01070036 (2) OF
l.lT.SW o hG DIVISION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
20642 KIRWIN LA SNOWDEN T ROOF SYSTEMS 01070x0}36
D�f�H�l�tS ROBERT L AND FRANCES M 6322 MOJAVE DR A07G/11/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 927-6959
MOO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
ad
0 BLDG ELECT PLUMB MECH
fir 6� CI fUl l� L I
i LICENSED CONTRACTOR'S DECLARATION Job Descri tion
0 b H-q 1 M1cmby effort thin I nm licensed und<r provisions of Chapter 9(commencing REROOF. p
�_f-W wh xeclloneoud)nr Divifinn lol the Bueinesc and Professions Cade,and mylicenae ( y
ams 5 rmI core,arta,Tree 30 YR. COMP.
z z 6 teen Cl." _ Lic.p
S:o ate r_o f Comma 7
w 3¢, ARCHITECT'S OECLAR ION / /
F I undcrsuM my plain shall be used as public records e 7
Ear It
aa Licensed Professional
ca /
e OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractoos License law for the
c-z a following reason.permit
t 7omme Business and improve.
de i bli Code:Any city or county
ac O which Tits a permit to amamcL alcor,improve,demolish, fi repair any swctum
i 3 p�orw u o Is. q pr ppliu tf hl Toru 11 'g edsmmmem - - - - -"
that be licensed ntvldm provisions rm Contractor sL< law(cnaptm9 S Ft. FloorArea . Valuation
(comm rcngwrh Seinen 7001 of Division 3ortheB dam ndP fasionsCady 9�ijwl � ] _�4�•d 4 7¢^, )
or mm he it exempt therefrom and the basis far the alleged e4emptlov.Any violation - -
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of net more mad five havered dmhrs ts500). APN Number i.' Occupancy Type
01.is aunt of pml,my.or my employees%ith wases as their.olea,mpenxaaon. 305 FRAME
will do he scroll and the sent is not intended or offered for are(See.'7N4, 307 — INSULAT
Business mid Professions Cale:The Contmctor's License Low does'not apply m an 10$Ilired Inspections
.,net of property Woo builds or improves thereon,and who docs such work himself 601 - ROOF TEAR OFF
of erred for
his own employees. building
that each vement nsol are not intended or •
cRpletionsale.ILhaweva.mebniwm dwhhid nue 602 - ROOF PLYWOOD NAIL ." _ ..
g or improvement Ic no year o ,
mnprove fon'the owner-builder will have the burden or proving that he did not build or 603 — ROOF BATTENS )
ipmer vnToxea
o1:as ownet of me pRwedy.amcx.ciu:iveir concocting with ua�=<ti-o�h�nom to -_ ... ._ . 604._-...ROOF- IN=PROGRESS . " _ ... .._.___...___. -.... ._
conswct the project(Sec.70-14.Bmineas and professions Cadet'The Conoco is
s-r' License law does not apply to an owner of property who builds or improves thereon,
_and who concocts for such projects with.a camractertsl licerard purwanLw the. _ ...___..-____ ._.. .... ... ... .. _._ L _--
Contractor's License Law.
❑I am exempt under Sa. - .B&P C,rorthis reason
_ Owner Da ""
Date
WORKI!R'SCOMPENSATIONDECLARATION
I hereby affirm under pewlty of perjury dor of the following declarations:
❑ I haveand will maintain a Cenificaidof Comant to self-inverse for Worker's
Comperisnim. as pmvidN for by Section 3700 of the labor Cade, for the
performance of the work for which this pcorna is ismed
O 1 have and will maintain Worker's Compensation Insurers,as required by Section
37oo'of the Labor Code,for he performance or the vo rk'for which this permit is
-,-„ rid PolisWrithe, am:
Campennuuon lnsonnce camera y
Curt DVN{r.fLl 4 ,PoliYN .: /2P'/JOY^�/ s .t' ., t 7isYt •y"I rat
",CERTIEICATION OP EXEMPTION�FROM.WORKERx'q 5 - Sit: t x 11 . is j.{�' x I ti9 J I` 1
....:. COMPENSATION INSURA<`,CE," �`• .. - ___ - _. __.. .._-.. .
Inks'sce ion need not Ile completed if the permit k for one hundred dollars .. `rr I "l t -'
IS I W)or less-),.
1 certify thin in the perf turiance of the work for which this permit is issued.I ^� .- 'Illy
-
shall not employ any pecan in any manner m as to become subject to the Workers
Ctimpcnmtion Laws of California.Date '
Appli2mt - - .. _... _ ". __ ...... .. - _t.. . ..
NUrICEt'OAPPLICAlaxi ;alter ma king ihie CenifI I of u Exemption.you should
hcmnm subjebt ufthe Wnikeh Cn i rostmn pnrviJuasof the Lubar Code,you must
Q
forthwith mvI'with such prevision,.,,his permit shall be deemed revoked.
-� •r' CONSTRUCTION LENDING AGENCY - _ t- --
F" 'hcicbY off rm the tMrcis S<onxtmdion IcrdidS agency for
the performemce .
-� of Ne work for which this permit is issued(Sec.3097,Civ C.) '
� Q Lenders Name .• - .`...._.
Lendx1%Address .•. . ... _.. ...- ._ .. _ -.
U 0I certify that I have read this application and state that the above information is
;a-,.[r ci omt.I agree to comply with:!ll city and county,ordinin m,and.e m laws relating
:wU to building ctnnVumlon,add blrtbyaadmrim repracmanses of this city to enter upon
>..W the above namimed, e.ind 'n.pc(' rip q, :
[r_G el.JUg t . Ile Ile d keph rml :th Cly against
z liab t 1 dg cmc 't. d expert.¢: h h may in mY way awrve ova ria said
U Z City n< q ce bt thel ung of thi t
AP CANT UNDERSTANDS AND L COMPLY WITH ALL NON-POINT;'
S uRCEBLGILAidolgs.'" Issued by:
nat�caaUCa Ismr,.� _ Data ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will he riplietint or future building -cvpam...or handle IbLrx t ns musical ,..Type of Roof, - - -
—
as defirod by the Cumensime,Municipal Cale Chapter 9l$ and the Health and Safety +r•� s - � - - -"' '.
Code'Sartain 25532(a)
❑Y - 'ow,,,, t r: 1' _ All roofs shall be, inspected prior to.any roofing.material.being installed__.,
WildItheapplicantorfutureWildingoccupantumequipmentord,eviect%hich If a DOG is itistai led,with'out first obtaining an inspection, I ais fee Ito reniove
emit hamrdous air conmmitmms as defined by the Bay Area Air Quality Management
Dismay all new materials for inspection. Applicant understands and will comply with
ore. - 0No - - all non-point source regulatio
1 have read the et ysdous materials5052 requirements under Chapter e.95.d mo-.
California Health gbeer Safety Calc. ,vatsant,th t it
yrespoad 34.1ityto stud thin
if the ce,,building mtcunwich oisibetmut my responsibility notify the
_ uic t t f the requirements/hh/ri/it/i�qb t p' miss f Certificate ar
U p y. _ _r
.,ignatureofAppli eat" _ � Date _
r' owne �a an cda 7 Date
All roof coverings to be Class "B" or better
... ._ - '-- ---- - ' --OFFICE