00070154 (2) CITY OF CUPEMI'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; PERMIT NO.
OWNER'S NAF: API'LICAI'ION SUH DA'Z'E
X7.31. SCOTLAND DR CIJRT FLETSCHER ROOF NG INC00070154
PHONE: SANITARY NO CON'IROI.If 1.
SALO LARRY M AND GRETCHEJ M 354 MONTICEI-1-0 AVE 07/24/2000
Z ARCIIITISCr/F:NGINEEH: '
BUILDING PERMIT INFO
°
(408)267-2679 BLEIG ELEICT PLUME MECH
xw—
��� u o o u
a
LICL'NSCD CON9RACTOR'S DECLARATION
S b nerahyamenana,tIaa„IieenwdunderandPlleInallCharter te9fe -en,g lob Description
,��� wnlaseeainn m(roJ Ime nnnn,mm cal rmre,nim,n Ito
¢—ice Ix in toll farcca crfahta
x a, ]-Iran.•Clau Lic.N--J—+!�_
D.nc Cunwucmr_/l
++3' HI'I'IiCT'S DECLAHA'f/ff0.1N
g Iandemm�amyplin—Imlheused asPublic mcnNs SHKAE TO FELT/COMP
e 5
e be p O Licensed Professional
m OWNER-HUILDER DECLARATION
y m m 1 nembe affirm that 1 on exempt from the Contractor:,License Law for the
F•Z Y following reusan.(Section 71131.5,Eusiness and Professions Code Any city or county
fF0 which requirt a period construct. II -on,pone.deroolkh.Or ot' any t arc
at Print'Ili IN 'I. I thicappintlarl II 'I In II 'g t Ltce .
c. motet 1 v I CiaWd1, n p III Ili,e h',l' eL, (waver9 Sq. Ft. Floor Area Valuation
or is e imps dua 711f and ev m 3r t the nae n option,Anes,v vi lotion
of Secy ho is 31.5 b tang applicant
p dual and the nuns torthe alleged exemption,Acv l Penalty of of more
a than by any dred d ll fora permit mblau the aPPlicam to a civil pcnaly.
m nm mom man Bxnhammddnuan(asuu). APN Number Occupancy Type
❑1,ax owner of the pmpeny.or to,employees with wase.ax their ole eampanudon. $6800
will Jo the work.and the structure is not intended or Offered for rale(Sec.7tl44,
Itunnexs and Pn,ressions Cia c:The Contractor s License law Aces not apply to an Required Inspections
,wnar of property Who bndib;or ireprovuv thereon,uad who arca-roan work Eno,If 36226055. 00
,it nn"ugh his own empinycex.pmvmed mat such Impmvanetns are ant Intended or
nlfercJ rnr sale.11:haxever,the bnnding or impmvumem Is sold within One Year of
cnanpl lor.the owncr-hallilcr will III holder oI pvl
mcg Ihn
t ha did oIII o
t Illi lr
imvm.efor pur,se11,1 ). 305 — FRAME
❑I.a,nwmerofthe lonfu .amev,hovelycenumctmswithhaensedIntoner .m 307 — INSULATION
nnuct the pmject(Sea 7M4.Business and Profession,Cale:)The Contractor%
im
�iccnre Law drc,not apply to an owner of prepeny who bund,or improver thereon. 601 — ROOF TEAR
OFF
-
and projects With a counterlicensed pursuant m m`cce ;Nm
602 — ROOF PLYWOOD NAIL
❑1 ran ex rapt under Sec. ,H as P C for this reason
603 — ROOF BATTENS
Oxnu
WORKER'S COMPENsnnONDIiCLARATION 604' — ROOF IN—PROGRESS -
I hereby allinn ander Ianally of lx inrr one Of me following declaral I,:
C I have and will provided
f Certificate Se ti of Cor370) Of
m Labored for Worker's
Cnanpcn.wtinO he provided for by Smit JiW nl tM1e Labor Cale, for the
perfnm,ancc of the work for which this permit is issued. ('�f
O 1 have and will maintain Wnrkcr's Compensation Inmrdnee,as mquimd by Section V(
7711E of the Labor Cale,iia the perl'onnance Of the work for which this permit is
wed.MyW rker' Cnrypanwlinn nwrunce carrier d Policy number are O
\_ m^r mph /,'�
PnlicY Nth`�p V
CI:IZI IIICATION U'C%EMPfI a PROM WURKEI S' f• -
COM1IPENSSriONINSURANCE
(This taction need not be complcnd if the permit Is fin one hundred doll.
(11100)or)ess.)
1«nify that in the pri fnnexacr of the work for which this varrat is iauad.1
shall not employ any Penn in any manner so as to become subject to the Worker'
Compensation Lows of CaLifnmia.Data
Applicant .
NOTICE HO APPLICANT:IL aper making Ibis Cat if icatc of Iisemption,you should
Ae,i n o object ea the Worker',Cnmvea,d in pmvisinvs Ol'the Inthor Ct,ve,you vast
O O li,nhwith cnniply aim such pmv'snaes Or aei<permit shall he dcaned revoked.
Z Vl CONS'I1I1UGnO4 LENDING AGENCY
a > 1 heresy ummvhat there is a caro uctiom lending agancy for the performance
fine work far Which his Permit is issued(Sea 3897.Civ.C.)
y Q Leader's Name
Z;) L Lender's AJJmss
V O 1 ratify that I have real this application and state that the above information is
fm trr aarrect.1 agree to comply with all city and county ordinance,and%late laws relating
laildo,,or,loaction,and anA,' th p fi 111 . ayt,,ancrupnI
r„yj die l ( I p tp aYOr I........
res 6t (W)agree I(I laws.indcaninty andkeep l I vs tire City if C p t .k ma00
Vl luhla ..d,reens. ou1 r,,na,,which may in any way invan,a, int said ` l��
C"Y m causes e e of ahs gm, ,g n in,perm t. \/
APP ICA ON N AND WILLCOMPLV WITH ALL NON POINT Issued by: Date
7-Z�1' if
sioilgnal nrAvph n Brame Date Re-roofs
HAZARDOUS I MATERIALS DISCLOSURE
N511meeCanar orfutureCo e,Chapter
Nomor and the Health
Safvtl Type of Roof
i dc.511 by the 321 a)'nn Municipal Calc,Chapwr 9.12,and the Realm anA Snfcry
6Mu,Swtiun 255321 a)' '
❑Yen 12 NO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orltnnmbuilding uccavan uo, cimdevice,Which It'a roof is installed without first obtaining an inspection. 1 agree to remove .
emit ha,arl air contaminants as defined by the Hay Arca Air Quality Monagcanena
nislriac all new materials for inspection. Applicant understands and will comply with
°t'°r ON. all non-point sou gu ations.
1 have real me hmurJous materials requirements under Chapter 6.95 of the /
aha buil Hgdoes Safety Cale,avea leant.that it
and 355W.lundenwnd that
of the building does not cut
have n team,that it it my re.Nmnnihility m amity the �!L
meatier of the requiremena which mast be met prior m issummu of a Cenilicaw of
Oceapuncy.
Signature of Applicant Date
0Dw'Na'it Ian:ml.ed ition uam All roof coverings to be Class "B" or better
OFFICE