00110052 (2) CITY OF
NG DIVISION
PERMIT CONTRACTOR INFORMATION:
Buaulrvc nooenss: CROWN -ROOFING INC' PER`11 01. 1.0052
20260 PACIFICA DR
OWNER'S NAME APPLICA'1' ) Sy9DATU20O0
FRIEDMAN JOSEF AND RACHEL 21.4 CRISTICH LN �� ai
1W PHONE: SANITARYNO. CONTROLNO.
(408) 369-7444•
OOC ARCH I'rliCl'/IiNGINEER: BUILDING PERMIT INTO
BLDG ELIiGT PLUMB MECH
5z. — IJ LJ L]
a
FF z LICE hat inCONrRACrderp DECLARATION Job Description
Zm C 1 horsy aflinn ab:d I um llamas]under Provision of Chapel 9lnunmencing
,n l–ce with Seoul 70yonfDiv lxinn?nf the Buxine.sand Profession Coale.and my l lcvmc
i,illfaBmreeandeBael. REROOF OVER 1 LAYER OF EXISTING SHAKE WI
aoaClass Lic" SHAVE
nalC cDECLA t
w 3 0. ANCIII'I IiCI"S DECLARATION .
u
01
1 amlerxlaml try plan"hall t e vice,Publi'¢cord,
—`sur
an0 0 Liecnxed I''"Ic"I ml
OW NER.HHH.DER U17CLARNrION
ne o I her aflinn that I assn cxen,pl from the Comes, 's Linm,c Law t'or the
C Z a fallowing re ,.(Se,lion 7131.5,Hai and Probe. x Cake^.Any cil,o unty
f 0 which realm..aPcuoul u t alle,unpoove.dernah,h.orrepartin,,vothre
al
i3 m pnort si...anve,alko re,rim,the pN tl It fal file a,il,rodo.mmmal
that hoe ,licensed Puraoma due pri I(ho Contractor,L (Ch:mter4 Sq. Ft. Floor Area Valuation
Honnnenci ng wish Section 7100)of Division 3 of the Business and Professions Code)
.,,bar he ill compl thrrefrnm and the basis li,r the allcgcd laent,ion.Any s'iolation
of Semon 701L5 by any applicant far a perruit subjects thea mietm m it civil penally
of not mom than 6rehundred dollars a50t), APN Number Occupancy ype
01,ox owner of the prnpcnr•m my employee,with wages vu their w,lc mtnpmnsmian,
will do the work,and be s om use is oat intended or offered for sale(Sem.IIIBi.
liminmz and Proks,ions Cale:The Canhctor's License Low does not apply h an ` `s •equired Inspections
owner of Property Who hu h6 or imProvcs thereon,and who does such work himself
or through his even employ's.provided that such improvements are not intended or
oBcred for sale.IL however,the building or improvement is sold within one year of 305 — FRAME
im,mpletion.the not act builder will have the burden ofpmvia,that he did not build or
prove lot psapiof de.). 307 — I NSI-11-AT I ON
OLaxowner afthe pmpeny.ant exclusively contracting with licensed comments h 601 — ROOF TEAR OFF
Li�ve�to,Lawproject
rwaa°t appl(Seey to an owner
of and P„y%hit e�ads o�im e cat'hercuns, 60 2 — ROOF PI_YI400D NAIL
rP r crape rroye, I_
and hat cormel, for such projees with a eonlanar(,1 licensed pm,uam Io the
coal603 — ROOF BATTENS
la/x I......c Law.
elanr:tcxatotlarsce. .If&PCI thislea,on G0-t —
ROOF IN—PROGRESS
Owner Daae
WORKER'S COMPENSATION DECLARATION
❑ iI herebyauthor ander jacinally ofl rl Ytrue ot the foll g declarafikav,.
I have anti will Cerlifical Contain to"It-itoom lot Worker's
Carryenortion, as P , d d f by Section 3710 of he Labor Code, for be
pcdrnmultire work
For hish thisp,all,I,isd. .
01 have and will mainain Worker's Compcaemion Instance,as ove,onal by Scars.
371X,of the Labor Code.for the performance of the work for which this permit is f//
issued.My Walkers C.nnpcn.mion Insuhncen
carrier and Policy i m fiber are:
Polio ��/O/ .
CIiR'I'l1y1lON 01:FP icy EXEMPTION G' FROM WORKERS'
COMPENSATION INSURANCE
This section heed not be nmtpleted it the permit i,for one hundred dollars
($100)or less.)
1 clarify that in the Performance of the work for which this permit is issued I
shall not employ any Person in any manner w as to became subject to the Workers'
Compensation Law,of Calilhmia.Dam
Appllcanl
NOTICE TO APPLICAN'I1 IL ager mukiny his Cerihcae of Else nua...a,you should
hecome,nhjca m the Worker's Co ofemation provision aria,Labor Cock.Yoe namt
C 0 forb,,ilh unn,ply with such provisions or this penia shall he devoted revoked. -
F ^ CONS'1'eUC'HON LENDINGAGENCY
7 I heeby adlimt that there in o cunswchon leading agency forma,perforntnnct,
of the work farwhich this lx7mit is Issued(Sec.3097,Civ.Cd
Lender's Naaue
z 1<nder',Add...
V O 1 ecoify that 1 have read this application mud state that the above'mhrmation Is
;aa F correct.I agree to comply will ill city and county onlinaaces and stale laws relating
C V tohuilbrg cunsuuodan.wW hereby auhuri'rc mprecenlmmes of this city loaves union
ahovcmemam,al any'ry for inspection purposes.
t}•a 0�. (We)agmen, se.inderand,and keep harmless the City of C.Nmmugaina 1
Zi Iiahililie.s,judgnems,coca and expcams which may in any way accme against said 111
Cry ill of lue'nour, it Its
V APPLICANT UNDERSTANDS AND WILLrCOMPLY WITH ALI.NON-POINT
tRcI:REGULATIONS. Issued by: D: e
Signahm , Applicant,Conlmctor Date Re-roofs
IIALARIHIUS MATERIALS DISCLOSURE
W.11 flue zpplicont a Boom building occupant,tare or handle hmvdemo melerml Type of Roof
us derived by the Cupeniaa Municipal Code.Chapter 9.12,and the Health and Safety
Code.oYann 255]21)7 ❑Nss
All roofs shall be inspected or to any r ng material being installed.
Will the applicant lin t muco building occupant use equipmcm or devices which If a roof is insta d witho t list obtai g : inspection, 1 agree to remove
. cm it hounlous air croornilmr,us dcriaed by the Bay Arca Air Quality Manageman
District all new ma ria , for ins c on. A 'cant nderstands and will comply with
O Vas 0 N all non-po' t. urce re la
I have read the hazardous material,requirements under Chapel 695 01 the
Cliff is Halal A Saf,ty Cndc.Section"25505.25533 and 25534.I nndcauand shat ` k•,CJ� /L//v
oi,,uhuilif dance nut'erundy have a mama.the it I"any reparl ef'my m naily the
umeupnna ul IM1c reynl mem"whlelt nnant be n cl prier m issuunes of o Cartif ieum of
D"a9tan`y' 'tuck, Bf A pelican[ Date
O—wnem i•edgum Daae roof coverings to be Class "B" or better
OFFICE