02050152 (2) CI BUILDII,NG DP VISION O PERMIT CONTRACTOR INFORMATION:
1WI,DLVd1RESSLM AV RESPONSIBLE ROOFING INC PERMIT NO. 02050152
OiR PHILIP P AND ANNE E 2882 SPRING ST AUTfnF2I
I,1'IIONE: (650) 969-6151 SANITARY NO. CONTROL NO.
o a z ARCHITECT`ENGINEER: BUILDING PERMIT INFO
r O O BLDG ELECT PLUMB MECH
z
LICENSED CONTRACT'OR'S DECLARATION
'S y`, I h«n conn mat 1 as ncen.Id order f Chapter 9 ummmenein lob Description
jz_o roe 'pmvi.l°n.o p g REROOF
11 with Section]0001 olDivision]of the Bas}essand prrreasions eode..na my Runs` T/O EXSITING ROOF, APPLY NEW 40 YR COMP.
i m 5; is in fun r rc 'I Hest. 'tJ(
re0 n U Lifers p
D Con had
riA IL
l LLO In ARCHITECT'S ARATI N
1 understand mg plans.Foil M1e used a.p lie iwmd.
Y
3 S o O Liccnud Profcxsional
oOWNER-BUILDER DECLARATION
y
_
I hereby M.that I am emmpt from the Comnom's License Lew for the
r?n Billowing reason,(Scotto]onto Business and Professions Code:Any city m county
adr a which requires u permit to cnnstma,alter.improve.demolish.or repair City structure $12000
to prior t ane also recures the applicant for such Permit fl signed umment - - - -- -- - - -- -- ----
_ .
Mi
the
snues
(Ch
(com :I with pursuant Division
3 o Ce Business and
Lapter 9Coe) , S,q Ft.,Floor Area,, qq �,•, Valuation
Icon 6 alk Section 7000) the
nor the alleged
eiProfessionsCode) r s ..rf.Is', „
or that he s 31.5 b any p,lue ma the bash roti the subject,
he exemption.Any violation 3'S 7 0 4'0 6 2'`0 0 .
Is'—
of Sectionmre ban by anyapplicantfor apermit subjems the upplicam toacivil penalty
rrnot
mare than rive wna«e cruors asoo). APN Number P Occupancy Type
0 L as owner of prompt or my employees with wages as dmh sole compensation, 305 — FRAME
will do the mk:and the swemrc'I,not intended m offered for We(Sec.nHa,
Business and Professions Code:The Contractor'Liccnx Law does not apply to an nspections'
r or porosity Who wild,or improves thereon,and who does such wore:himself 601 - ROOF TE
owner
his own employees.provided that such impryvemcois are not intended or __ 602 -- ROOF PLYWOOD NAIL.-- - --- - ---
offered for sale.Jr.however,the building or ielprosemrm is sold whin itone year of
complain,the owncobullder will have the burden of proving that he did not build or 603 - ROOF BATTENS
improve for purpose of sale.).
. 604._.7 ._ROOF.. IN=..PROGRESS ._--- -'-"- ----
01.as owner(if the progeny,am exclusively contracting with licensed contractors to
construct the project(Sec.70a1.Business and Professions Calc:)The Contractor's
License Law does not apply to an owner of property who wilds or improves thereon, -
_.unJ who.contructs fm-such p«)ects.wid,a comracum(s)licensed pursuant m.the ... ... .. .. .. . . ... .. .... . . .. . .. ._._...__ _..__.. __.. ..._.. ,__.Con Mrs License Law.
0 l am exempt under Sec. ,B&P C for this ration FINALE
. . FINN E
®
oDamwer _ WKER'S I
COMPENSATION DECLARATION O 2�OL
.' Ihereby affirmanderPenalty ofPerjury one ofthe following declarations: JUN
0 1 huv'e and will maintain a Cenificatc of Consent to self-insure for Worker's t,
11�J
Compensation, es provided for by Section 3700 of the Labor Code, for the BVILpgt�.7�7 f`�
Txrformwife work for which this permit s issued. ��VV
01 have and will mainmin Wod.ers Compensation Insurance,as required by Section.
3700 of the Labor Cale,for the performance of the work for which this permit is
issued My Workers Co�qpe [ Ins.0 re 111uhe,number are
rr,ei OT CN Pol
:. CE tTIf LCAT PI IONhROM WORKERS s � v" i4 i.,. t ' .1. .o- (•'a.'A.1 t s ,.
COMPENSATION INSURANCE " -.•_,,_- __
'(This section need not the completed if the permit is for one hundred dollars " ` s '
IS Hill or les.)
t
. .' d e
I tnthat in the performance of the work
.,''y. herfo 'mewnicn this permh mares,'
ihall,mm employ any person m any manner an as in bccom<subject .,,he Worker'
CompcnsLows ol'CaLrmmia:Date
,Applicant , '
NOTICE TOC,n.to AM:Ir,Cmrmakintor rCisic.,fth,of Emmption.dyou should
Most
hcomesicomply the Workers Compensation provisionsll the Lowr Code on must
0 0 (o nnw'rtti'c°mply'x'itti such provisions or this permit shall h deemed revoked.
rA - 'CONSTRUCTION LENDING AGENCY'
> 1 hereby affirm that Them is a conxwction)ending agency forme perfoamnce
W
of the work for x_hich this Permit a issued(See.309).Civ.C.) "roe s .... . . I ..... . ... ._... _.. .._. _
Larder's Name - .' -.. . .. .
=.Z finder's Address
C.)
0 I cantly that have reed this application and state that e the above information. i.
cmmet.1 agree to comply with all city and county ordinances and state laws relating
[) to building construction,and herebyeuthorize representatives of this city to enter upon
the shove-memioned properly for impection purposes,
(We)agreem
to save,indemnify and keep harmless the City of Cupcnimo against
V1 liabilities,judgments,costs and exist which may in any way accrue against said
f.) .Zs City in consequence of the Counting of this permit. - f �J V
APPLICANT UNDERSTANDS AND WILL COMPLY WITH NON-POINT 2�i
`- s URCF. UBATIOYS.' .. _Z,j Issued by: Date
G� Re-roofs
,ftnate«of APPlicanVComranor •.. Dae. .' .
e _ HAZARDOUS MATERIALS DISCLOSURE `
. '.ar I pp0cautarfbthrewlldmFhcupantmore orhandle kSnrdousmaterial -Type.ofRoof ..- .. . . .. ._._...
O Yes v - n no Mun I Cale Chaps 9 12,and me Health said Safety - -
Cale Seaton 255321 ) '' " s
a ymecupe . t r ' . All roofs shall be inspected-poor to any roofing material being installed.
WTIth ap,l t r Mingoccupant_ -seequipmentordeviceswhich If a roof is installed without first obtaining an'inspection, I agree to remove
smith rd iramtdm'n run
the Bay Area Air Quality Management
Dist �t all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.,
1 ha<lor
d, the ham does mat riot r q .rtmenu unser Chaps r e 95 of the l�Gf
Calf a H hh&Safety Code.St ns 25505 2553)and 25534 I understand that
tithe building ng does not cumn0yh <em t that t myrc po bllyt -notify the
Fic p t f the ecida ms which est be' t p o m iss are of a Certificate of
°" p y Signature of Applicant to
5-L
<<.., w I or aun,onxee agent r.: . , , , Date All roof coverings to be Class "B"or better
a.
:.
OFFICE -.