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OFFICE.......--,.
OF
CI BUILDING
CONTRACTOR INFORMATION:
DIIVIISSIIONNOPERMIT
BUILDING ADDRESS:
PERMIT NO.
18745 LOREE AVE.
ROOFCO OF SILICON VALLE
01100006
OWNER'S NAME:
HOWARD & CELCILIA WASHINGTON
844B EARLE AVE
APPLICATION SUB DATE
10/01/2001
PHONE:
(408)795-3335
SANITARY NO. CONTROL NO.
IN"ARCHITECTiENGINEER:
C O
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby affimn that I am liecnsm under provitiam of Chiller 9 (commencing
REROOF.
ea
whnseeamn9l>on,)aroo;,imn3mteenaiimssanalhoresmmcmeandmyR«ase
remccio.`and re`-' IJee 77 %y
T/O TAR & GRAVEL, PUT BACK
Dale /o-.ni vi Common,
3 PLY & 72 #CAP.
ARCHITECT'S DECLARATION
I understand my plans shall M uui as public records
p O
Licrn,cd Profession.)
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OWNER BUILDER DECLARATION
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1 hereby affirm that I am exempt from IM1e Contoi License law for the
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ruling reason, (Section 91131.5. Business and Profes,ions Cm=: Any city orcoumy
=.poi«t
which requires a Permit to conswct, alter, improve, demolish, or mpzir any structure
'gam
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a mm
such alatemenl�
i noticert9 the npplment f«pemdu Ile
,SgaFt FloonAre . _
a\ t :4i
{g1 anon
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e mud ptuplwn to the Pm ns o(mc Comra<lors L tt Law( IChapm 9
tbm in s lice
SPu 9(gkjl, f D v limn t Dw,ines. d Pmfesnions Cade)
Icmm e c ng with a oRhe
he �s'exempt Ihcrtfmm'vnd me basis for the allcgeJ exemptbn. Any violation
or "athells
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;
-of Section ]031.5 by., a,Iinm for a °omit subjects me a,Picaau.. a rnil penalty'
'ofoolmorethan role hundicdamuam(S500).
372 YTY u'T4FO
1,•'•:u':,' Occupancy Type
° I. as owner of me property, or my employees with wages as their sole compcnmtion,
-
Will doilhe siIk' and the 11midure is ..I intended « ORCRa for sal (Sect 7W
eu. a naProfession, Cad Th C tmemr', License L d pply lm an
.
3 0 5 - FRAME Required Inspections i 'it'
rosam f Protein,, Who builds p s thereon, and who does such work himself
imptmv=me
307 I NS ULAT_I_ON
Or In gn li Ply P a a mat such t t ded or
proveentis old Mm one rear of
iofferedf )' If h w In Wilding or mm
- --
601 - ROOF TEAR OFF
completion the owner builder will have the burden or proving that he did not build or
improve for por,coe rnl=.).
602 - ROOF PLYWOOD NAIL
ri i.;°1:
-- ._.... _._ ...--- _ _ -.. enec—
as own=r aflhe pmPeny. sun exclusively contracting wit licensed contract.
-603'---- ---._..... - -...- - -
603 — ROOF' BATTENS ---I Hl �'�. .,, 1':i ItT,.: D"
construct IM1e Piojest (Sec. 9044. Business and Professions Code:) The Connector i
604 — ROOF IN—PROGRESS'"
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Li«nx I�w a«s nn, apply m vn owner mf pmpcnY who builds or impro,rea thereon.
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_.mi who contracts, f«_such. projects.wim.a.convaclnr(s)..licenud-p.rauum.m IM1e
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C minor is Liccmc Law.
Clam empt unser Scc',"' "!!'.B'&PCronhis muvn
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Owner,is r�,. ..,,,. Dac...
C.... WORKER'S COMPENSA'I ION DECLARATION
FINAL�®
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" 1 hereby affirm under penally of arjdry one of the following dechimaimm:
❑ I have and will maintain 'o'Ccnificur ofLCnnenl'to xIf-insure for Worker's
Compensation,- as for by s¢tinn 37M of the Labor Code, for the
OCT O gJ .•) Lo O�
-
provided
'performance brthe wed for which this pcorna is issurad.
57
01 lat,if xie ostatin W A s C np ns t n hmmrmnle, as rdimind by Se mon'
J900 he LeMircme f d Per nn of flow krwhichms .
l,UILDING
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.'b d My W k Conn mol mr, 1 a.m. earner and Polarle
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i'1�!'. ti1;iFkr 1!"' �'it.ti.,. 4lT�i.4
CER
,.,. TIPICATIONOF EXEMPTION FROM,WORKERS
.t .d
COMPENSATION INSURANCE'_-
:.°`a'(1Tlils'eAh�n 6cea nui x4mmpi8Fd aln<permit is r«mn<nnndrea emnars
ISIOONule
h ht f the oil f Ndt th pe 1 I. slued • I
I c rl 1.fY iI m te per rm c
•�'•1-1i _.I '' Sji '<t K)L`• ..
shall a. employ any'jierson n any mann _ a, Io become b.. to the Woikeis
Cmnpen:' I Law's of Cal r . Date
NOTICE TO APPLICANT If after invking,his Cent ic.,c ofE emption you should
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become .bleat thew rkN. C pensm pm "ns ofm Lahr Code. you .t'
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formovilh comply witti wch p to visions«th i s emn it shall be de mrsed revoked
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., -'CONSTRUCTION LENDING AGENCY
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Of t I hereby that Ih helm I q led g C ra tM rerfomidrice
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which v
_Lend work fornam, per I: . JIg'c 307 Civ.C)
Landes ". ....
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Namc
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LcnBer's Addrea-. "•.: .. ', r. �..:. n:• ..,
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1 smidly Ibm,l have mad thin applicmimn�aad ,are mute above infotmmion is,
dorm I. I agree to, cm ony.with all city had court, ordinances and pate lawn relming'
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,un,
m building eonstrbetion: and hdrcby 5mhoiiu'rep .natives of This city la enterPn
is
me idbov,r immoralp ,dy for inspectionPipost
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IBI gre Im sa a ndcom ry and keep ha st the Cny of Cupemnoa`gaitut
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Iii l li 1 dg �, c I and cxpc .ea which y, any y accrue against said)
City in 'e sea }} Tin nrng orPermit.t
of�
'APPLICA I fL S DSAND WILL COMPLY'WITH ALLNON POINT"
Issued b
DaleDial
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Signal bl AppIRabVCo (cl �'i : %•, i r ."': Date^, i ;.
Re -roofs
'at HAZARDOUSMATERIALS DISCLOSURE
Nllthe applca I«ILmre WRi goccunion slmle .Bandl halallou mi",
.. Type Of Roof- .. - _' __...___,._-..__ _-'-_ — __--
sdefined bytheCupen M.d (pal Code Coolant 9.12. dlhc Health andSafety
Cme) 255321¢)
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I` t "� Vc * 1i
❑Y 1' 7°N.. f'1 J . YT't)' rl�pt t .t
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All.roofs shall be.inspected prior,to.any roofing material being.mstalled,___ -
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,,: Will thepPI c s rt huf la g pat equip devices which•
If a roof is installedwithout first obtaining aminspection;'I ogre' .to remove
a Y Y Quality Management
m h N . m ,. defined .I .I B Aiea'A
o aVlcl
,
all new materials for Inspection. Applicant understands and will ,comply, with
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all non -point source regulauons.h, ,. I
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1. t 1 ha has under Ch 695'of the
t ,
rdmu.i maicrial, req. remeru
a pre
rcad'lhe
Califgrnin Within,k Safn3� Cild6 Laminas 25505,25.S33 and 25534. 1, understand lh.o
_
llyytlhhe bulldm of currently h e ¢ t mat I s yre,s bltyt notify the
of Cent ficate
/occupant uiremems wh ch'must he m I prior toissuance of a of
imc
Signature of ApplicantDate
All roof coverings to be Class B" orbetter
7. , I, "at .,
oli m. atnari:mag I 7.
OFFICE.......--,.