitnt.the owner-builder will have me burden of proving that he and not build or 604 — ROOF IN—PROGRESS
prove for purpose of sale.).
❑h as owner iajec properly,vac Business a contracting with liar)Th Contractor's to
consumer the oes n(Sec.Alla,Business and Professions Code:)The improves
tea,eon, .,
,
- and who
law docs noirapplysuch
to on owner with
a conty who builds seimproves t tooth, -B NAILED A ILE
and who,,Li ns fur.xuch pmjeas with.0 commnor(s)Ilccnscd.pursunm to.the, 9 tl
C mmnor's Liconsc Law.
l am ex pl untlm LS.-. t - .B hPCfor this mason
MIT IDS AT N JUN 1 0 2002
I hereby affirm under penalty of pedury one of the following dcelamuons BUILDING
01 have and ill maintain a Ceni late of Content In self-insure for Worker's
Compenemion, m pmvidcd for by Section 377 of the labor Code. for the
performanec of the wool,for which this permit is issued.
0I have and will maintain Worker's Compensom.I nsurance,as required by Section
. 3700 of the Labor Cole,for he performance of the weak for which this permit is
issued.My Worker's Computsmion Insurance entrier and Policy numb are:
Con ' Policy No.
CERTIFICATION OF WORKERS'.-,
'COMPFJSATION INSURANCE
,1 ...,
1 us union need nut be completed if the permit is for one hundred dollars ' t
($I00)or Icss.)
1 emify that in he perfurittance o Ihe work for ovoich this pcmtit is issued.1
stall not employ y pe y r e es�q become x.b)wt a the Workers '
Com t 1 w of C am
NM�/fH�S1fP CCA Tlfaft gthts Cemfcam o(Exe pl on you should
Oh n bj ct to the W ke Compensation provi.i ons of the Labor Code,you most
fonh nh comply'with such pmvmons or this permit shall be deemedevoked.
zti .. -. .-
^'5i I' CONS(RUCTION LENDING AGENCY '
> Ihereby affirea that flocrev,a constratlionlending agcny in
r the perfuemance "
W..Q of thenwork fee Lich thio pc 'I mat
.it 3097.Civ.C.),, .n+,
Lenders Name . . .. -. . . . . '"-. ..
Leader's Address -
V I I agate that 1 have react this City
anddoo any settee that the above information is
tobuilding
1 agree to comply with hallereby
city and county ordinances oand nate laws elusion U �--
>, W the aboingconstruction.andheminspecorixreposentatives of This city to inter upon
�, W the aM1n(We)rrioncd,gee 1.properly for inspection ad keep
purposes. ,
[r 0. (We) ts.costs
end Awhihmayin the way of accrue
against
W liabilities,judgments.costs and iexpensesOfthis
which may in any way carve against said
V .Zi City in Consequence of the NDSAg D this permit.'
APPLICANT UN ER$TANDSAgD WILL COMPLY WITH ALL NON.P SIN Issuedb r Date r vv
s 1 �G' Ano' . Y
mFe of Appli<anAContmc or "t a_ Re-roofs
..,. .,,
HAZARDOUS MATERIALS DISCLOSURE
' Will the upplicanla furorebuildinge.occuport ptstoreor handle M Health
an Safety ... Type Of ROOF
C de,Sed io the 32h),no Municipal Cale.Chapter 9.12.and the Hcahh and Safety
Code,Seniors 255321a1? p:
t. o.'. . :'.'tit t 1. :4 );• v
OYes N
.w. .. - ...
. _All-roofs shall be inspected prior,to any roofing material being installed.
Will the applicant orfuture building Occupant tor equipment ordevices which If a roof is installedwithout first obtaining an inspection, I agree to remove
mit tantalums air contammams is demand by the Bay Area An Quality Management
oiatrict? ,. all new materials for inspection. Applicant understands and will comply with
❑Y" ' Nn , '` all non-point source regulations.
requirements_ _
1 have
read the ham
ray
an
mals and Ch pt Ii 95'of the
C llf in hh&Safety Code.Section, 5505 itis y responsibility
1 y t Iotif Chas
fine bu ld' ndoc otc src dy is a Lena t that I' my rcsponsiM1llyl notify she
upa t f Ih quircm [which set be met pit m issu a of a C<n'fam of JC• T�
°"mD'°;y' Signature of Applicant Date
armour,,agent ate All roof coverings to be Class "B'+ or better
. . _. .
OFFICE