01100066 (2) CI out Di G 1IMSIioNNO PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: 1 PERMIT NO,
10271 LOCKWOOD DR CALIFORNIA SECURITY ROOFING 01100066
OWNER'S NAME: APPLICATION SUB DATE
ROSS KEISER 90 UMBARGER RD 10/10/2001
t HONE: SANITARY NO. CONTROL NO.
1/I _ I (408) 363-6400
q s i ARCH[TECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
ori, 1'U I—I L= L7
nay
vNi Z LICENSED our,,CONTRACTOR'S DECLARATION I Job Description
Z O I hereby ulflrm that 1 am 1 tenseddunder proJm
snof Chapter 9(commencing
s
W✓{ 'Iwith Section]000)af Division Jof the Business and Profex%iom Cody and mylicrnx REROOF.
mg7 is in full trete vnde
z ' atlua uc.a I REMOVE WOODSHAKEr INSTALL 1/2"
r'O De
Vm /O—/a+ Ori Contra aor
p.
gGj ARCHITECT'SDECLA IDN CDA PLYWOOD & 40 YR. DIMENSIONAL COMP.
3. O 1 undenund my plans shall he used as public records '
T
i a,p 0 Licensed professional t
o , OWNER-BUILDER DECLARATION
vihereby am exempt from the Contractor's License Law for the
I affirm that 1
t z a 'fallowing reason.(Section]031 to Business aria Profeesio Caae:Any city or county
zzO
which 9 permit .trot h mva
impdemolieM1 orrepair my structure
�3$ �pthrid«i ht 't iIlshl m fsahcmitmfbeagnM ou t ld ; _. . _ .
_.......
__ _ ___
lw(Chrintor) j ationcI S-_CySietO $] 2V
u auPrpfassons Code) t� F1P Sq•TC1 t 8 with Division 3 ofthe Buur
he nx exempt therefrom end the bass for the alleged eaempt'uv Any violation '
.fSection 703 L.5 by myapplicmt fora permit subjects the applicant m a civil penalty pp�f N
of not more than floc hundred dollars(SM, 3 4 2 3 0 0 Ou t b�r0 a Occupancy Type
O 1,as owner afire property,us my employees with wages as their ache compensation,
will do the work,and Ne structure is not intended or offered for-sale(Sec.]OW,
Business and Professions Code:The Comuaor's License law a«x oat apply tom3 0 5 — FRAME 'Required Inspections" -
owner of property Who builds«improves thereon,and who does such x.,k himself I
or thmuaghh his own employee:.provided that such improvememx.re ret intended or 3 0 7 - - -INSULATION__ _-
offered for sale.If.however,the building or improvement is sola within one - r. . _ -_. ..`•,_.._.. ._. _-_.
p p proving year a 6 O 1 - ROOF TEAR OFF 7' "' -- ` `'' ---_-
- tom lesion,the owner-builder will have the burden of that he did not build« I
improve mrpaspoxmf Sale.). t 602 -_. ROOF PLYWOOD_NATL- _._ .. ..._..
Di,svw&�aFihe p,olsrty,nm�xdasi.eiy cammaLng with hcrn%ed camraaorsm 603 — ROOF BATTENS - - - - _
_ f conswn the pmiacs sec.7W,Busirteu and Pmfesiunx Cadc:)The Conuacur's
udwhocodulax.f,such an owner wahiscomywho baucensds ed proeextnt theon, 604 — ROOF IN—PROGRESS '
-a Comome ,"License
Low,,,protects with a contrb:tI . licensed pursuant.to the
_ CoI am exaLicense lrw,,,,, -
❑lameumqundersee: '' 'B@PC f«Nie rtuon It`I„
Ownel':t"- ,,.I: e•: ^'Data :.
:c WORKER'S COMPENSATION DECLARATION
Ihereby affirmunder pcmlty,ofparjuryp^e of the following declarations: FINALE®
1 huve'and will`�irihtim a Cenifichm or Corsair,to self-insure for Worker,'
mmpcnsnion, u provided for by Section 2]00 or the Labor Codc, for the
performance of the work ror which,this permit is iuyed" OCT fy a.
ElIliod will mai t Wmkcrfa Cerppc t Insummt as requited by Sensori /� b �O 01
2700 of"slit labor Coda f the performance r the work for which Nis permit u
,sued My W rk fa Cna�pe eau Insure and Pol Yy number are:•w
Came� '�t'YiNey'fPoLcY
ix ell
aiR r �y�B�U1L -rte.--.
„� 1' I: CERTIFICATION OF EXEMPTION MW RKEILS'l, a
tl••.:(tTie�1diosi need ores tie coin lnedifthe rmiuxr, 1r:•- _;, „ ,. , F.__..__._-...__..__-......_-.�__._.
COMPENSATION INSIIRAN -.
•..t” anentindrteeaBars r,i=\ \�.d.3r��'f ''I"'
P Ver
• 1 Nfyahet in the pert mcc of Ne wort for which th' permt'i its ed;l P„,a l'1`C Lt', i'"it'll:i ^ t'%Ota
shag r pt,,,anY on nanymarmerea Imp�o me stNycr�spA WmRers
Compenu't - of Cahfm`a.D e;' `C'✓ '
NOTICET0 ]CL ANT:If:afsermald gthis esof Exemption.you should ' ' '• ` '
o
Z ctw Newmr;:ex Compehsationpm snonsofthelabor Code,youmust
QQ fdnhwish cmply with ouch provisions or this purest shell be decreed invoked. _ -
7 c mem
'CONSTRUCTION LENDING'AGENCY
7 'I Aeteby alflrm that Mete is v constmetion lending ageiry for the perfoimanm' •' '
-� 0R6e lv«kfor which his permit is issued(Sec.309].Civ.C.) ;
Q Lender's Name
.i .: .r.y. .. .. ...:... _. __... ..._..-... _..
^' Lender's Address ""' •.
V Q 1 certify Net 1 have read this application and state that she above information is
.ra:E., correct.1 agn<a comply with all city and county«alma rcu and%rate laws relating
vu to building cousmuhion;and hereby authorise representatives of Nis city to enter upon
Ne above-mentioned pmpeny for inspection purposes.,,
0. (we)'agtee tb mve,indemnify and keep harmless the City of Cupenlun against
-h liabilities,judgments.costs and expenees which may in any way serve again,said
V,� City idemsequencearthegmntingof Nis permit. . - ' ' ' I.
_ APPLICANT UNDARSTANDS'AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date
SOURCEREGULATIONS,01""" 1,
Sig am f Appl'cart controro -' Date - I Re-roofs
H RDOUS MATERIALS DISCLOSURE I
wtilNe°pohemt ftdrebuld gar pasta arnmNehizvaousmt 1. Type of Roof'.
u defrted by the Continuum Municipal Calc Chapter 9.12.and the HnIN and Safety �}� is + t,^'fl , I •flat - r' I Dlit ti)
32( 1 { ; '.b: �C S�{ n'l l%.'[^ ,
1 .in Nm.'. ,. 1 vY:, x''•13 1 ,
Code gets 255 1. '
❑Y x - .I `�- _.All roofs-shall be.inspected.pnor_to.any_roofing-maternal being.tnstalled _...._.--.__.
wtu N applicanta I..holding p,t ax qa p t a pm If a roof is in'stalle'd without first obtammg an tnspectiori, I agree'tol'-move
rout h b contaminants adefined by the Bay Area ArQiltyManagement
District? all new materials for,inspection. Applicant understands and,will comply with
17Y non-
y t i - ❑No t I,. all source regulations:, y, ', ; *,t„ ;,;fl,
flout"read he haa.rdous materials req,amens ander Chapter 695 of Ne
California HrilNk Sarery Cdda Sections 25505.25533 and 25536.1 undersand that -
;if Nc Dgilding dues not curtetisly ha%<atewnt.Nat it ie mY rtxpmnsibility mnotify the t.
'cilepmt of Lh rtgeirtmants h¢h mast be t p tv id n Y CcnlRcau of �+-��' -
°c p f Ignature of Applic nt Date
All roof coverings to be Class "B•'or better
em sed agcm, ,Date. l
OFFICE
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