02040004-. ..._ OFFICE- -...... .. --
CITYt Dwc DOF IVISIONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
19651 DRAKE DR
GROMO ROOFING
02040004
OWNER'S NAME:
APPLICATION SUB DATE
CRAFF FERNANDO D AND VIRGINI
121 W WASHINGTON AVE
04/01/2002
PHONE:
(408)746-2075
SANITARY NO. CONTROL NO.
O
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTORS DECLARATION
I hereby imr I licensed
Job Description
P
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t5
di that am under provisions of Chaim, 9 (commencing
with Section 7000) of Division 3oftneBusine undPmfe-anaeode.andmylicense
REROOF.
w�
is
rad `°nn= 9 u1: 1 ,F77
ass
T/O TAR & GRAVEL, INSTALL 30 YR. SHINGLE.
Canl
O <
A CHITECTIS DE RATI N
1 undernand my pl... hall be used ac public records
Y
p Licensed Professional
e LL OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contactor', License Law forme
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following .... (Sexual 7031.5, Businessdna Professions Code: Any cityor cnonly
which q Permit t construct, alter, p demolish, or repair any swcmrc
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�.pnoa t h q res theapplc tf uch parnan. fileaargrudamemem
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that h licensed p 3ua t in the provisions f the Contractor s Licence Law (Chapter 9
(cam ng 'thSeq n,700)) fD c 3 fdue B u ml&ofmronsCode)
':�� T{.s ,Sq:I"t.--'FIOOrArea,s•
'" • ' x s' - k t (4 t V i.
-
alua[ion
or that he N exempt therefrom and the bass for the allil exemption Any violation
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- of Section 7031.5 by airy applicant for a permit subjects the applicant to a civil peneln
larnofmarztn.fivehundreddollars(s50)).
A um er
Occu ane e
n p y'Iyp
D I, as owner of the propcny, or my employees with wages as their sole compenamion,
_FRAMR
-%ill'do the work, and he'awnmre'is"not intended m offered for sale (Sec: 70,14,'
tBusiness and'Professions Code: The Contractor's License Law docs not apply ,o un
-
307 - INSULATRaNired Inspections IT"
owner of propeny Who builds or improves thereon, and who does such work himself
.r corm It his awn empl yeea p 'ace N t seen ,a „ ears are not intended or
uffe�cd for sale' If, naw a to n la., rimprovement ' sold within one year of
601 ROOF TEAR OFF
- -' --'----.. ........ .. ..—'-- ----. .._ .. ..aped
'completon,the awnerbmmerwill have the burden or in that he
proving
602 ROOF PLYWOOD NAI''L' .::�
improve for purpose of asap).
,
603 – ROOF t
aped.._mexclu.r...._...ct -- licensed
_ 4a;pt acme propeny.am easiness
_BATTENS
– —..–
604 — ROOF' IN–PROGRESS---
Cher
- _ ocense the project (Sec. and Professions dc:)Th Contractor
a, Business and Professions CW c:) The Cammreon.
License law dos not apply t., an owner of progeny who builds
to improves thereon,
'^ `%,•r I
se
Co who License La,uch.prolexm.,witha comroctorts).li<enscd pursuant m.Nc.
- Com t License ,
❑1 pt dcr SW* ;B&PCf this mason
p� `I'[•:is ', •1
- WORKER'S COMPENSATION DECLARATION
AR
aa��
"r 'Iner<byaf6rmnndIe: Ppp�ry, of per)ury 6'n'e,of the foiiowmg dularmil -
D I Ill ata' viB' mai6tn{n"a Ceni6ame or Camera lo' mlf-insets for Worker's
APR 0 5 2002
Compensation: as_ Provided- for by Section- 37W of the Labor Code,' for the
- performance of the work bywhichthispewitisissli%ued.,,,,
D I have and will mainiami Workers Compensationlmurimm iequired
�UILDIN G
as by section
3700 f the Ula Cod f theperforma a of the"' a k'ro which this pear t
My Wok Co pat ton 1 ural came d Policy number arc
r3 TIJ r;r f'yn'yPoliy Ill
CERTIPICATION QF EXEMPT FROM WORKERS
V, ('.� i a. \. r, k,/!'. 2. i'.,.{C..`•,, I R...'1.
r
- COMPENSATION INSURANCE
.!I`T CriThl sauteneed-be complexed f the perms is for one hundred dollars
_. .._— .-.._' ...
'I ----
(slO )mlesa)
t ( 1 en fY y- t ' r pe forma f use k r which th' parrot .... d I
hell net amps y °ny,pc many -moon as tiecome
- - -
,so to subject as the Warkert
Co micnsauon Lewa of Celifomie: Data "' "' '' •• ^"
ApplicHnt'r...r ... ....., ..
-
.._ _...
afl�Crtf fe of
I NOTICE TOct
ANTrs
-_.. peep_. _.. ... ..___.. ... .._ .__.. _. ..
,U -'-----
Intim Cmrmrsiumn Laborode.00u mull
C) bdcome sobjexna me on Provisions ons dr the labor Calc, you mon
Coons
'
inch pr or t
O fonliwitN comply with inch provisions or Ni, permit shall be deemed revoked.
_.
'� 'CONSTRUCTION LENDMG AGENCY "'
v
Ihe'byaffirm hi'thtthem is aLusuution hushing agency fothepee .on.rice'
of the o k f which N permd's issued Isec 3 Crv.
'Q v c:::.......097.
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cmI unify Nat 1 have as his application and sate that the above information is
em: ragree to comply with all. city dad cpumyrordinances eM state laws relating
[) to building conawciion; and hemby 3umonie leprea tativea ofthii city to enter upon
'
Ui the above-mentioned property for inspection purposes. -
Oi (Wc) g'etb sav rode fy and keep hit lcsme Caty fCup<n 'sgairat
liabilities. judgments. costs and xpenses wh h may y way erne g just aid
Z 'pi
City n o eq of the gmnt g of this dri t - ,.
APPLICANT UNDF NDS AND WILL
asolus
COMPLY Wh'H ALL NON -POINT
SOURCE REG f yam' ,-, l/y/oz
Issued by:
Date
$grTan, Eof ApplmanAC RDOU
HAZARDOUS MATERIALS DISCLOSURE
the ppl cant fumrc bu lein giucapant more hirdl hazard materiel
.Typeof Roof—
oof ._
ad
as defined by,Ne Cupcm Mur pal cod Ch pt 913 and Health asafry
,. .• .. - .papa: ..__
Cede section 2557 00
,. rlt /¢q t J v �ax'>-'
-
Tt"� 7!4'`a t`,t to{^'s71 rfl i? t
r
_ All roofs shall be inspected poor [o any Ing material. being installed,
witm pplocru'nt f t bwldmgac p r equip t device
em t haz b tam a t der ed by N ll y A Ai Q a1 t Ma a t
_ ___
If a roof Is installed without first obtaining an inspection] agreeao7remove
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all new materials for inspection Applicant understands and will comply with
th I"I
tread'Ne
all non -point source regulations. " -
a''
I ha hazeNo met npls rzymrcmeno orderCh pte 695 of she
- ' " ' ....
C 1 Tamm & Safety Code 5 cat ata 25505 and 35534 I tide m d that
8does
m, do
Hiner W Ia n d not cartela mason, that t y respon b I t t notrf th..
t it I, Y
'ciccupant
f the rtqu rtm ¢ which m st & t t ssuantt of a Cen f am of
p
Oexupa
n _
.Y
a
Applicant Date
r
_ -
All roof coverings to be Class "B" of better
m zeaagq t
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