02060069 (2) TINO
CITYBUILDING P ISI
C UIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7774 OROGRANDE PL ROCKWOOD CONSTRUCTION CORP. 02060069
OWNER'S NAME: APPLICATION SUB DATE
TAT NATRAJ 248 BELDEN DR. 06/12/2002
rHONF.: (408) 227-7999 SANITARY NO. CONTROL NO.
Oma ARC)Ill FCT/ENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
BF-aa
O H Z LICENSED CONTRACTOR'S DECLARATION
1 hereby alarm tint 1 n 3 of
B sides provisions oof tos Code.
and mmecense lob Desert tion
w;in soniormaBl of Dis,mm�3nr me Business and rrmesmnx cone. dray license RE-ROOF FINALES
:- in foil force and c� �(�,� /_i�
:m .Data Class Lia.p
:D a m Date L ,
3 3 0 F-" - ARCHITECT'SS DECLARATION n 2002
RATION SEP 2 J
.'=°g 1 aaaerstana my plans snml x used as public accords
J
I A,
O O Licensed Professional
A. Oat I AM BUILDER DECLARATION BUILDING
Ada Q-'
KI hereby affirm Iha ora exempt from the Convector's License law for the
1-a< following reason.(Saction 703 1.5,Business and Professions Code:Any city or abo my C 10000
5-o which rtquius a pem,it m consumer,alley,improve,demolish,m repair any mucmrc Y
i3m Pdo tots h; e,atm requires the ,pliant for such pcmau File A Ai,A,dstatemeni -- ----
that he is licensed puhuant t the pro (Chapter 9
innim. theceBusines and v g FtI , , f , . Valuation
lr ,that g ilpSeatde roman ro'bamnor the a Bnxmex ai rxnnxilMom
or that Be is hem P7 tbeiefrpli and for basin for the ct%the eaemptinn.Any violation
,of Section,than by any Applicant for a permit wbj¢ts the apPiicam to a civil penalty
,,if nest mine man Eva hnnarea dollars fasntl. 3 0�1PN I�u�E Occupancy Type
❑h as owner of Ne property,or my employm with wages as their sole compensation,
will do the work,and the structureisnot intended of offered for sale(Sec.9644,
Business and Professions Code:The Contractor:License Law d«s nm apply to An 601 - ROOF TEARqubWnspections
owne
r of property Who builds to imprnves thereon,and who does such work himself 602 - ROOF PLYWOOD NAI-L-
,
nr ihraugh his own employees. Wilding
that such improvements arc not intenear or _- - -- -
R red for sale:la however,the Iry Iden or improvementfpois n sola thin one car of - - � '- -- -� - _ .. .. ._.. _. . .. _ .
�Pmpreean,one nwmer bu lacy will have me namr proving mm he dies not wiles nr 6 0 3 - ROOF BATTENS • '
improve for propose mf ale'). 604 - ROOF IN-PROGRESS
al - . ..
❑l,asdwnernfthe �n',am exclusive( trvetin with licensed cammeors to - - �- - -- - -- -�---�- --- --- -
p(Sec > ycon gwt .
instruct the does
(Sec."11144.Business and property
who
Cuae:)The improves
thertor s
eon,
License law docs not apply m an owner of pmpeny who builds ceimproves thereon,
and o contracts fopsucn.projmu ammnorts)licensed pursuant.to d,e . ._ .-_._— .__.._ _ ._ __._......____._. _ __L_ ..with a c
C cors License Low.
_ - lam cscmpt under Sec' ,B&P C forthis reason
Ownc 'Dine
WORKER'S COMPENSATION DECLARATION
1 hereby nfhm,sneer penalty of perjury one of @c fallowing declarations:
❑ 1 have and will maintain a eeniecata of Consent to self-insure for Worker's
Compensation, as provided lot by Section 3710 of the Labor Code, for the
'performance of the work for which this remit is issued..
❑1 have and will maintain Worker's Compensation lmormiee,as required by Section
37W of the labor Code,for the performance of the work for which this Permit is
issued' „ „ Insurance carrier and Policy number arc:'
- - MM1WorkersCompenutian lusoran
,.. ... . . .. _ .. .. _.. .. .. _. . .. .. .__ . ....... .-. _.._._ __._.___.
-' Cave ,{ L ' •` Policy No.: ,.,,..t ., ,,; ..
s 7, CERTIFICATION OF EXEMPTION FROM WORKERS'i t.s.%.'c !;• •• +t/ V t {% c•l � k
COMPENSATION INSURANCE
mis section need not be completed if the permit is for one hundred dollars
100)or less.) .
I ify th fInm I A ref f kf hch ih perms '..0 J'1
shall of employ a ypc y y 'n i m )eat ,,hLLW rketi `
-�\ Comre a on laws of C Bf Dar
d� "
_Apel c
NOTICE TO ct to .}�g n i f E bort n ,you m lst •a '
z mcom subject to W k C p resat provisions of the Labor Code you must
Q I'onh lh rnmpi'wlth su h p n'.'ons ooh.permit shall be deemed revoked.
z Q
HVi +'•' CONSTRUCTION LENDING AGENCY t '• '
; of '' 1 hereby affirm that there is a construction lending agency for the performance
the work for which this permit is issued(Sec.3097,Civ.C.1
� Q Lender's Name.. . . . ... •...•'. _ _. _ . . . ._ _ _ _. .
7 z Lender,Address _
V 1 eerily that 1 have read this application and state that the above information is
4T+`[-t correct.1 agree[do
,comply wiiM1 all dor inti ttmmy urdinnnces and state laws relating
QT,) tto he aboie-mentionedoopertycrcinspecby onuapasematives of this city mcn¢rupon
�. W the above-mentioned ianed pma:ny mnity And k6 p WMoIA,
I lY aW.j agree m save,indemnity and kap harmless inc City of am ertion against
.rA liabilities,judgments,costs nes expenses which may in any way accrue egdnsi acid
fJ.� City inconsequenceth ranting this permit. 2,n
ANTUNDER
SOURCE REGU "SNUS ANDD WILL COM WITH'ALC'NON-POINT Issued by: Date
U
nmr
HAZARDOUS
^Date ,t Re-roofs
cHA]1sRDtU5 MATT ERIALS DISCLOSURE
t
Will by ,C.pam o Mfutn.1 CWA..Chapter
r 9 12..a lime H.Im us Safety ,Type of Roof -
asdOSial
edbytheCupent M 'circ(Ccvfe Chapter 9J2.a and he 11 hh and Safety -- - t
Code Section 25532(.)? �" s 1 :i}r '\ i,,�' ,y ' ,• � ' "
ovaa -:•- ' ?. - - All roofs-shall be mspected,prior to any roofing material being.installed.-, -_ ..__
W i m ppl'ca t r t Ba la g w
or use equipment or devices which If a roof is installed without first obtaining an Inspection, I agree:to remove
nit Wabodina,x,contaminant fined by the Bay Arca Air Quality M gement
uxm t all new materials for inspection. Applicant understands and will complywith
1R'; ❑Y x No _ all non-point source'iegulations. ,
1 have'r..d the hazardom materials requirements under Chapter 6.95 of the
California Hialth&Safety Cade,Sections 25505.25533 and 25534.1 understand that
dibehuiiaingdoesnot curremly have a¢nant,that it is my responsibility to runty he
occuphnt of the mqui Ann which most be met prior to ivauance of a Cenlfcate of e
oanPaner Signature of Applicant Date
ras a agent - - Data roof coverings to be Class"B"or better
amer Ad 'OFFICE ..