00090185 (2) CITY OF CUPESION O CONTRACTOR INFORMATION:
BUILDING utvtsu>" PERMIT
BUILDING ADDRESS: PERM If NO.
OWN12R's NAMI'617 PEACH BLOSSOM DR WOODS ROOFING _ APPLcrcno
I'°DNI'"' GRAY LARRY D AND CAROL A 1020 HICKORY CT sAaITARY N( c � rat
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ARC
(831 1 637-5576 .DING i'LBN11'I'INP(l
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LIC17NSIiDCON'I'RACIOR'S1l1iCLNlA'I'IGN fob Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
.f-w with Smtinn 7lNlt)nl Divixim3nflhc l3u,incex unA l'mtcsninns Cock,unA myiccnnc
is in full fore an �}
ac m¢ I.icmm,e f�lp�5
0""'a )"° 30 FELT & 40 YEAR COMP SHINGLE
ul ARCIallba,., .hire
NION
g 1 undersmnd my plan,,Fall be uuJ az public rcroNs '
Lmen,ee rrre,tnral
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O0
OWNER-BUILDER DIiC1,ARA'1'ION
W u. I Intent a firm Ilium 1 ran asempl from the Cadmium,',License law for Ilia
C=< following comm.IScctiun]0315.Ratio—and Professions Cod,:Any city or county
-O which"mines a peold in consimc,altar.improve. ImliQ,or mpairany structure
3 it 11)I Ino In, pidandl It nuan,fife :g d:tatement
thod he is licensedp"'m todo,pm "ol he Contractor,' L Low(Chapoe,9 Sq. Ft. Floor Area ",Valuation(ammncnemg with SeatielI 7(NNnof Dlr,aen 3 of iliaHnsmass and Pma,,inm Col.)Ina,be ks c,amin therefrm cad the has,for the auegad asamptlon.Ads violutinn
of Seetinn]Ba1.5 by any apPraesam fora pamdt,objects me applicant m,a civil penaltyAPN Number of nom more Nan five hundred dollars($5110),01,as owner of ILe prpardlormy employees wllh wages astheir,ole compensation.
will Jo Ilia work,mW the atrcmre i.nut intended lir offemd for sale(Sec.7(011.Business and Protestor.Code:The Contranory License Law due,not apply to an 3661 1 1.43.R-squired Inspectio
u,narof properly Who hodd ar Imprmen Thereon,and who does wch work himself
or through his own employees.provldead!Ina,such impmvamcns aid and intended ur
obared for .IT,.If,however.,he building or impnavamen,is sold within one year of
nmpletinn,the,,wner-bulhler will have Ilia burden of proving that to did not band or 305 — FRAME
atprnve in,p,ttpey,afsatel' 307 — INSULATION .
❑I.a.owner
nnhcpropeny,ad
rae. mtvelycontractingxsthh ,m
e9nsedeomnr,1. 601 — ROOF TEAR OFF
rnswm heprjea(see.7w4.Business and Paofeasmas Cndc:l r1,e Contractor's
License Law too,nut apply to an awper of pmlw•my wno buimsnr imprms,hercnn. 602 — ROOF PLYWOOD NAIL
amt no e,tltmel9 fn,wen noplas wilt a comma(,) Iieetwm m
ad on,unto a
Cmnmetn,.Lic...aLaw% 603 — ROOF BATTENS
0 l am eaempl code,sees H k It C tm Ibis re:awn
Owner Data 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION
1 herby affirm under penally lir Perjury one of the following declatalimw:
7 1 bare and will maintain a Certificate of Consent to>elf-in%mm for W'orker's
mnpenwton, as pnwided rod by Scrim, 3700 of time Llnnr Cut . for time
rfhave an of the wnd fnr wM1ieM1 tM1i,permit is i...ed. U
I
haveand will maintain W,rAcr'a Cnanpcnm,ion Inslmntt,as required by Section
7tN)of the Lonor Code,for the c,funnmme o1' he work fnr wham this Pcm,Il is
It sued.My Nor ,mp1en.auonJlvsarancc asoner and¢Po, ,,number are
CartieerJ"^tet-Policy No.:
CCR I'IPICAI ION Or EXHMI'i'ION FROM WORKERS'
COMPENSAr1ON INSURANCE
I'Ih
is section need nm be completed if ermit,he pis tor one hundred dollars
($IINII lir Ic".)
I"Idly Ilan in Ilia'11loo carte of the work For which this permi,Is issued.I
mall no,employ tiny parson in any manner so as,o become subject to the Workers
Cnnapcn,alinn Laws et Calil,dies,hate
Applicant
Not CE.10 APPUCANP:It..ahcr snakingthis Ccniti,dae of E.aemptinn,you should
become,object I,the Workers Cmnpensation prri,i,na of the Lunar Code,you met
p fnntwim enaaahly with sad,powiv....s or Ida p<nmit hall lie daemed re,uked. _
F _tea CONSTRUCTION LENDING AGENCY
0. > 1 hereby affirm me mere is a cunswc.mmi Iending agency forte padLnnance
of the work to,which mi,Ie,mi,i.Idamd(See.3(19].Ci,C.)
0.. C Lendeh Name _
Z Lender',III
U0 1a lly t-tibase need this ppint ..I]wand tht,n ba r er
m F.
correct.I s t comply with all city d county r c,anti slate l refining
OU ,nNoe-constructo Ihereby a' p ,t -:,ran ctrl t poem /Zy/
y n
lime d —tor. Iy f p I , 'ma's
L✓ Rs (W) li , J fy Jk ph I., a Ca 1Cpen 6 _a
y City hies.Judgment.,coos and expo lie,which nes)an any w. .moue ages list said
V z
City in cnn,equence of the wanting of this permit. ♦, • � n r
APPLICANT UNDERSTAND LCOM WITH ALL O I'O Issued b Jr`—)A' CO Date
SOURCE REGULATIONS. Is
y'
Signature lir Applicant Indictor — /l u�/re Re-roofs
HAZARDOUS. AIEHIALS UISCLOSUItIi
Will n,e:,ppliealmt lir faire nodding r.e,pam core lir Handle ha,conn,mdenal Type of Roof
as defined by Ibe Cupeninu Municipal Code.Ctapacr 1)12.and the Herllh and Salary
Code,Section 255720111
ora, 01 � All roofs shall be inspected prior to any roofing material being installed.
Will ilia applicant'it bourabi'aIII e•—iniaaluse e9nipmemmdevice,whilh If a roof is installed without first obtaining an inspection, 1 agree to remove
snit hmmdou.air Contaminants; by the Bny Arca Air Quality Management
�i.Idatr 1/ all new materials for inspection. Applicant Understands and will comply with
0"s 0N all non-point source regulations.
I have read,he hasaMnua materiah rtduiremmnms under CM1apmr 6.95 of,he
d,the rnia health F Sandy Code.Seclmun 25505,2553?anti 2534.1 nnJarsmnd mal
tithe luailding does nm curfenty firma ocmmA thm it is mY......ibility to nmifythe 2 9 a Q
eeupant ol'mc rem n I, hiuh oma be Incl pram as mu.uue of m Ceni'caac or
"".Pavey di Signature of Applicant Date
ownern amn,nri,eda ail All roof coverings to be Class "B"or better