01070147 (2) NO
CITY DINDII I SN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
22093 BAXLEY CT WESTERN REGION ROOFING 01070147
OWNER'S NAMEAPPLIC TION UB DATE
SCOTT BARRY C AND JUDY C 231 N 12TH ST 077302001
PHONE: SANITARY NO. CONTROL NO.
(408) 360-9111
�azp ARC[11 BUILDING PERMIT INPO
GU L ELECT PLUMB MECH
N a i J 1...1 1_I I
8 w Z LICENSED CON'TRACTOR'S DECLARATION lob Descri tion
OZ-p I hereby affirm that 1.,it licensed under It...l"ms of Chapter 9(commencing P
Tyra, wI'll Section]oBmofDlylslon3ofheBmineeaaadPrnfesnmasCur add my REROOF.
�xpa= Int°� "' _ �C{ e(1 TILE REMOVE & REPLACE .
C z¢ Llceaa Cm.p n
w 3 a N °om Contractor
ARCHITECT'S DECLARATION
o' 1 and—dind m shall be tired as blit records
se ca my public
ii p eL Licensed Professional
On BUILDER DECLARATION
++
tK'Z--'m mostly reby affirm chat.,I cin exempt from In,r Gurus a Licence Law forthe
y
C Z G followinguires a permit
i ]113 L5.Business and improve,
dermli Code Any city orconnty.
a,P o which requires o permit tit construct.ober,im forsu dentolal t fi repair any mormene
63,a that heor oslicmm�cgzhion'I-(heres tneapplicummc Contractors
LicnseLa (Chaffer
_
- mathei:fieenaed Seniorm00)ofDa:oa.nnofill, raetor,,anenarLawon%Crer9 _q, FL Floor Area , Valuation
., hot e.,rwith Section"IBROnof he
Sof the Businessolid Prooh.Ad,
Crude) ,
.r mai he is exempt there Goth end the basis For the alleged,lueeninn.Any vlal.try 'enrnqr nn
"' r
of Section.' me th n v any imputed,dn.t far n p<nait.(chloro me applinant t...mu peawty Occupancy Type
'of nonmore mast Tive hundred dollars rsspol. APN Number
Cl L a,ovinertrthpor,i y employees will, -yes asthersale compen.-Minn, 305 FRAME
-
w II do'th F and(he t t 1 intended or offs cd for site(Sec.7044, --
❑ d Promotion,C 1 The CroadmiLi ,e Law Joe,ma.,,I,I. a 307 - INSULATIR)34uiredInspections"
on
r of property Who mildly or improves thereon,andwhoAnes such work hiaoalf
or through his p1 y ..porvid,dba,alien improvements t intended or 601 — ROOF TEAR OFF ,
ger rdenofprovIa m evenror 602__-ROOF PLYWOOD NAIL
m pl compos, b 'lmrwtnhave the baraetofpro�agmmnedid notnnldor 603 - ROOF BATTENS
improvef pm r 'I I
d Las literal,lifateppty a 'ROOF- IN-PROGRESS
rise
o
construct 1h "circ,(S 914 ❑ e d ____ ._.. ....
P f Cudc:)'Iho Cormarmal,
- License Law does not pae formally I h I I p thereon
.end n t c,f hlllicensed p rsuvntto,he.
P Je t th ...lith1 s
Contractors Liecc,df "'-
°I mor coo,ol,pa motherS B&PCfonnie reason
WORKIiR SCOMPF.NSATION DECLARATION O/
I hareby affi rill trader pe la,of pi one of the followi ng der fortiori
I h
p ave and will inainoin a Certificate of Consent to selM1ineme for Worker's
- _ Cempensallon, as provided for by Section 3700 of he Labor Code, for the
performance of the work for which this permit is issued,
4q+I Irrve a td w ll co t i Worker C p Imsamord,as dyUirCd by Section
S]IXI of the Labor Code,for the perform"tce of the work for which thin perm t is
start,Say W Worker C p t a Ins. I lid Pot cy lit liber m
���r�, a :
'Ca er�yJ.ylN IXE'Ids! y N41
E 1CAlION l99�pRR IiTIONINSURANCE
NSUR WOR ER
UNANC 1,
COMPS SATION INS
(srh'. 'efonwad am be enaplctedf the permit is for ane hundred fit... J'-Lit.
(41001 or less-) '
1rentfythty er,performancefwork- fwhicht' p "t ' issued,
shall not employ any pe sen n dry nn s hi became sn bleat m the Workers'
Compensation Laws of Califdrnla.Date
Applicant
-
NOTICE uOAPPLICANT It, on"ak mil Cratifc"te'of hsenpfon you should
z. barovildecm to he rurker'a Colons or tlod rioniou of me Luhm Code,you'mLLa
Q O fo th 'th nply with rush p 'sines n this wrmit shall he 1 ed revoked.
F.� 'CONSTRUCTION LENDING AGENCY . .
In ehy affirm that hemi,a riashortlenle tdiny egency 6rthe parfunwnce
.� locri
Ith k C hich th pe is icer ed(Sec.309],Civ.C.7 -'
� z Lenders Addksv
V0 ,I certify that I have read this application and state that the above information is
"g ;� coma:I agm<to comply with an ally and commy rodura was cad chute law,relating
C-V m huildingemisouaion.mad herchy authoriiompresenrutivesofthisciiy menterupon
t-P, the hu f edp p ty 'pmt p p
Fs. iCI0L (W1 't" a fy 'and k ph inad say
fCpn,muo,said 6.-
LL z Cit 1 d ix. "t d lie h may In nny y gain' acid
U �Z City IC y RSTAN tag W ......t �'.3a-0/_
�O/
APPLICA NDERSTANDS AND WILL COMPLYWTTH ALL NON POINT'
C Tlon Issued by: Date
St UR F 4A �mr. -;Dare Re-roofs _.
g Ap
IHA RDOUS MATERIALS DISCLOSURE
W u ilm apprca t driLturci taliffingoccapaill shom,orhainfli,h`o mutes mamma Type of Roof
Ca detSeo Section
the Cup n M n'c pal;Code.Ch Pt J.12,a J th H hh add Safety
Code seatotzssl'fnl , All roofs sinspected-prior
p'N I ,
hall be to any roofing being installed.._
W IIm appl'c ' ball b Id Imtt : ell par m ' swasch If a roof IS installed'Without first obtaining an inspectlori';'Taome to remove
as h d t t lelndby the B'yA aArQ IlyM agement o
°i all new materials for inspection. Applicant understands and will comply with
Oreo °" H om source regulations: 1_;,•,, - -
`sN' .: 1 n r 1 the hoe to te'h. quireHent d Ch pt -n.95 of the '
'C£IfmiaH 'hl &S,ill,Code.Si,cimar 25505,25533 and 25534,1 miderstandthat p , 1
ifthe thildin,der,netcall h' lervart.L tit : re,somfulitytmoody the
eep,nt bf the rlibullands which raos,be met poli r it's eof a Certificate of 1 �f
oe Signature ofAk 'cant Date
_= owner - Dme All roof coverings to be Class "B" of better
OFFICE . . .__