02040041 CITY ofcnnERO
• N PERMIT
CONTRACTOR INFORMATION:
. ILDINGADDRESS:
PERMIT NO.
` 10104 CRESCENT RD PRESTIGE ROOFING 02040041
OWNER'S NAME: APPLICATION SUB DATE
LEE ENNIS 725 MIRAMAR 04/09/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 268-8003
a O O ARCHITECUENGINEER: BUILDING PERMIT INFO
c mu C BLDG ELECT PLUMB MECH
S N i LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under ons ofcha ter 9 hommencln Job Description
jry_0 Ya prmisi p e P
._t J wdnsaarn7 )oroivision3"ftneeu.ane::nndPmressionscwe.andmyBcense REROOF .
;xE,, �smrau rare eerc<pl. � L
Our Q LiccnSe Cla n` LiC M INA
/t� o
LLou a < - Cont o 1 Q F9INA LE®
g 1 undenm d my PlansCM1allEbc uused a punl¢Artc Ns Ye /fit
tdp0 Li«nsed Prtdcsainnal
APR 16 ZOO[
OWNER-BUILDER DECLARATION
w_v, I hereby affirm that 1 am exempt from the Contractor's License Law for the
1Z following realS
son, ection 7031.5.Business and Profession.Code:Any city or county
zF o which requires a permit to consume,alter,improve,demolish,or repair any structure 1 Q
cam _ptionoits issmmc atm requires the applicantfart«h«naduo Bleasigr¢d sutemenr
- (cournincingwdpuiswon7000ofDiiision3otheBusmrstittnulawQhaµer9 F r a-.; . e, , Valuation
(cdmmhe Iieveim,dberan800o)d he vision 3orthellaameA mYfion.Any Code) t':�.•Tr32s@z�re��:`�`6-.; ,, , •��.
of S that He is 31.5 by any applicant
ar a per Tonne subioljects
th applicant to Any violn lty -
-of Senior 703L5 by any aPPlicam for a Permit subjects the applicant ton civil Penalty-
imp
enalry- SA
tnf not more man live hundred dollars(5500). 3 0 SAPN'M� '1 efn „ Occupancy Type
❑I,as owner or me pro«ny,mmy employee..with wages ae Meir ante compemation, 207 _ TN2111I
will do the work.and the structureis not boarded or offered for sale sec.-70L1.
'Busineis and Professions Code:That Contractor's License Law does not apply to an 601 — ROOF TEftqu gq pinspections l ''Fre:,.,i F
owner of property Who builds or improves thereon,and who does such work himself
or through his own ean&ycas.provided door such im umarn<ms are not intended or -__ 6 0 2 — ROOF PLYWOOD NAIL
"olfe¢d for sale Jr.howwo;me building or impru6vtimelis sold within one year of _--'--_'
completion,me owner builder will have the burden of moving but he did nor build or 603 — ROOF BATTENS ^• "— '^
improve for purpose r sale.). 604 ROOF IN—PROGRESS
co f f the P pens - alas i-c1y t rae r i i r, 'in l'_c on,aJ onovamors in I.,la . 1:•; _..
_ consumer the ods n(Sec.7044 ownrBusinessand Professions Cade)The improves
tmnm s
License taw does not apply m m owner of n who builds seiso S;!
.. .- , pP Y property w proves thereon,
r :. .. _and who.con License
La such.pmjecta wim.a comracror(z)licensed-pursuanr.m.me
Conummh Liccnu law. ... _..__.._._....... _.__.__._._ .. . ......_.__.—_.__..._.__.._...__._.__.__..... _............. _ ._
❑lam eacmpr under Se c, `,B&PC for this reason yCll^ii:;,l
"Date'
"WORKER'S COMPENSATION DECLARATION
I hereby affirm model Pc by of paijar,tim, fine following daohooiom:
. � O I have and will'mrinti C anifieate of Consent to self insure for Worker's
�!- - Crfomhnce ofine nounimr. as work for whichrovided Per J70U of he labor Code, for the
pe permit is Issued. r
❑1 h n.a and sill moinriiri Worker's Compensnion Iniunnce.as required by Section
3700 of the labor Code,for the performs«e of the work for which this Permit is
issued:My Worker's Compensation Insurin<c cvnier and Polity number are:
Carte rdf� t rill J ,at•"!.Pol yN - ._ _.._ . ._,. _.. _ . . _._
_.
i
CERTIFICATION OF.EKEMPTION PROM WORKERS :�a I N( r I '' a' ''l.."aw.tl
_COMPENSATION INSURANCE' I"' _f r t _ t a , \ Yt, ,) , y ••
_...r. - _. ..
I':1 Cfh s iearoh rad not be complaed f rhe person is for one hundred dollars 'S• - t IL'C I:J:.'?, ' .�-r _ -- —
Ig100)orkss)
J cierrify that bethperformance ofm<workf whichibismitin
issued i1
shall t pl YSnYa yma fro thatWorkers' , s ,;In, } ` . .
��1fpp nests s eco "'
APPI c���/ 11 I f- Dat .- .. . . . . .
Coope t W
NOTIC9TpA�ICANT 1 f kit ih Cnfcm fE - ---- '-"'- -----
( }on g M1 old
Z ode es
,IS,, 'thcW le4iC Pe 't prookimn,of'he
eeme y. It
Irnh th mpty boli h pro s o or m p 't hall bed dd Invoked.
O '_
0,of, " o !CONSTRUCTION LENDING AGENCY - _
a`> Ili by ifr 'that the- nariucrion lending agency fr me perforrmaie .1
r of th ork for which m pemmi lis rssued ISeo 1097.C v.C.)'
d.Z -Lender'shame-'.••'—•._:_�_._..._::.....u....r.._._,..t- .•....._—!- ... _ __ _. _ ._ ... ..___._-._ __...__. ..__..___._. .... ...
Lend s Add
V t c
I c ri fy rbar I base read this application and state that the abnove formation is ///(/[\]///✓/�
coma I agree to comply with allcity and county ordinances and state laws relating V
tqb buildingconstruction, e
nh by ehrlaxrcp liver ofm city neerupon
>o
t aw me bo e m t a'd Property f peri purposes.
L., G s,I greet s ra m Ipe d keep h may the o ry T CSma spin'[
against
Z Ctliabilities,judgments.con nd pc h ch may any y a<c gains olid
U-Z City m cAIN7.U nee R the granting O ter.perms. L .. - I
90 JRCAiT UNDERSTANDS`NO V/ILI COMPLY N'ITH'ALL N')N-PoINT
so mcE fsF �uLAnol4s.>" Issued by: Date
Sign m cfnpgy< mroraclor r'• - .;',. Dna ;. Re-roofs
ALARDOUSMATERIALS DISCLOSURE ` "'
^' WII me liiam lift all in « ''''
Pp 8 Panl iv oil dl hoardedarroomil __Type of Roof.....
az dcfnee by the Cupen on c pal Cod Chapl 9 12 and me H also and Safcry - ---'- -- -
Coae S<con 255321 p . '.- \. .( •, ._. .
❑Ys Z I" i-N i t Ylb- ; a r, 7I
\ I All roofs shall be-ins pected.prior•to any_roofing_material being installed,
:IwnmaapEarlicnm rurarebuliing«apantuscegnip U. itaevr<to .a., Ifaroofisinstalled: ithoutfirstobtainin an ins ecuori;'I•agree:to'remove
eon hit olid coed t az d Bull by m Bay A a A Q el(y M agent t
°s'"c' ' 1 all new materials for inspection. Applicant undersstands an will comply with
av _ .. P
. a116on-point source regulations
" 1 halead'the hmanikins material eyu Ch
neats'unde apter 6S5 of the'
Califomu Hcalth&Safety Code,Sections 25505,25533 and 25534.-1 understand that
'ifflehilding cors not currently have a tenant,that it is mY rtsponor bilitymnotifY rhe
«cu et of the rtgeirdmena which To bimeifpBo missuan<c'afe Carter are of
... Occuoil pancy:' .. .. ., .... .:.
,Signature ofApplicant Date
coor armho
d ar All roof coverings to be Class"B or better
te
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