00060148 ct Bu r,oOF,CUPr
xml.ul;lulvtsIoN,st°n PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: I'CRMI INO,
10541 WUNDERLICH DRIVE GROMO ROOFING COMPAlly 00060148
VNER'S NAME: APPLICATION SUIT ONE li
SO 121 W WASHINGTON AVE06/^21/2000
PHONE: SANITARY NCONTROL NO.
(408)746-2075 o.
0957 ARcUirECTrIENGINEER: BUILDING PI'.Rh11T INFO
µO❑O - BLDG ELIiCr PLUMB IAECII
�uE I_1
6i
LICENSED CON'18d unOrprio CLARATION fob Detilrlpt1O11
Q1 hemhy mnmt ihm I am oIll,licensed under pr,viuons of I,C Iv9lenmmlo cin,
F_Cw is in fedmn]Iand effect. un9nl'Ihc lfurinuss unA Prrlcwinm Calc.unA my llccn,¢
=y ixlmm�romeaoden n. ft NO CONDITIONS df
O V License Clau Lie.N
Date tS ARCHITECT'S
DELLA 3 u v ARCHITECT'S DECLARATION
; I undcnhmA my plum shall he nrcd as public mentis ,
•[ Deemed Prnlcssimml y
Oa6OOC
OWNER-BUILDER DIi he ARATION
Coomwou,
='v 1 no—or
afire on 11. exempt fmtn the Cnnimi,Cu Linnet latw for rhe
C fallowing reason.rennotat ]1111.5,Busioc'x up we,d aions CnJe:Any city orcnumy
whch yu e, tt t t p J f.l r Fa y:n cess
LSm pnon t issuance, 1requiresthapplicantfor such pe ttfl -gel statement
(cont with
it ih III t 1' t ,, 1' oChaocr n,Code) Sq. Ft. Floor Area alUHt1O11
mnmmeeeing I%exe nsonefromNuolDwdis onnblle,edexmptio unit r tn.a«te) 8000
or mm he n exempt merehom.mm me bt.i'for me anesrd exemption,Any violation
of Section 90315 by ray agq,l reito Tor a P=raia suFleuis the applicant m n civil punulty
of nor ore than five hundred dollars($500). A PN Number —Occupancy Type
)m
El 1,asowncrol'theprnF:rly.orn,y cntpinyov,wish w:Igesm their role e"n',ror n. 37533020. 00
will do the work,and the.tectum is not intended or offered for sale LSce.I0,W. Required Inspections
Bus and Profex s Code *I Commcmr.License Law dues mn apply to n Q
orvthinr of rowrty Who Wilds or hnproves mercan.and woo does such work outset 305 — FRAME
rnagn his own employes.provided that such impmralnems am not intended or
littered for ori, 11L howevcl,the buddialg o.impo,vemem is.old wiihill one year of 307 — INSULATION
completion,the owonFlor alder will have We huNen of proving that he did not build or
imp°oc for purpose ur.ale'I. .601 — ROOF TEAR OFF
❑1,it%owner ofthe property.ame.elkirvOycontracting with licensed contaIl 602 — ROOF PLYWOOD NAIL
Limxu'uct the prnjeet(Sec.70,14.Ittlxinus and Prolcxslors Cnde:l The Contractor's
cense Law does not apply to art owner of property who builds m impovcs fl ercon. 603 — ROOF BATTENS
and is ho contracts for such put with a contractions)licensed pursuant h,the
Cmume,orxLicen.eLt . 604 — ROOF IN—PROGRESS
171 on exempt time,Sec. .B&1'C li,r this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hemhy union order pi,ralty ol'I<rjury one of the follmwing dcklamtianx.
❑ I have 11111 wall ^ d Celtilicme al'Cemsmu to wlf-insure for Worker's
miided
Cnmrouracno, he provided for by Section 3]W of the Luton Code. bur the
perfilnnance of the work for which this permit is i'nucJ.
❑1 have and will nonfood Worker's Cmnpemmion Insurance,as required by Settled
37Ip of the Labor Code,for the pcdont rxe of the work far which this permit is
,sued..My Worker's Cnof,smatinn Insurance earlier:and Policy number am: _
Car,mr:AT/1F�'ohcy No.: eQy —
CERTIFICA'1lON OF EXEMPI PON FROM WOR KERS'
COSI VIiNSM'[ON INSU RA NCB
(This section need not be completed if the penman is for one hundred dollar
($11X11 ar lent)
1 e=dify that in the performance of the work for shish..his Permit is issuni.I
'hall not....play any fears...is any Inun^cr u,ax m become subject u,the Workers .
Compensation taws of Culifami Dam _ —
ZA 'ant _
«x NOl'ICG'rOAPI'LICAN'C IL allcnnll edx Ccnl¢m a(lixcanptlnn,you boll))
bmmno
ce subject the Worker's Con,cmation provisions of the Labor Code,you must
p Q Ibnhwitb cotopiy with such provi s;oos or thin permit shall he divined revoked,
F y CONSTRUCTION LENDING AGENCY
I hereby affil In the thele is a consum
uction lending ngk^cy for the perh wnce
y _
L17 of the work for which this permit is issued(See.3097.Co,C.)
F. ❑ Ixndcr'x Name
Lender's Address -
C.7 Q 1 cenify Ilett 1 have mad this a"'licnnio I and smm..hat rhe above information is
mIs 1.1 ague it,comply with ail city and county ordinances and state laws relating
p V mhtudding construelim,n^d hemhy audorim mpencou ivesofthi.,city ,,enter
ugm
etc nhnvonmminncJ Pore.ind roti mrpedikn purnnsu-
rrFi y (We)agree m sm'e,indemnify and keep M1.annlczn Inc Ciry nl Cupcdinn again..
14 linbiliaie',judgments ao,l,and expenses which stay in any way acerue...ias said
U Z, City in ronscyucnoe of the gmnti^g al Wil Hour 7
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date f�
SOURC f GULATIONS. %• CII/—DO
Signa mofApoirmi (in nor Lime Re-roofs r/ -0�� J /Z4--/L �d/� 3 0 Y,f92
IIA%Alt D(lUS MATIiRIALS IIISCL(15URE - tf 1
WIIl the applicwt or fuwm WilAing meupam sum or handle ha®Nouovicriul Type of Roo
osdefirod by the Cupenino Mo 'c'
al Code.ChaMer 9,12,and the Hcahh and Safety
Code,Section 25532ia1'1
oY=< No All roofs shall be inspected prior to any roofing material being installed.
Will the upplirm or lwme hodding rncupo,use eyuipmcnt or devices whidm If a roof is installed without first obtaining an inspection, I agree to remove
emit letrardom air contaminants m defined by the Bay Area Air Quality Management
n;'Ir;er. I �/ all new materials for inspection. Applicant understands and will comply with
0Ye• Na all non-point source regulations.
1 hove read the vomdom mania),requlrenmnm nook-Chapter 695 of the -
California Health&Safety'Code,Sections 25505.25533 and 25534.1 understand that
•it'thc holdingdocx nm ndreney have a temmLnhat it ix my rexWnsihilhy to notify the
receptor of Oe myuiraner v which must Ir met prior B.mssuunre of a Cenilicam Iia' / f
Occupancy. Signature of Applicant Date
—�'
6-21-00
act it Data _ All roof coverings to be Class "B" or better
OFFICE