02010083 (2) OF
• CI BUILDING DII ISSIIONNOPERMIT CONTRACTOR INFORMATION:
Bul RARE S: PERMIT NO.
X63-8' ELDERWOOD CT R-M YOUNG 02010083
OWNER'S NAME: APPLICATION SUB DATE
GALLIVAN JAMES J JR AND MARI A 14549 S BASCOM AVE . 01/22/2002
'1 PHONE: SANITARY NO. CONTROL NO.
(408) 358-6977
0 O O ARCHITECT/ENGINEER. BUILDING PERMIT INFO
z BLDG ELECT PLUMB MECH
a d I_J _I L_1 L_J
y Z LICENSED CONTRAC OR'S DECLARATION Job Description
i z_� 1 affirm hereby arm that 1 am Iicen
xd under provisions of Chapter (commencing
„�t< with:err°n7")ofDivisi°n3 of the Business and Professions Code.and myhaense REROOF.
izwaLicense CI fique" LLiica.a�7L�Z G�--
O n U Dora -.1
ntranor
ILL ta G pIAaPRCHITECT'S DECLARATION
ucontraband
O 4 1 my 1s shgllfic of a. Ins records
;E00 Licensed Profess osood 1 �,
OWNERBUIL R DECLARATION
1 hereby offimt that 1.am exempt from the C.ntiacon,License Law for the
t-z fallowing reason.(section]031.5.Business cad Professions Code:Any city or county $9800
E x e which requires a permit m connwn,alter,improve.demolish,or Mair any muaure
i3� ...prom t '. also req rt theapplicant for such potato fl 'grcdstamment
that Tet ficerviod Irrsdaa to the Provisions of the Contractor's License La (Chapter9 1, 1S FI- FIOOr'Area y Valuation
commencing 0S t 1]fgN)) fDi,.mn3 tithe Bus nes DP fc..ions Coda $ ( i� t '\..,iQ'i •f... f. r „,til'k.
or that he is exempt Therefrom and the basis for the allegM,&_mPt on.Any violation
of Section]031:5 by any applteam for a permit subjects the applicant to a civil penalty
or not inure than five hundred dollar,S500). 3 0 4PN P Y yP
Occu ane T e
❑I,as owner of Me property,Lir and,employees with loges as their sole compensation, _
will do the work,and the xuunure'is no,marchedor.Rnvd for role(Scot 704y'
Businds r
aod Propositions Code:The nt
Coact.,.License Law door,a.,apply or as 601 - ROOF TEPAin kiRHhspections'"`,,t -_a/, I„
owner of property Who Wild.%or improves rheraon,and who does sum work himself 602 - ROOF PLYWOOD NAIL
or through his own employcez.provided that such improvenomms arc not intended or
-.Rad for sale 1[howeva:the Wiltlin u is sold within one - - f - - - - ---"'-- "-'---' -
g°"mPro"`m`" "'° 603 - ROOF BATTENS
completion,the owner-bonder will have the baided of proving Nat he did not Wild or
improve forpurps of sake). 604 - ROOF IN-PROGRESS
❑1:as.wnepr0e property,am exclusivelyc.mronirig-withoakr) do Coazwrsm h'1r b."di
continua the project(S¢.7U44,Business and property
who
ildc:)The improves
tmaam i
License Low dos not apply m an owner of property who builds a improves Thereon.
.and who convaense Law.., projecu with a conuactor(s).licensd.purtuanl.m.las
_ .. Commamors License law... 1. ,t ... ._._ .-_.......__..-_.... ._.._.._ .... ._..__....... ..... . .. ........
___.__.. ...--.._.__._._..
❑lam exempt to Sec. ,0&PC for this maven .O;I Ise:':f'�lifa:
Owner•. ., Ddlo,.. „
WORKER'S COMPENSATION DECLARATION
I hereby affirm under,penalty of perjury one of the following declamations: C
j•O 1 to aye'anniOonse
d will maintain''Cecahe or Cnt to self-inure for Worker's r
NALED
Compensatir,n. as pr.vided for by Section 37W of the labor Civil. far the FEB
Performance of the work for which this permit is issued O O p 002
ElI have and will maintain Worker s Compns
eation Insurance,as scghired by Section
3700 of the lab. Code f the perfo - Formit in
amd MY .ins .0 po . into . ..BUIL-DING
a Car kir which
n mie e d Policy bn
Cpducl l CERTIFICATION OF E%EMPf1ON FROM.WORKERS a asst}A ( 19i lit k?ig's, -
_..„,c„,,.:.,;. ....,. ENSATION,INSURANCE'... 1•
., flirt wniori need COMP.. ,. .. .:',n.__.r,...:.. ... ...._......___._- .� �.. :1 J,�o �. •'1.,.. ;. ..
I%
,.
hat be'compind if the permit is Interim hundred dollars -- --+-.�--_--•--' �- � t -_-- -_-
(EIW)nrlcssJ '
1cant,fyihat .the pert n< /th kfor xM,h th pe;-i ed,l i t ,I:' 1 :".t t!)h, � Y ,v'Y,•• ' �` -
as any me
b as
id, is Cam
ut
O e,OTIC us tO Upyday a Cklpf C �ekia tP roiv.Ac ll be dcemedtrc.okea. must.
shelf c a t her a b)a I the W kers
of 5affial
ter
ari
P you should
ons of the Labor Cod
O f.nnwith coat with such r o ons uh half _.. .
�,h •t - t70NSTRUC ION LENDING AGENCY
a 1 h iebY ff uh t Itie onsliuc( d g agency for the performs ce „
W Or of the work for which This perm t is issued(Sec.3097,Civ.C.)
,.. .Address
r..) O 1 certifythat 1 have read this application and turn,last the above informmioa is
.gree 1.
0 comply_with all city and county ordinances and stem laws relating
O f) m building construction.and hereby authorize isItac unitives of this city.m enter upon
ube a arm-m rommd property for inspection purposes.
F.r L (w)agreeto sevindemnify ad keep h rmle L lha City f Cu peri .against
m liabilities.judgments.cot d expo xs which mayin any way occurs,ag m;t said
U Z Cityimquence aide goading opthisperni
s�SP��P)1 DE A SANDWILL COMPLYWITHA LNO lllf `
b'N}'RGF �I. - Z W u Issued by: tate
S✓ig�natureyf ApplicanJComra "" -_, Vit^ •pate''L
If
O MATE L DISCLOSURE ''” Re-roofs
Will Ne appl'ani orformer b 'ld' g c tstem handle hazard :mammal Type Of Roof.
os tlefnd by the Cpen Mue 'p IC Pte 911 dm Health and Safety yP _ _ -'-d""- -T"' : -' .. .--
CWe OYe 25532(') ®N • F } I
rit
..All roofs shall be inspected prior to any roofing.material being installed. _
•” tan th ircontaminants
t ants b fdim,inedoccupant-yAequipment d :v.•meh If a roof Is installed without first obtaining an inspection; I'agre6,to remove
emit M1
Will
a c u m t. refined by far Bay use A Quality M s mem
D.td O all new materials for inspection Applicant understands and will coat I with _
all non-point source regulations- P y'
` - - .t a'tfar,
!,r 1 h - d fl h za d mrials iegmrtmems undo CM1 'mr 6.95 of the v r ,_
California Health&Safety Cede.Sections 25505 25533 and 25534.1 understand that
if the Wldng does not command,hamnatlhat it is ms.vuane f Cniotify h`- - -- .- - ., .,, .- _ ,
Deco tMuh're Yaspo siblu t motif t
tkcu qu em m h ch imslbe m t p'?m of
..
.� 22 Signature of Applicant Dale
Oxmcr.r.mnmiad'gem , Dam All roof coverings to be Class "B"or better'
... _....
. .OFFICE.