00120012 (2) CITY DINGDISIONO V NPERMIT CONTRACTOR INFORMATION:
-
BUILDING AT
)ttl&;73 HERMOSA AV -
�}/ PERMIT NO
00120012
OWNER'S NAME' APPLICATION 5 tl U T
MARCHI ANGELO AND JUDITH 1cu1� /20v7Zt
'HONE: - SANITARY NO. CONTROLNO.
C at Z ARCHITECTIF,NGINEER:
BUILDING PERMIT INFO
,q U BLDG ELECT PLUMB MECH
ve Z i 1=1
o Sy N LICENSED CONTRACTOR'S DECLARATION
o I hereby seldom mat I ata licensed ruder pruvismns ofehapur 9(wnnmercmg 4 Job Description '
E•,o,E(_w wilhsemiun901x1)lis Division 3orthe Business and Pml'eseions code,and my I cause
mal i.sinroBforceandeffect. REMOVE TILE. INSTALL 30LB.' FELT AND c01
°woa`u LieaseClass Lic.p CI;AYMAX
u7 3 a y Date - Comroade
ARCHITECI"S DECLARATION
I dictatorial my plane shall he used os public records '
�a�aE
O O
Licensed Professional ,
OWNER,cal If
us he CaA'1'ION
ce I hereby ullinn that 1 ton exempo tomb the CanVncna's Gmnse Law fur the '
Z 6 following reason.(See, a 9031.5,Business and Podassioes Code:Any my or,me ty
D which requires a serum m conelruc(alter,improve,demolish,of term,any structure
to printfail,issemtce.uLa requircuthe vptilicnnl for sneM1 rabbit la file neignN sWlmnenl ;
tum he is licensed poesoaa m the provisions of the CanraetoCs License Law(Chapis,9
(comma,cing who sechoe DDoo)ar.Dmiah,n3onh,Bdsmecs a ad Pmfesnms Code) Sq. Ft. Floor Area Valuation
or that he is exmupt therefrom and the basis for alleged exemption.Any violation _ .
of
Section 70,31.5 by any upplicmn fora payout rojensthe upplicrad,a civil penalty
of
not more man five hundred dollars(s500). APN Number Occup' tic y e
D L as ownerof the property,or my employees eah wages as their 10le compcnsalinn.
will do me work,red the ameure iv not intended or nOe ad for rule(Sec"70,14.
Business and Professions Code:The contractor's License Law does not apply to an 15 .e (luired Inspections
r` r of property Who builds or intpmvcs rhereut,mid who does such work himself
othrough his own employees.ptovlded War such i rameneenls are nom intended or
offered for sale,If,however,the building or mmmvctnaot is sold within one year of 305 — FRAME
completion,the owner-builder will have the burden of proving that he did
eOfmild
or
Improve ^(b7 — INSULATION
for air sc f sa
ole)
'D 1,as owner of property,am exclusively contracting with licensed contractors to 601 ROOF TEAR OFF
Lnumthe prosect(Sea,Busmen send Profesion.Code:)'net Contmcmre G ROOF PLYWOOD NAIL
b c Dor
icense Law does not apply moan()"net()I property who bunds or inipmves Thereon, 60 T
and who contracts or such projects"fill a unweloeso licensed pursuant mo the 'Er�3 — ROOF BATTENS
Car I,.,od License Law.
❑Inmescript order Sec. B&PCfothe,access, 004 — ROOF IN—PROGRESS
owner Data 9'—Itl�{�r' LED ,
WORKER'S COMI'ENSA'1'ION UECLARAI'ION
I hereby affirm under penalty of perjury one or the follow lay dcclar do I, _
46 O I have and will maimnin a Cerlecate of Cdrum no eeiriilme for Workers OCT 11 2001•
eontpersaenn. as provided for by Section 37OU of the Labor Code. ror the
per ormmnce of the work for which this permit is issued -
I1h .,to will mairmin Worker a Conti ad a bromance.c, orpenadby Section BUILDING
�1�1 ��A�
1 1 theLabor Curr n
fohe performancef thework f which this l nt, v
is ` iVG '
i...our MM_HWkm pYensemrGa 1 s`ur ' -
and Policy number art
Carrier e00b23'8�p�e '
CF.R'1'iFICAT1ON OF EXEMP'NON FROM W GRKF.RS'
COMPENSATION INSURANCE
(Tin,section need not he cnndired if the ronin is for one hundad dollars
IS 100)or less.) -
1 ceti ry that in the performance of me ,,,it lot which this pcnnii is issued,i - -
shall not employ any person In any manner m as to bemmenubjccl to The Workers' -
Compensation Laws of Tambour.Data - -
Artificial
NOI'ICH TO APPLICANT.If,after making this Cenmeme of laempdon,you should t
z become subject to the Worker's Comgtmanon provisions of the Labor Code.you must ,
ZO f rlhwhh comply whh such provisions or this pennll shall be deemed revoked.
Z ..
F CONthere is TION LENDING AGENCY
ai I M1kfor affirm that come it a mued(Sec. leading agency for the performance
W oramr, k for which this ownnll is rosucl(Sec.9097,Civ.C.) ,
z Lenders Name
� z lender's Address r_ t
V C) ieerilytaw 1 hove radthis.,Pitcarirn and Kram that theabove I nformatione, '
W [r correct.1 agree to comply with all city and county ordinances and state laws rehiring -
0 (, to building arms,...don,and hereby armonze representatives of Ibis city to enter down 1 +
(y] the above-nmuleared property for inspection purposes,
F. ry liabilities,
jard,artmv,costs dgrecmeave,l told csrynnd swhich
hu do,
inthe Cily oferm,i alum id
Cil,in cruse deme of the gr ran of This oe -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH.ALL NONPOMT
SOURCE REGULATIONS. Issued by - Date --`�
Slgnvtmeor Appliaen/Comrabins Date, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fume,Funding occupier store or handle hvnnloes mmcrial Type of Roof' -
m defined by me Cuplant,Municipal Cade,Chupmr 112,and We Health and Safety _ -
Code,Station 25532(u)?
DYes 1 0N All roofs shall be inspected prior to any roofing material being installed.
Will the vmI cant or four,M1uJding o-aem tine equipment or devices which If a roof is installed without first obtaininginspection, I a to remove
fit haraudous dreenwmmams as dermcd by he Bay Ara Air Quality Mice"cncm an P agree -
District? all DNo all new nt sour for inns eti
all n Dint souplicant understands and will comply with
tf- ce reg at
I have read the hamrdous materials requirements under Chapter 0.95 of the
California Health k Safety Code,Sections 25505,25533 and 25530,1 understand mat
if the beilyt dens not currently have a lyIran( ,I it ryrcspmreihility to notify the
ecus m(unr t u reyuiranents ht h t Rs p' Ir issuunm of a Cenilreal
Q" gnature of Applicant Dale
Ow maathodmd start - All roof coverings to be Class "B"or better
OFFICE