01090066 (2) OF
CITY
DIViSiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22410 JANICE AV 01090066
OWNER'S NAME: APPLICATION SUB DATE
SOLTANZAD IRADG AND DEBORA 09/17/2001
iall
HONE: SANITARY NO. CONTROL NO.
O eeZ ARCHITECTIENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
z
P w LICENSED CONTRACTOR'S DECLARATION 1 herebyfirm that 1 am licensed under r Cha 9(amtnerrcin Job Description
a provisions Tri g
iyt-u0i
with Section](Nln)of DirizionJof the Business and Pvfexsionr and my license REROOF.
-' is in rml tura a lir
LieroseClasa ��4i FFiG;<.» REMOVE SHAKE & INSTALL COMP.
_
o iti Daeennwaor
a u y —( ""-> ARCHITECT'S DECLA
O g I umlersu nd an,plans shall be used as public licca /it,
t i
80 Liccmcd Pndcssimwl
'
o
wn OWNER-BUILDE0.DE TION
I hereby ofBrn that I am exempt from the Comment's License law for the
C?G following reason ISectinn 703 1.5,Business and Professions Coda:Any city or county
Y M n which reclaims a permit in rownceh alter.improve,demolish,or repo r any nmcture
n3'° vriort u' firer. I 9 rc-th appl'umt forsuch"amttofl ugrcd uasemem. __ _ _
- ma ha.1 nod po ant wthe p ohne canon<tora License
«.e law(enapt 9 / 'Sq.-,Ft;,Floor aluation
(commencing
with Sesta ]dXy("fDviom3n"he Busness nr Proresaonx Code) n.6i:, i „va. .l. s 73`
or that tie is axdmpi t itrefrom'anJ the wsix fur me alleged exnnpoon.Any violation
-of 5«tion]03 LS by any applicant far a pemris subjects the apphimad m a civil penalty
,of..,more than fivehmineddollao($500). A um er "iI-•:u Occupancy Type
❑I.as owner of the progeny.or my employees with wages us their aisle compensation,
will do the work-and the structure is not intended or offered for sale(Sec 70.W.' - -
Bmincss'and Professions Codc:The Contmv.,'s License Law docs not apply to an 307 - INSULATRMJired Inspections"
owner of property Who wilds or improma meremn,and who does such work himself 601 - ROOF TEAR OFF !
or though his own employers.provided that such improvements am not intended or
affcrdfirilr.If,ho a,ar. he Wildinj or inlimvearmin I,sold within oneyear or 602 - ROOF PLYWOOD NAF'L" "
pkt the .4i IM will n the wore rpr g Rod he did t Wila'w
Pr r r ma tar) 603 - ROOF BATTENS i
Oi.uamwmeufinepn,pony,annsauisay<tnna<dngwmfi«nsed<mnrmcromm 604- - ROOF -IN-PROGRESS
- -
onuruct the project(Sec.7144,Business and Pmfcsvons Code:)The Contractor's
License Law does not apply to an owner of progeny who wilds m improves daemon.
and
who
License Taw., c cerve pis cant to the
and who comraense Law.,
x.ith a . 11 . rlel.li is
0 lam exempt under Sec. '•: In .."t..B&P C for this
_ Owner Dae
_ - WORKER'S COMPENSATION DECLARATION
1 herehy of lira carer penalty of periarym.,oLme following declarations'.
❑ 1 hove and wal•mimuid'a certificate 4 cdmscnt'to self-insure for workers
Compensation, as provided for by Section 3700 ofthelabor Cade, fur the
perf orma nilhe work for which this permit is 6sued..r„
❑1 have and will maintain Workcr's Compensation Insurance.as mgared by Station
37M of the Labor Code f the performs ce of the work for which this .it is
issued:MyW k r.Cn .w 1 once cam<i andPati
carner r <, 1 i`', r !.. .i`it. €. �.��r^��,,, \', •.i. i',•1; ! D
) `CERTIION OF EXEMPTION FROM,W
ryQRKERS'I
FICAT
f ; ,., COMPENSATION INSURANCE'. .. ...._ __.._.._...._._�.__.,._... _._._,........ __.--- ---_ _ _
ITh ssen on need not w completed if the permit is for mm hundrrd di lars 1i'�• '.I; : .- L ;•'),Ase'. t s,
1«nf twtiri the fform ce of tlr mkt which tbjpe tis Workea Ir,-1 ,• s.(� i s•,.
"hal 1 en plcy miy is n y na t i be omc- b)en to the Workers
Com'miai.on lawsnf Cabfomor Date�c
:Applicant ' -
after NOTICE TO APPLICANT'If. making this'Ce of Exemption,
you
ould
beeb subject theWorker,C.hirl piliisot the Labor mail
OOforthwith'complY with lh poion%othis 't hit be
'
_
-CONSTRUCTION LENDING AGENCY
> f I h for
off th t th s is.wd(Sen lends g agcr¢y fo the performance - 1
r
of the ark for whish rets perm t :rsmed ISee 7(9] Cis,
C)
=.Zr I-coers Addresi _ s
V.0 1 cenify the 1 have mad this application sed stare swum above mfortwtion is
fsip.
. , correct.I ii,om In comply with all city and coca,c lmeoces and slue laws relating
O V to bodding<onstmctlon:and hereby authorize repiciontatives of this city to enter upon
the above.mentioned gra y for inspection purposes ".. ,
Fs ps 1Wc)agree to sap uWemnify vnd keep harmless the City�f Cvpenirio against'
Vi Iiahililies,judgments c and expenses which may in any way reser against said
U_Z City lin consequence eg ming of this`pumit. p
APPLICANT D, <i gAND WILCC MPLY 'ALL NUN-POINT' is by: Date
SOURCE RE[' PION. y•
5igna
Code tare Sccoon Ica t nor' E - - - Data a' Re-roofs a—
AZARDOUS'MATERIALS DISCLOSURE
w n d pidiand of(uturt w Iding m¢upant tore or.fian0le hazardous rtumnal Type of Roof -_ • '• -
asdefiinedbytheCopemnoMunlaPlCW Chpt 912.and the Health and Safety s •.,f. 1 .g� rtr•.,t'._t T s !i'..d . ❑
oY°` s3xo) kAll.roofs.shall beinspected prior to,any roofing material.being installed. ...__._
will the applicant or future wilding occupant use equipment or devices which If a roof is installed'without first obtaining an'inspectiori;'h agree'to remove
ren hazardous mm t. defined by theBuy Area Air Quality M gemrmt
D aur et all new materials for inspection. Applicant understands will comply with-
09 0, °i °N all'non-point source regulations,
naso read the bzardnus mumrials requirements under Chapter ti 95'of the
California Health&Safety Code.Sections 25505.25533 and 25574.1 undersdZ that _
if thea it - hat curzcntiy hevcateowt.tomtit u my aes raibAuy m aotify me' 04
iKebphn a iegaa rent,wnich'Inti.a be and prior m isxuan<v uta Cenificam of �_/ "' /
`Y' -p Si a are of Applicant. - Date �-
X warmo eDam " All roof coverings to be Class"B" or better` . -
OFFICE