00100075CITY OF COPEIO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUH.DINGADDR2�Ft104 TLILITA
ECKSTROm ROOFING CPr:RMr'so'
00100075
GwNER•s NnME:PAULSEN
363 HARRISON AVE
^''rucnnoN sup u0n�'10/2000
AGI
'HONIS:
SANI'T'ARY NO, CON'INOL NO.
(408)378-1626
ARCHITECT/ NGINEER:
BUILDING PERMIT INTO
O
aLIX' ELECT PLUMB Mr;CH
G
I 1-1 fu 1_I
j LICP.N, tAPION
Job Descl' t1U11
I aCUcensedCIOR'ads, p Skion
mutInmoffe
It
70efatm Bunderpnw;dan,of.. Codeandnnmealang
a. with ofect. an?nl the Bu,ineo axil Prolesions Code. onri myliccnse
TAR $ GRAVEL TO R&R
full foreland
is in full 4rttt and Rat.
a License Class
Contractor �' Date.S DECLAr
In ANC .C,r,,DIiCLdRATION
<j I nnderrumd myH,wa„Iota be mm ur pnnl;a Iaamds
fill
-
Jp Licensed Professional
P., OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Lew for the
following ooson, sector 7031.5. Business and Professions Code: Any city or county
❑ which I famatr conmonct. after.p dicarolkh, or repairy ,arrrcalrc
)car, to it, -o e al thsappliwandl parrat IIIIIe ,red,manallat
that he is licensed momart I,are I a is at dhe Contractors IJ,cr, I (Chapter 9
• Sq, Ft. Floor Area
still1`g71(}�pL�
Iaommeeng wall sedan 7000) of Uivsioa 3..l the Bur,imr, ad 11 I a, Gel)
pl�
AJJ7C,
or that he S exempt,herefront and the Iasis for the alleged exemption. Any violation
of Section 70315 by any applicator for a permit subject, the applicant to a coil penalty
APNI,$yrCSb 0070.00
Occupancy Type
of net more than five hundred dollars (S5W).
h tl
❑Ism..sear of the"T'lly, or illy cntployvxwin, wag•• a, mair.ole aonipcn,nlioiI,
red Inspections
Re p
will do the work, and the stricture is not ;memluJ on nHercd lar state (Sec. 7144,
dons
Businee and 1'mfe,smn, Code: The ComLicense Law LiLaw nal apply In un
does work himself
305 — FRH(tl
owner of progeny Who builds or improves thereon, and who Such
or hrough Instill employee,. provided Ball ...It improvement,. a.., intended nr
'
offered for .ole. If. hawevar. the building or in,pnweinent is mold within one year o1
307 — INSULATION 3
icompletion, the owner -milder will have the hurdcn of proving that he did not hu;IJor
601 — ROOF TEAR OFF
mprove lar pn"'a of rule.).
602 — ROOF PI_YI400D NAIL
,Ivaly.animating wicrn,ametorr amra
proprn..t excwth Hm
01.ar awna,ord,.n
7iria.
Liname, he pmjce, (Sea. Bmmns and rmle,mon, C,amu •me Conmacn'r `
603 — ROOF BATTENS
cense Low doer not apply u, an owner of properly who bunco or ;ill Bacteria.
and who canlmels for Such pmjeel.s with o formal Hcenwd pursuant to be
604 — ROOF IN—PROGRESS
Contractor, License Low,
❑ I am exempt Title, rice. . B m I' C her bis reason
Owner
WORKER COMPENSATION DECLARATION
I hereby affirm under Penalty of perlury one of me following declaration,:
❑ 1 have and will maintain u Certificate of Consent m wlhimnm for Worker's
Colnparvation, u,' provided I'or by Section 371X1 ..( the Labor Curie, for the
perfonnama of tire work fat which ods perinit IS isaocd.
(a.�
V
111 have and will maintain Worker's Compcomar. Insurance. o, ret lired by Seca inn
or Cale, for the permrance of ,he work for which this permit is
3 7W or the labm
,rued My Worlter'c Comlenwtbn Insurance carrier and Policy numher am:
Currier: Policy No,
CI?R'I'IPICAIION Up EXEMPTION ROM WORKERS'
COMPENSAI]ON INSURANCE
rrais section need not he completed if the pami, is for one hundred dollars
1111000 or les,,)
I really that in .he pert'orranee of the work for which this permit is Lscued. I
,hall nut a Troy any pars.... in any Toms,,, u, to hexons, ,at,r, to the Wndod'
Com,.omiun 1aw:r..1 C:dila nla Data
A,d,ma
NOFICli TG APPLICAN 1. If. after making his Cafficate of 12mail n, you should
7 Mcome subjecnothe Workers Compensation provision, of the Labor Code. you mu„
fnnhwith coat ly with such provision, or this pcnnn shill W Jcaned revoked
4 CONSI'KI1G'11ON LI?N DING AGENCY
1 hemby affirm that Ibn.e Ix a ...mane.;.... Icndlng ugomy lin the Performance
fire walk for which This Penni, it issued (Sec. 71Po7. Civ, C.1
Lender's Noun
Tlender', Address
I caddy that 1 have read this application and state that the above farcical it
aa. I'''ll to comply wlth n 11 city and county ordnance, u01 stat, lows rclatlng
J Itnl
t,hadding conmarefioa. E hemby umhad,, v, senwtlrc, of his city m, ether a pace
S.7 the ubwonncnlioned prol,ery for im,pcaiont par ow%.
y (We)agree to case. indemnify and keep harmless he City of Cupeninoage;mt
and cspen, which may in any way.,me against Said
V) liabilities, judgment,, corn se
_ s
City in amw,more of the pruning of this panni..
APPLICANT UNDERSTANDS AND WILL COM PLY WITH ALL NON -POINT
Issued by: Date /
_
SOURCE REGULATIONS.
Re -roofs
Signamm of nppheanfCammemr Da.e
HAZARDOUS MATERIA(S DISCLOSURE lateral
Will the opplicam m future building occupant mom or hall financial material
Type of R f
a, deired by he CaKchan badm,i ail CMe. Chapter 9.11 and the Harlh and Safety
Calc. Section2553201'1 O N -
❑ Yes
'
All roofs shall be inspected prior to any roofing material being installed.
Will the apppem,lar farm halting aecaln,nt a,e equa,Immr at davieus which
If a roof is installed without first obtaining an inspection, 1 agree to remove
nit millions air contaminator as defined by the Bay Area Air Vuality Mm,agentem
all new materials for inspection. Applicant understands and will comply with
,frier.
eye, 0N.
all non -point source regulations.
Ill doh 1 I 't cl t ndrCh'p. 695 n the
CWl ' H hl kl tye 1 .. T 55115 it 15514 I nddut
it the II I'yd t tlyl a tITS,l'. y T bl'tyt tly the
occupant of the re'a'm nc ns which mut he our ptiar m is.. ,ice f o C ri Ccme ..t
occupmrs,
Signature of Applicant Date
All roof coverings to be Class "13•• or better
owner oramn..,aeaagent Date