01070136 CITY BU cDI v;NISI[' CONTRACTOR INFORMATION:
swt,uwc unaxtuN PERMIT
BUILDING ADDRESS: PERMIT NO,
1040 TUSCANY PL EXTERIOR SOLUTIONS 01070136
OWNER'S NAME: APPLIC TION.ggUB DATE
SCOTT JERRY L AND APRIL L 1771 SMITH AVE 07726/2001
PHONE: (408) 358-1233 SANITARY NO. CONTROL NO.
o s z ARCHITECTIENGINEER: BUILDING PERMIT INFO
O❑O BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
O z 1-O 1 hetvny alum that 1 am licensed under p nd Pree of Chapter 9 and
(commencing se
1-ac, wansemron7Wolnfon;an+n3onneBa,NaaameProfe,.emn<eoae.ammrheen REROOF.
is in full force and elr�st.-o 77/0$ REMOVE SHAKE . INSTALL 30LB. FELT &
—z a a Licer. Class C._ J 9 Lic.x
K°a Da'e7- 9L �f c^^baetnr 7/16" OSB & DELDTEX PRESIDENTIAL.
+++d a. ARCHITECI"S DECLAR
t=O g 1 uoderuand my plans shall be used as public reeoois
E:p 0 Licensed Professional
ca
`,Rn OWNER-BUILDER from
FINALED
1 M1<rtthy arErtn that 1 Bfrom the Contractor ATION<License Law fur he. _
C Z a following reason.(Section 7031.5.Business and Professions Cods:Any city or county,
f o which requites a permit to construct,alter,improve,demolish.or repair any strucmrc
,a-
prior to its iswmtce.almmercies theappllam fei permit to fileeeigned statement -
bar neislicensed puracam1.heprovisinnsofthe Contractors License Law(Chapter 9 S Ft. Floor Area $80)'�uation
(smmenem,with Section 7000)of Division 3 or the Business and Professions Code) .,q _ 1. t. l;+.
orthat he is exempt therefrom and the basis for the aregf:l exemption.Any violation
- of Section 7031.5 by any applicant for a at subjects the applicant to a civil penalty 3 5 9� 6 �d
+ar not inure than five hundred d,,11,,(5500), m ccupancy Type
0 h as owner of the property.or my employees with wages as their sole compensation.
will do the work;and the structure i.s'net'intended m offered far sale(See.7044; "
v Business and Professions Cole:The Contractor's License Law does 3 05 — FRAME Required Inspections
not apply to an q p '
owmtc,of pmparty who Wilda or improves thereon and who does such work himself 3 07 — INSULATION
ATION_ ___ _
o,through this own employees.provided that such improvements are not intended m '
aortiarat:seat.B,however, he will avether urden of ,Nd hedid not yar lir 6O1 — ROOF TEAR OFF
'completion,the owner-builder ofsall.).will have the WNcn of Droving that he die not build or
imvmsx am pu,Dme rtsale.h 602 - ROOF PLYWOOD NAIL
01;as owner of the pmpoey,am exclusively contracting tracting with licensed contractors 03- - ROOF 'BATTENS
cnmtmct the project(See.7044.Business am profession Cee)The Contractor, 604 — ROOF IN—PROGRESS "I'.. I •r.:
r'
License Low data not apply to an owner of property who Wills or improves thereon,
.sand whosmmcts.forsuch.pmj«ts.with.a ronuannr(s6licensed.punuam.to the _ .__. . -. _.-... . .... ._.. ___.___.._._...-.._.._._.1....___...._.___—._- ... .._. . . ...........
-_
Ciaramosecteri,License Law.
- 0 l am exempt under,5ec. ' ,B&IPC.m is rtamn '+%", t�C,CI'I Jit 1;11
Owner. `Dam "
" 'WORKER'S COMPENSATION DECLARATION
Iherchy affirm under penalty of perjury oneof the following Jedaratinns:
❑ 1 nave and will maintain a Cenircatc of Consent to sdf-imurt for workers
Cumperosmion. as .....died for by Section 37W of the Lamer Code, for the
performmtae of thi work for whim this permit.is Issued.. .
01 base and will maintain Worker s Compensation Insurance,is required by Station
AIN'of she WWr'GWe;for the Mrformance or the work fur which this permit is
ssuWlM'y Worker's Compensat`I-on lnsumnce carie.and Policy�nupmberarc: _
- -
Careicr/Y A'{mx,-ALS ✓NIe��P,ilicy Nn.:LIJC Jv0 C-F74Y _ -. _ _ -_ .. .. ._.__._i:._.�_.__. .. -
CERTIFICATION OF E%Eh1Pl'ION FROM WORKERS'+ ' -
' - COMPENSATION INSURANCE' :- , ; + ` '
IFNs secti,in'Accd'nm be completed if the permit„for one hundred dollars ' . .'.• i..i\„ i':;L ..❑s:; 'f. n
(SlWlm less.l s i
rlT ap than: th' lin a f th a to
fi h ul m't wuroa,1
1'
hall nix empWY any pe n m any manner w az to become subject m tar Workers
Compensation Laws of Cal foram Dum, "
NOTICE TO APPLICANT.If,after makinStble Cenilicme of Exemption.you;should
O .
4
Qbecam subject its thew k/ C penat ytu softh Wbo Ceeyo must
forth th c pwith such D s os or this t. hdeed revoked
+ to - - -..
V
" CONSTRUCTION LENDING AGENCY
"by toffirtriffoon,ificW is e n.irvcfimi lending 4.
agency or,the perfoinurme
C1
Wm sAJdrc,,iI309�Civ. _,_t,
a.Q W JersN me
•••• . .. . __-. . ... _ -
DtZ
V.'O I certify that I have read this application and stone that the above information Is
Tres'(• smatter.I agree to comply with all city and county ty voliaturi and state laws relating
to Wlldingconxtruction,and hereby authorize rep ,ntativesnf this city to enter upon
the anovcnmmioned property for inspection purposes. - . .,,
F.v46 I Wel agree to save,indemnify and accept harmless the City of Cooamiouigalnu
VI liabilities,judgments,Costs am evari which may in any waY verse against said
V-Z city in ss,temb fth gr tmg athis P.r I non. -
Al e T UNDERSTANDS AND WILLCOMPLY WITH ALL NO -POINT Issued b : Date
get h' -GULATI0 1 ! t t 2�`� y
R �r
S+gnalurc�APPLru tem ,. , ` . : , ..Dore Re-roofs
-- •HAZARDOUSMATERIAISDISCLOSURE. , O
... Wlli lbi ayplacant d,stare Wading«apart stoic or M1amle hasammus material Type.of Roof
as defined by the Gupenino Municipal Cotte,Chapter 9,12.and the Health and Safety
Code.Section 25532(a)7
.—All roofs.shall be inspected.prior.to.any..roofing material being installed..__ ... _-.
,Wil the applicant orfuture building occupant a cequipmenttordeviceswhich. If a roof is insialli isvithout first obtaining an'irispectio''J agree.to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality!Janagement ,
Dint.0? all new materials for Inspection.,Applicant.understands and will comply with
1 ova No'- -r , all non- oirit source re ulati_onsl 1.
I h e rt J the hazardous nationalsrequirementsd Chapter 6.95 of the
C l f n P lb&S I ty Code,Sentic,25505 25531 and 2550 I come....ad that 1
dtl b IJ %doet currently h' tenant. . pa
that t n.bd't)t notify the
.Z C. G/
Deep t f q met which nu t homes f i m an or C mfcata of
2 f;_,� _ Signature of Applicant Date
d aAll roof coverings to be Class "B" or better
Ca ,w
eTx.,e or mnonzegent Date
I r.
OFFICE
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