00060023 (2) cl BUIoMc DPFRTNPERMIT
N°
BUILDING CONTRACTOR INFORMATION:
cc_ VARIAN Will PETERSEN BEAN lNe 0060023
BUILUIN IA) i... PERMfI'No.
7980 ENTERPRfSE Bm 2000
OWNER'S N x APPIAC6f t SUI r li
ONE: (510) 494-9982 SANITARY NO. CONTROL NO.
C ARCHITECI'IENGIN'EER: BUILDING PERNUT INFO
O O Ii ELECT PLUMB MRCH
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m i Lrro dem iD CDNTRACmR'S DECI.ARA'f1ON
0Inaehyaffut imlm„Recheedoins,,madi1 fics,fcnnmee (commercial, RE—ROOF Job Description
F,��a. whn Sectlon)ntXO of Divisiun3.f the Bn,incsanJ l'ndcs.irn,Cala and my license
in land l,,ree
o d Date 3/ov DECECLLor_O ——
ARCHITECT'S DARA'1
1 understood my plans shall be used as public records
W
io 0 1�at„ed rrom„hinaf
OWNER-exempt from
RATION
a ^— I naso math,that 1 a exempt 1 sup me Contractor's Any C law for me
{_ G whichfollowing reason,Ierout l IIIJLSCBnainer,and I'c,dcilons Cafe:Any city lir county
I S C
which rcqulrcx n pcnnit In mnaruct.:Jtar,iinhrovc,dcntnli..h.or repair any srunum
ce
i3- 'hammiacensedca6o rcyulte provisions of
for wchpermit Liecow Law(Chapter Code)
(it
Sq. FL. Floor Area
(commencing with Sermon 7(X1anof Division J of the It alleged
ex and Profession,Cold
or that he is exempt therefrom m and the basis for the subjects
the exemption.Any violation
of Section 9811,3 by any roof dui for a pcnnh,nhjcea the applicant n,u civil penally
of mor more man foe naadrm dollar,tg30gn. L ffl -5• VIP Occupancy Type
01,as owner of the property,or my employees with wages a their sole compensation.
will do the work.and the Nructurc is not intended or offered for.sale(Sec.'nus. 305 — FRAME
li-ine„nm1 PtoEe,,mox Cala:The Contractors Liceno,Law docs not apply to an ey�ired Inspections
orr of property who baud.or nnprov s meroou,and Mon does such wo,k ri—elf 307 — INSULATION
through his own employee%,provided that such improvement,are oat intended or
uttered for sale.If,however,the h riding or improvement is sold within one year of 601 — ROOF TEAR OFF
completion,the owner-builder will have the burden of proving that he did not build or - -
h,provefotporpn,uofxeae.1. 602 — ROOF PLYWOOD NAIL
01.as owner of property.am exclusively contracting with ucenxed commetors to 603 — ROOF BATTENS
construct the project(Sec.7614.Businms and Profession,C(xk:)'The Contractor's
License Law Jtmi not apply man owner of property who builds sur improves thereon, 604 — ROOF IN—PRO RESS
amt who comma,rot mah projects sour a comraaons)licensed pur,uam m the
Cnnmwmr's I,',,p,c Lox.
01 am c cna,under Sec .11 M tic for Iris cavort /
Owner Onto
WORKERS COMP(LNSATION DIiCLARATION -
1 hereby infirm under penalty of perjury nuc of the following decuradiino:
,] I have and will maintain a Ccnifca e of Conan to,elf-inure for Wnrkef's
Gnnpcn,uliun, m provlreal for by Section 3700 mil' the Lobar Corp. rut the
performance of the work lin which this pennu is issued.
1 have and will rounain\Yorker',Compensation Insurance,as restudied by Section
Tnlh of the L.nhn Calc,for the performance of the work for which this permit is
issued.M1yW.W...oo t"'ni,emntion huurunce carricr'an t Pnl icy nwnherraare:
Curticr._Ii(//!. Apo, YNn.: 7'Y_9J�
CLRT1FICA'1'ION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
f ir',ecdon used not he cnn,pletcd it me permit is throne nandred dolhrx
MCI))or less.)
1 cendy mat or floe permmoaace of the work sur whkh td,permit is k,uee.I
,had mot employ any ncr,on in any.no.tre,Io 11,r,become,obit',to me WorkcM
Conq,vioahnn Laws of Caubtrnia,Dane
Applicant
NOTICE TO APPLICANT.1f,ufrar making this Ceniheme of Elent,nom,you should
become subject to the Worker's Com,,p%tion provisions of the tabu Cale.you most
0 mnhwith emtply Wim wch provision,lir this or ,hall be decnacJ revoked.
F [n
CONS'fRUCI'ION LENDING AGENCY
> I Itemby M.that there is a can ath,s a lending agency fit,the performance
of the work for which this petmlt is issued(Sec.JIX)J,Co,C.)
1t Q Lender',Nn me
Z) z Lendcr',A&L,,,s
U 0 I anify that 1 have read this application and state that the ahmv information is
LL t:. correct I agree to comply with all city and county ordinances and state laws relating
0 U to bnllJing,onxtrvginn,and herchyuath...wr aprmcnoloves on this city m euro upon
me nbome.tncm,oned property sur tnpa,ion patpu,a,.
t}„ Z es.judgmeis nts.
cost andei,cand A which ndes,
the wayaof Cupe ainragaimt /•
V1 liabilities,judgment,,coats and expenms which may in any way wane aguimt mid
U City in cancyams:of the granting of to i,permit J't/
APPLICANT DSANDWI .COMPLY WITHALL NON-POINT issued by: Date
SOURCE Nr L 'IONS -- /S/spy y'
signantmoicanR(- mracmr L/Da/ Re-roofs
HA.AR000S MATERIALS DISCLOSURE
Will the applicant or faille building occupatm stoic or handle hazardous material Type of Roof
on def...J by the Cupenlno Municipal Calc,Chap(,,9.12.mod the Hwlth and Safety
Cale.Section 25532(o)7
All roofs shall be inspected prior to any rooting material being installed.
Will the appfeamormmry nuilding«e'tpant user'ytrponpurrdeviee,wl,ien If a roof is installed without first obtaining an inspection, I agree to remove
oil hvordous air comentinann ns defacd by the Ray Arca Air Quality Ntunagcmem
)is all new materials for inspection. Applicant understands and will comply with
DYe, all non-point source regulations.
I have Health
the Safety
ardiCode. liencricorionuls regnlr 5533%o tinder 4 1 terono b95 of the
Collfnmlu lkahh F:Sr cty CrJc.Sce.lemon,that if I, yo,,loJ4.lundcr,anJ Lou
if the building docs not carnntly hnvca¢nam.that it i..my respnnibility to notify the `�G/, V S 00
occupant
mf the c is x hick m f i ran prior to isuance of a Certificate of f
y,
o"t,paey' `�� Signature of Applic: t Date
owner oraum—ize ,gent us �— All roof coverings to be Class `•B•'or better