01080019 CI FGUDN
PERTONO
BUILDING
ut DNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21230 HOMESTEAD RD # 1 ALL SEASONS ROOFING SERV CES01080019
OWNER'S NAME: APPLICATION SUB DATE
VILLAGE GREEN ASSOCIATES 2640 PACER LN 08/03/2001
PHONE: SANITARY NO. CONTROL NO.
4089724455
q 0 zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
baa L I IJ IJ GI
IF- 2 LICENSED CONTRACTOR'S DECLARATION
0 O N' I hereby offnthat 1 am licensed under provisions of Chapmr9(commencing Job Description
°ym tad with Section7a10)ofD"sion3oftheBasmovsandPm(ession'Cntle,andmylicense RE-ROOF TEAR-OFF •OSB•COMPOSITION
m I
,an full forte an ¢it. ' f r z
a:re< LiccnseClass `� 3� Li[.. ������D
X 3 LL N Dale Canlra[tar _
h O ARCHITECT'S DECLARA 10
I understand my plans shall be used as publicEr
r
o o Licensed Pmfcssianal DEC 1 1 2001
OWNER-BUILDER DECLARATION
u�^_v 1 hereby,oRrsn thm 1 am exempt from she Co hrhd.r's License Law fur the
following reason.(Section 7031.5,Business and Professions Codc:Any city or county
55 o which requires a Penna to construct,alter,improve.dendulkh.or repair any structure1 ,u�,g 2 0 0 0 0
63< P t is ace.al. e9 .Ina.ppl' vlf h pandrin file asm
gned.ganent BUILDING _ -_ ._
01hgll' sell p1 tato the pmbis oftl Cntmcmrs Lcenw Lass l Clnplr-9 y t��a�qat d,piy� a •-I (-I. Valuation
(C n"ng With S t 17") f Division J f she Rus nese aad Professions Code) - 3 Ab 3U W8 UlJ A ,a',
.,,hot he Is exempt lheafrom and the basis for the alleged aaempu e,Any vlolauon
of Section 7031.5 by any applicant fora Permit subjects the applicant in a civil penalty
,of nor mare than eve hundred dollar,(sca). 305 APN 3Tl� v. Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or ofered for sale(Sec.II164,
Bminels ane Professions Cede:no Camara,.,',license Law does aat apply to an 601 — ROOF TEAWcIDM Inspections
owner o -
f prohere
perly Who builds or improves ton,and who does such work himself
-airggh his own
red fr-sale:If.howove, he building ortiinpmvem nteis said within onle year of _.. 602 _ ROOF _PLYWOOD NAIL
completion.the owner Wilder will have the burden of 603 - ROOF BATTENS
p proving thin he did not build r I
improve fee pprpose of sola.). 604 - ROOF IN-PROGRESS
❑i as owner of she progeny am exclusively d Prof
with licensed Character',
har t ct to
License the present(Sec,7044,Business pea Professions Coda)The improves
trumen. ,,t
License Law docs not apply to an owner of progeny who builds teimproves to the
"
and-who.commas.for such projects-with a conaanoris),Ikcnsed pursuam.m she .___ _ .... .. .. .. ...
am sor's License Law.
0 1 am exempt under Sec. ,B kPCfonM1is rtazon
_
Game, Data '
WORKER'S COMPENSATION DECLARATION
1 hcmby affirm underpeaatry of perjury omicron the following declarmimmi
❑ I have and will maintain n'Ccnificate of Consent to sdf-insure for Worker's
_ Cimpemotinn:-te,provided for by Section 3700 of the Labor Code, far the
perfrma
once of the work for which this permit is issued.,
❑I have and will'raturr in Worker's Cima,matim.lmrumnce,as required by Section
-- 370()of the Labor.Cale far the affearandric,of the work'ur which this permit is
issued,MY orkei Compensation Insurance carrier/a✓add Policy n mherae: 11 .. .... .....,_ ...__.. .....
Cle'-,CERTIFICATION OF EXEMPTION FROM WORKERS'ly 0 O `�,B ��/ t`/ t•1 ' t
_ -COMPENSATION,INSURANCE,,' ___.._.__... ._...__ ___.---------.,__.__._._ .___.__._._. ._—_....._._—_... . ... .. . ..._
sectiov need oat be cumplcmd if the permit is rar one hundred dollars - `' ` ' h ,t 't
Is 100)or less.) -
'1<enify,thatinthe performance of the work for which this pelmil is issued,I
shall nm employ any person in any manner so as to become subject to the WorkeN "
Compensationfawsor Califomia.Data
Appllcom
NOTICE TO APPLICANT Work r s afterC6a,vaknifion rCenone,o or Latior Cedc,y should '
become subject o the Workers Compensation provisions f ter
Lohor Code,yen must
z Q fonhwith comply with such provisions or this permit shall be Deemed revoked. 1
CONSTRUCTION LENDING AGENCY
I Imreby a(rnn that them is a conswclion lending agency for the performance
`. bf the work(or which this permit is'issued(Sce.3(y)7.Civ,C.)
p0 'Lenders Name -- - --
;;)-Z L'endbrs Addmss t� �' •.e
V' I[enify that l have read this application anJ xw¢shoe the above ininrmmion is
Lss [r correct.1 agree to comply with all city and county ordinances and sate laws relating
Q U to building convmnion.and hereby authorize representatives of this city to enmrupon
�..W she above-aamt aned propenY for inspection purposes..
E. 4 (we)agrtr eo save,indemnify an keep harmlevthe City of Cupeninoagainsl
l.(n liabilities,judgments,cases antl which may in any way accrue against wed
�.) i City in camsryno ace of t1A gra in is permit.:
SOURCE REGULATIONS` L COMPLY,WITH ALLTNON-POINT Issued by: Date
Sigmwre of Appli["WConlrnct Dae Re-roofs
n
:. HAZARD MATERIALS DISCLOSURE `� t' •3
Will me ahpbrant orf •ipal Co e.Chapter
stare no handle n ealJru mSafety 'Type of Roof - - ....._.. .. /l ._.. .... .. . .
as defined by the Cupenin nicipal'Code,Chapter 9.12 and the Health and Safety
Code.Section i{
ores ' oNe• t,_i.fa.,'x , ..All roofs.shall..beinspected.prior.to.any-roofing.material being installed.
. Will thea applicant or future building occupant use 1.
pp g pan cc.Ait Qntordev ar which If a roof is installed'without first obtaining an inspection; I"agree to remove
coil navardats air[antammatns as defined by the Bay Arta Atr Qaaetr bmnagen,ent
Diatdcn all new materials for inspection. Applicant understands and will comply with
°Y" ON. - all non-point source regulations. ,
I have mad the hazardous materials requirements under Chaplei 6.95 of the
Califomia Health&Safety Code.Sections 25505,25533 and 25534.9 understand that
-'if,ihebuildin he tapeot cu oilyhla mdml a 'hatitrmyssuanceof is llinrify the
O c upas y.the rcqui ¢o' ich man be and prior to issuance of a CcniOcom of
Occupancy.;
Signature of Applicant_ _ _ Date.
Owner orauthor i gent, - - Date All roof coverings to be Class "B" or better
OFFICE ._ -