01080020 CI eut F c nPERTIaNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21230 HOMESTEAD RD # 11 ALL SEASONS ROOFING SERV CES01080020
OWNER'S NAME APPLICATION SUB DATE
VILLAGE GREEN ASSOCIATES 2640 PACER LN 08/03/2001
PHONE: 4089724455 SANITARY NO. CONTROL NO.
�
❑ Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
ne
Z 8 y i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z=G I hereby Union that I am licensed under provisions of Chapter 9(commencing
1 0, at withSeenma7W0)ofDivision3ofineBusinessandProfessionsCode,andmylicense REROOF.
<xa45 Iain clrAaClass `fn 9e S' 09 T/O & REPLACE OSB & COMP .
z z a a License Class panda - / 7� Lic,N
3 a y Data Ceri ncmr .
a ARCHITECT'S DECLARA N
zi
I Understand my Plans shall be used as public ree
�Y
ii6m1 i p Licensed Professional V
ou OWNER-BUILDER DECLARATION
m 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
F'Z a following reason.(Section 7031.5,Business and Pmmadons Code:Any city moronity
E x C which requires a permit m conxtiuct,alter,improve,demolish,m repair any smnapara
tc
i 3". priorm its1 quira,14c.,pliwUntf hp hill :l, dtmnnen. - _ _ 6noo
Intl vl `, Ip' ( tu'01 love RI C t ti L I ILhapn9 Sq.FL Floor Alea e: a1D'aLLOn
( ncing with Secn 7000)of Division 3 of the Bat` e.'nd Profgnioac Code) y f3'_ _
or that he is exempt thelrefrom and the basis for the alleged exemption.Any violation .t{.t1_
'
-'of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
:ofnot more than rivehundred dollars(S5W). um er ._ Occupancy Type
❑I,as owner of theproperty.or my employees with wages as their sale compensation, _
will dothe work,and the structure is not intended or offered for sale(Sec.7043, _
Business and Professions Code:The Contractor's License Law does not apply to an 307 - INSULAT It�Nuired Inspections
owner of property Who builds or improves thereon,and who does such work himself ,
or th gh h' ply provided that such improvements arc not intended or ,. 601 - ROOF TEAR OFF
offeredf If.wne ' tobuilding have
the urden of proving
that
hind one year of 602 - ROOF PLYNIOOD NAIL''
7-
complete,the owner-builder will have the burden of prow ng that he did not build or
mproveforpkrooseofmta.). 603 - ROOF BATTENS -
_.__. _ .. - - ' -
❑L s rofject(Seeny,amexsinessadProfessiwithbernudcanvanorsto 604 "- 'ROOF ROOF IN-PROGRESS -License
construct the project(Sec. to a Business and Professions Code:)The Contractor's „. -, e_'•
License Lnw Coca not apply n an owner of pivpeny who builds or improves thereon,
.- _and woo amarrds for such proj,e
cts with marramtslicensed
ConcmrsLcenseLaw gn uVEDOlamexemptunderSce B&Pcf.,tantenna
—
It
= _ Owner Date
)YORKER'S COMPENSATION DECLARATION DEC 1 2001
1 hereby affirm unde[penvhy of perjuryone of the following declarations:
O I have and will maintain a Certificate of Consent n self-insure for ¢�9qpp11 ,tl�
Compensation, as provided for by Section 3700 of the Labor Code,Pti -DING
performance of the work In which this perms is issued.
O 1 have and will maintain Walker's Compenwtion insurance,as required by Section
370X1 of the Litho,Codi,for the performunde of the work for which this permit is
issued,My rkeisC pc" tion Ins racechrtier pd Policy number are: _
.,Corti ( - Cd a.Poll,No.: i-V C3UO
6f ':V
iCERTIFICATIO OF EXEMPTION FROM WORKERS.
`
-COMPENSATION,INSURANCE :',', ;,
.:., _•.. ..1",_ ." _COMP ..... . .._._ ._.... -.__.._.___._.._._
secCoW handout Be completed if the permit is for one hundred dollars �� �•
(S I00)or less.) -
1 rerf fy(hat pc f f to 'k f M1 h 0 p t 'souk,I
shell oat employ any pea rson n any manner so as to beco tee subject the Workers `
Comitant un Laws of C5lifornin.Date
Appl-
NOTICE
A .... th Cen:ficai f Exemption,you should
NOTICE TO APPLICANT If aftiti Compsmakingbecome prod runsll the Luber ra,.kcou must
z is
Q O
forthwith<nmply'with h p ovisions.,,his p nit shall be devoted revoked.
.FoZI - - CONSTRUCTION LENDING AGENCY ` i - ---
he eby affinto that th mpsmppdmi lending agency for the performance
orthe workFor which thpannits iso d(Sec 3097,Civ.C.)
LendersAad esk
V 0 IrOtH,that 1 have reed this appl cefon and strap that the shove information is
IT- E. 'conem.I agree to comply,with all city and county ordinances and state laws relating
O !) to building constriction,and hereby authorize representatives'of this city to carer upon
'r�
the above-mentioned progeny far,ineppaion purposes._ .,
(W)agree t d aifyvdkeep harmless the City fC,pnine against
F'VJ I bilin. luit m I .( it en a which y in y a) cc a againstrid'
Cry n co sequence f t rA- t of th permit.
APP[IQANT UNDER AL DS NO WILL COMPLY WITH ALL NON-POINT
N [sued by: Dale
SOURCE REGULAT :;s'
S gra t of Applic JCon for , ' Date Re-roofs N61 `�
HAZ DOUS MATERIALS DISCLOSURE. '� I\ w S" /
N61 the npplca future building pit handle n dou. teal Type of Roof - -' --"--- - " '- '-- --'
defined by the Cup aMn 'palCode,Chapter 912and the Health andSafety
Cd SAY 2553 ( 1 ❑No I'1.
91
_ ... Allroofs.shall_be inspected prior to any.roofing.material.being.installed.
W.umeapprparlerfmnre building mctipant use equipment or devfvs which If a roof is installed without first obtaining an inspection,I agree to.remove
District? defined by the Bay Area Air Quality Management
emnna.amaks:dreontaminanisatde all new s o ima[erials.for.inspection. Applicant understands and,will comply with
OY ., ON . ... - . ..... _ _ -
_ _. ,.. all non-point source regulations.
have read tire Nuidaoc•marerials requirements under Chapter 6.95 of thel
Cali f an Health&Safety Code.Sect .25505,25533ad 255341 understand that
I`theh "Id .building t Oinentlyhaveatenant,that it is my responsibilitytoartilythe
cugans of the rNi rements hich t be at priur to issuance of a Comficate of is
Occupancy. .
Signature_ofplicas[ ,. . - . Date
'owner or enmorizei - Data All roof coverings to be Class "B" or better,
- ':•'I .•.. .,.'.. ": .. '.i. . . OFFICE- _._..