01080040 OF
so CITY BUILDING DIIVCIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
21230 HOMESTEAD RD BLD 2 ALL SEASONS ROOFING SERV CES01080040
OWNER'S NAME: APPLICATION SUB DATE
VILLAGE GREEN ASSOCIATES 2640 PACER IN 08/07/2001
PHONE: SANITARY NO. CONTROL NO.
4089724455
O ARCHITECTIENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB SUCH
fz LJ I__1 I._3 CI
a
Z�„��¢ LICENSED CONTRACTOR'S DECLARATION
w 1 hereb affirm that I am licensed under r p g Job Description
O z- y pr visions of Cha ter 9 nd mmencin
l-„F
with Saha 7,a01 of Div }ofthe Business and P feaamns cane.arta my license REROOF.
a S Liter, ClaosanJeff T O INSTALL OSB & COMP.
Kee s d, License Class -3g Co M or /O / r
a 3,N Date S DELLA
ARCHITECT'S DECLARATION
SBiu.O� 1 undercwntl my plans shall be uud as public recoNs
w?p O Licensed Professional
X o ff OWNER-BUILDER DECLARATION
cum, 1 inneby infirm that I e empt from the Contractor'.,Licence Law for the
F z following reason.(Section 7031.5 Business and Professions Code:Any city or county'
x which requires a permit to consuuct.°Iter,improve,demolish,or repair any structure
i3 - prior t 1 ante,also_requiresthe applicantf such Permit fl -tined statement ---
that he licensed pa_ nt to the Provisions f me Contractors.License Law(Chapter 9 Sq..-Ft. Floor Area,, Dation
(commencing.withS to 7”)of Dl ' ] f the Busier.'and Prrasions Code) ,
or that he is eaempi therefrom and the basis for the alleged exemption.Any violation -
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more then five hundred dollars(S5ao). Dull e Occupancy Type
D Las owner of the property,or my employees with wages as their sale compensation,
will do the work,and the stmctum is not intended or offered for sale(Sec.7044,
Business and Professions Code:The Contractors License Law does not apply to an 307 — INSULAT I]blguired Inspections' -
owner of property Who builds or improves thereon, d who does. h k himself
or through his own ply provided ht.scM1 prove Idam within one _ _.. .601 —_ ROOF TEAR OFF..
completion,
ease ver- thebuilding 602 — ROOF PLYWOOD NAIL '
completion,the owner budder Will have the i Nen of pent is that wi did on build or
improve far purpose°fwdc.)._ 603 — ROOF BATTENS
❑I o ftM1epropety clulyc unclog lhlceud<on0an to 604 — ROOF IN—PROGRESS
consumer the project(Sec 7044,Business and Profession,Code:)The Contractor's
License I.ow does not apply man owner of progeny who builds or improves thereon, -' r
..and who contracts for such projects with a.contractor(s) larmsed.pursuant to the .. .. .. ....... _._ ._. _._. .._ _ ..._.
Contractors License Law. . . . . ........ . . . ... ......_ .. __ _. .. ._ .._. _.
D l am exempt under Sec. ,B&P C fannisrmwa
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby oflirenunder penalty of pejury one of the following decimations:
❑ 1 have and will maintain it cenif ace nI Content to self-intim for Worker's DEC 1 1 2001
Compensation, as provided far by Section 37M of the Labor Code, for the
- performance of the work for which this permit is issued..,
D I hale and will maintain Worker s Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance f the work
Cf rwhich this Permit
.is
ssuedM�AoQ '.nlBUILDING
n
art Policy Nowif
_.._.__.. . . . ... .-.-+,....,. ... .. ........... -..
'CERTIFICATION OF[XEMPfION FROM WORKERS'
.'COMPENSATIONINSURANCE'"
Tfti s Saturn neW not no completed if the permit Is for am hundred dollars
(SB)0)or lexsJ
Icarfify,fidithe performance f the Work far Which,his permit is i. u nd,l LL' - — -
Madl not employ any pc,arm in any miner so us 111 bio rte subyct m the WorkersIf
Compensation Laws of California.Date
Applicant -
NOTICE.OAPs the Walker s mounCompensation
this provisions
Labor oa.de,yea uld
most become the Worker's Compensation provisionsll tM memo(Code,year must
Q O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY 1 "
1 hereby,alb that there is a constmcnan lending agency for the performance
Ey.
of tM1 rk f which this .it is issued(9ee.3097.Co,C)
Leader's Name
. 7.Z I Ad ,,,
: .� O 1leorl 111111 bate recta iia nvpha.a.I arta ante 11lu ill,ammo nal cumlis
! W;F correct.1 agree to comply Willi all city and county onlime nces and ,are laws Wiring
i'0V to building construction,and hereby authorize represenmlivesrf this city m enter upon
t_W the b oned p peny f !nap t p rp .es.
Pa I Wm agrees ane do f 'oil Is IF ml s theCity f C pear no against
-tA 1 City in in a) y again �-s
APPLICANT
of pnning of th, hh a isad ss` ._�/
SOURCE REGULATION
ANDR LY HALL NON-POINT 47/
' souacERECGLAnoN Issued by: Date
Sgrr 'ofApplica/Cmaoam Date Re-roofs
HAZARDOUS Mriug�capoam
DISCLOSURE
-- Will the appl' t future caudroom` anre handle nldausmaterial Type of Roof
as defined by the C penin Muer cipal pter 9.11,and the Health and Safety t il
Code,Section 25532(a)9 1 ,A!
71 Yes, 13 No
r All roofs shall be inspected prior toany roofing material,being-installed.. _
• " Will the applicant o Future buil use equipment or devlaes which If a roof is installed without first obtaining an'inspection, I'fii to remove
em h d us air ata a ma as def d by the Bay Area A Q id y Alan gement
District? all new materials for inspection. Applicant understands andwill comply with .,
❑Yes ❑"° all non-point source regulations', -
1 have read the h....der,rrrmonls requirements°oder Chapter 0.95 of the
California Health&Safety Code Sectmns 25505.25533 ad25534.1nderst dden, _
fth b Idingdoes ootermeadyl, <at nt the,iIi nr espr sally to notify the
mention of the requital" t prior to f o er Cf ate of
o c°Paa`y� i Signature of Applicant Date
Owner or authorized agent Date. All roof coverings to be Class "B" or better
.. .... _
OFFICE.. ._ .. . _