01120039 (2) ceO DIS
P ION
BUILDING PERMIT CONTRACTOR INFORMATION:
folb�1a1gR1'Ss'`TERLING ROAD CONRAD ROOFING SERVICE PERnfll"°' 01120039
0SK15TI& YEATON 332 PHELAN AVE AP"AJIffry b1
(408) 294-7615 SANITARY NO. CONTROL NO.
a z 2 ARCHITECT/ENGINEER: BUILDING PERMITINTO
C BLDG ELECT PLUMB MECH
=3 L__1
y
LICENSED CON]Rd under S DECLARATION
rcby0)ofor I am worn3oansmuodesandPlansafnsCode.andmmenethg TEAR-OFF TARR G A �;pt19°NSTALL PLYWOOD & S
wl-Jwith Section 7(IOO)of Dirisinn3Of the RminessanJ Professions GOJ<,anJmylicen¢
is in lull force and e[[[[[[rect. 2/
:o W V License Clesz Lir.a i f
3 a to Dam fL-/ — contractor
ARCHITECT'S DECLARATIO
C I undersand my plans shall he umd as public records
.non
i n Qp O Licensed Profexsional
as OWNER-BUILDER DECLARATION
usi="- 1 batch,offimm'het Ian xempl from the Contrucmis Llpnnse Law for the
!'z following reason.(Section 7031.5.eBusiness and Professions Code:Any city or county $4400
which requires a permit to consBua,alter,improve,demolish,or repair any smmrim
is
prior to its unince,alsorequires the applicantfor such Permit file asgned statement ��y
thaih licensedpurt athnd lop- .ons of theCm I iLcense Law(Chaprer9 39 P6 OWW p.t*d11 - Valuation
(eontnonen,wah Seclon70f1010fDi,wio 3n fine B.,ma,,mdPmmss.m Code) s;T, }; t.: }s I•�:, ;
or trial he is exempt IM1<refrom and the basis fa the allege)exemption.Any violaion
of$anion]than
1.5 by any hundred
dollars
o l l fur a permit suajmts the applicant m a civil penahy
or nm more than Bve wmeeea emlars(ssw). 3 0 9.PId NiRkME Occupancy Type
❑I.asownerelperfect,.,crynnployeea»sthwagaasathebaalecampcnsaaon, 307 - INSULATION
,id do the work,and the'emmwre is are'i mended or offered far sale(Seo IDii,
Business and Professions Code:The Contractors Liecow Law does not apply to un [ions
h
r of property why boa.m i.. ....rohereon,and who duct aarn work him, f 602 - ROOF PLY D I A>�L
or t
or through his own employees,provided n Thal such impute is of arc not the 0.,or
-orrerea I.,stile.If,nnwevn, Its Wilding .... I i>sold aimi�one. r - '60 3 --- ROOF- BATTENS. .
g nr„npmvemen near o ;...
completion.the owner-builder will have the burden of proving that be did not build or 604 - ROOF IN-PROGRESS
improve for purpose
sso»'ner Of the ".. .. -
co L property.7,am Business a conwning with licensee C.O nors m .
License
nine project(Sec.]lain Business and Profession,who
Code:)The Contractor's
License Law acts not apply loan owner of property who builds or improves thereon,
and he commns for such projects with a<nmractnrR),IiceroeJ pursuant ..,he- _ _. .. _.. _ .� _. . . __ ___. ... —. ._ ._._ _ _ ._.. __..._.
nse
01 ant veil ea Law. „JJII
❑Tum exempt under Sec. • ,B&PCfor this reason '
Owner Dwc -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cenificou of Consent to self-insure for Worker's l j
j+ Compensation, as provided lot by Section 37W of the Labor Code, for the G
Of.....0,0 orme wod for hch this permt-s I.mad,
❑I have and will maintain Worker's Conatemeflon Insurance. required by Section
37W o1 the Labor Code for IM Performance of the work for which this permit is
issued.M��Wo..r��k..e�1rs��Co((9¢.��pol . recta c 3dP,licy 0recta i
Carr er Policy No: Utz
. CCRTIFlC CO ENSOF EXEMPTION]ON.IINSURANCE'
KERS' -
_ COMPENSATION INSURANCE ..•.. � C ..�.. _...._.._..____-_._..........._.._.—_.-_........ ...___.,__.__�.__.__...._.._____
OThisscnion ncetl not be compineJ it the pennil is for one hundred dollars .'_I
s
ISI00)nr less)
" I caddy trial in the performance of the%'mk forat
watch this permit is issued�I - ... s .•L :,l I ;(�I„
shall nm em to anyperich any trtanner so is to became sob tel io the Workers '
Compensation Low,of California.Dare' -
NOTICE
-Applicant APPLICANT:If,after making his Ce � - - - - _ - - - -
Pp
noes of or Labor Caere,
you a mulst
Q Obecomehimuntmthe Worker's a loner ,tion Pa.itt hail the Labor Orosil must
forthwith comply with.wch provisions or this permit shall be JcemeJ rennkN, '
CONSTRUCTION LENDING AGENCY'
I hereby affirm that there is acomemCdOn lending agency for the performance
of the work for is Mich this pcmrit is issued(See.3097,Civ.C.)
(� tender's Name ,. ._ _. .._ ... .. . . ... ._
Z) Lender's Address
'U . I certify that I have read this application and state that the above information is
W F., correct.I agree to comply with all city and county ordinances and state laws relining
Q V to building construction.and hereby authorize representatives of this city to enter upon
r U] ;the abcon mentioned property for in...I....purposes.
rF. C. ("'a)anee to save,indemnify and keep biomass the City of Cupenmo against
'n lobll'tics.judgments,costs and expenses which may is any way areme against said
V z City in aonmgncnce of gamin fthiI permit. '
APPLICANT Ua' TANDS JILL C,OA1PLY WITH ALL NON-PONT Issued b r Dale / ��—
SOURCEREGUt y
Signnmrc nrA plic rocammct(oorr - 1 L Date Re-roofs /
IIAURDOUS MATERIALS DISCLOSURE s material Type of Roof
Will Ilppl'cam ar rut building p share handle hazard as defined by the Cu,se pal Code.Ch is 9.12.and the lie kh and Siroly'
Cod
oY a von'; All roofs shallbe.mspected prior to.any roofing material being Installed,..
N 11 th ppl ae t f t holding Occupant q pm nt n devices which If a roof is installed without first obtaining an inspection, bagree to remove
•
mil h Jus mat t d f J by theBay A A Quality Management
ria t - all new materials for inspection. _Applicant understands and will comply with
s`( Py No all non-point s ree ygulations, 1,
\_lP I h - J the h d } -mattruds requimencials under Chaplam6,95 of the
California Health&Safety Code.S ci ns 25505 25533 and 25534 1,underhand In.,
if thaIding does nal currt Ilvh un t fl t n. tyre p 'bill to nmtifylhe
oceupa t i f e eq tri t 'h ch mud be m i pan Io issuance f Ccnificare ars ! I
a`apa Signature of Applicant Date
r
Owner Or aathnrized agent Date All roof coverings to be Class "B" or better
. OFFICE.. . . .. ..