01090001 (2) CITY
I s OF C o v�RTINO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
fBILL10255 HILLCREST RD BILL GINGNAC & NANCY KED 801090001
OWNER'S NAME: APPLICATION SUB DATE
GINGNAC & NANCY KEDER 09/04/2001
PHONE: SANITARY NO. CONTROL NO.
Cal ARCHITECDENGLNEER: BUILDING PERMIT INFO
LD ELECT PLUMB MECH
< L 1
LICENSED CONTRACTOR'S DECLARATION
Sy I hereby affirm that I ran licensed under provisions of Chup¢r 9(commencing Job DescripC n
lIn with Section 70M)
of Division 3ofthe Businessand Professions Code,and mylicense DEMO.
s, - is in full force and effect.
i7 f License Class Lie.a
Data Comracmr
!a O ARCHITECT'S DECLARATION
r
g 1 understand my plans shall ar used as public records
I i p O Licensed Professional
'� OWNER-BUILDER DECLARATION
H,
I hereby affirm that I am exempt from the Commcmr's License Law for the
S which req ins o perms to cnnswc,,sincss and Rnfesslali Cade.Any chy or musty $6700 6.7 0 0
_O 6
(gem ]OJIS H
I¢ m danalish reps anyaworent
w Pa t t caul , 4 N pari tf hpenntt fI Law(Chapter
_ _ - - __ ___ _ ._.__ ___ __
a 3— thah 1 Bpumuonnoire pm"sm f0 C ,acme L Law(Chapter9 pp F r•F�[�a- n Valuation
(comr„cmap9 'ith Section]000)of Division 7 f In,Business and Pr fissions Code) ,3
or a hers exempt therefrom end the basis for the alleged exemption.Any violation - )
of Section 9031.3 by any applicant for a permit subjects the applicant to a civil penalty-
of at mons,the.five
enalty-ofnmmotethenfive hundred dollars S500). NO Np 'dftb INSPECT ONS-'- " Occupancy Type
❑1,as owner of the property,or my employees with wages as their sale compensation, 1
will do the'workf and thfsuucwre is not intended or offered for sale(Sec'.7044:
'Ifmihdex and Poldeaslmt,Cade:The'Contmnars Ltoetse I.aw does net apply m an Required InspectidliSK'•;'t'
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees,provided that such improycmenu are not intended or _,-
_ ..
,,om le f rale.oson-W a the building improvement is sold within one year of 1', .t,, •; ,,,
complet on the ownc W Id II have,h When of proving @m he aid no,build or
,completion,
fo ryou f12 Is.).
r. as ,the
of the pmpenY am Business and moaning With licensed conwetnrs m /�p� L I'.
License
et the ods no PSeeapp ]014 owner of and Profess ons Cade 7 The improves
Contractor's �j.. r, 1 LL III; r t
License law rices not apply m an owner th armpit who Wilds ord,p muai,hereon ��'alall
d h c t is fa h.p 1 ¢cath a.c t mrlsl lamd.pursua n-t Cho- ,
.
01 am
Contractors Pt titl Sec t 't '.. B�PCfonhis,casan 1 17 i l.i:ftll .
as, Date
OR(LRS COMPENSATION DECLARATION
I hereby affirm undergenalty of peijurytone of the following declarations:
A O 1 WJ and--will',ladul in a'Cenificmebf Con.mm a.self-insure far Workers
_ _ Campen ation, as-prnvided for by Section 3700 of the labor Code, for the
perfonnance'of thewark.for which this permit is issued.
❑1 haveird will m6 , s Con
W k ipe t til hamanb s iequion!by Scetiun'
37W of,he Lm6r Code,for the performance of the work 16r WElch'this permit is
iiiued MyW rk sC apo sato Insurance comer etd Pol'yn 'b rare: � _
an,
� 1 cf s^.LPalicy N6 I; tx`(—..vn
t t. CERTIFICATION OF,EXEMPf10NFROM WORKERS'
i'
COMPENSATION INSURPNCE',".,. ._., ...,___._
"''(Phis scctibri need l*hot beFnmpleicd if the permit is for one hm,tlred dollars - `'t)'- 1 ^ "„ i';C'h'ii:i%\ tj i'x
151 W)ar.less.l
Icemploya pli Pcrn mw a int th 1. whichhisp heWkis l,I ,°k .
':hull nm employ any pesos m any inner s nfm Inca rte abject to the Worke a
Co
Applicant-, nLaws pf Calf D,e -'
-' '
"NOTICE TO APPLICANT:
Q APT If.'after making this Certificate ficote M Exemption.you should
zbecome subject to the Worker Cionstio pionsthe L41b Code,you ratast
fohmplwith schprosns or tperthall W Jdnewed.
'
1
- —__ -------
CO
Fs� ' NSTRUCTION LENDING AGENCY ; '
I hereby'flan that themonstroct o i led ll g cy forthe performance l
'9e > he wok fo - hch thispmlu .sued(Se 3097,0 C)
-I:eMcrF Name ' .. ..•. ._ .. __ .. ... _... .. _ ... __ .. _. .__. _ - ._.. .. ___ . .. _. .__.....
Lend Addhocr
IT. +T Icenifythat l have read this application and nate thattheaboveinformalon is'
'Lv.:[.. correct.I agree to comply,with all city'and county ordinances and state laws trading
V to Wilding construction.and hereby awhchie reptexamtives of this city to enter upon,
the abo a mini oned property f inspection psandiness. _ _
F„ 0. (W ) gra ms indemnify and kesphrmltes IS;City (C penmo against
0�V liabilities judgments.costs end expo.which ma,to any way accmn against said /
.Zi City m c n quince of the gra t ng of th permit •ry' /'
AP CIT UNDERS'I'ANDSANb W'ILLCOMPLY WITH ALL NONPOINT
PREc r ONF + .. �, ti 0! Issued by: Date
xSi&,"f Auld,eto ,'ITt o tE1 Re-roofs
.t HAZARDOUS MATERIALS DISCLOSURE
" Wll the applicant or futon Wilding acupant nardi or handle buzordou ..aid'[ _ Type Of ROOF
ntd fined by,he Cupennm Mun opal Cods.Chapte 9.12,and the Health and Safety -
Code Section 25532(al t' t .1 ,3 t Ji. . •s - •• " . . > • 'i i •• + .l , 11'_..._.__�_
t f]Yes
'ON.
Y" _ , ,` _, All roofs $hal be ms acted riocto.an roofin material.bets
P P y g- g.installed.. _ _.
Will the applicant orhuman budding nccupont use equipment ordeviceswhich If aroof is installed without first obtaining an"inspectiony'I'agree'[o'remove
mail
hazard Dorn moot.e defined by,h Bay Area A Quality h1anagement
Dram t - _ . -„ all new materials for inspection. Applicant understands and will comply with,,,
T Oyes f, 11 ❑No�„ t ': all non-point source regulations,.,
have ieed1the hozmdr us materials requ remems under Chapter tins of the.
Caltfomia Health&Safety Code.Sections 25505.25533 and 25534.1 understand that'
T,thc ,W ng rias not currently ,,e e ac am that , y responsibility w otify,hu - -- - - - —
re
re para of a requirtmem ch most be t ar t t s e ce of a C mfcate of
pan
`P 4 0�. Signature.of Applicant Date _
Owner oranmmnape _ : Date All roof coverings to be Class+`B" or better• It
. 1 . OFFICE.... ._._' ..... ,. ... ..__.. .. ._. .._ .. .. _ . .. ,..
::.p t .,,..':, , .. . ..,