01050011 4,
cl BUIL NGup IeTNNo - CONTRACTOR INFORMATION:
• PERMIT
12ml.nwcnDD 200' LUCI'LLE AV # 105-106 , ROYAL ROOF.T.NG rERMlrlvo.• 01050011 .
OWNER'S NAM` APPLICATION SUR DATE
`1-RAMMELL CROW RES SERVT ES , 1345 VANDER WAY, - ',05/01/2001
PHONE - SANITARY NO. CON'I'ROI.No
•. ' r
(408),279-2332
p z Z AItCHI'1'I!CT/ENGINEER: -
BUILDING PERMIT INFO
PLD( GL[Cf PLUMB MECII
NiU CJ O O O
iFa?fa3�nCLLzoro„ wIi'o, cls LICENSED
NSED CONTRnCDECLARATION
G ' y
' Job,Descri t
ion
1 herebyanrmIna1am asnderprneaon.sfchapmrdmmenemg
t n9f0oD' riaofthe❑ ndPfscrCush, my license
lnrsc. en RE—ROOF REMOVE SHAKES. 8..INSTAL'
LII/2” C:
mz 1,in .] e93
DIe2 .c Contractor .CERTAINTEED .SHINGLE.' CARI-ORI,
ea
ARCIIITIiC` I3ECLAKA'
I anilerstand my Plan,shrill be
mall
usA us public records 8-
,, -
u o O Licensed Professional ' - -
°'e' Oat I am 3UILDER DECLARATION is y
- 1 hereby,(Sirs on 1 a1.cBusin from the Committee's Any c ty o for the
F Z following reasoa permit
il]oJLA R.alter.imp Profession,Cale:Any city orcounty ,
IFC which requires issuance,permit m dines the ppee improve,demolish or repair ed mmeare '
e. pal heIor it),lts enseahom 1.the theapplicantforthe Cohpctors RleaeLawi Catcmem
mmWeisairig with
"Swam mthe provWnsion3o the Holmes andfrelmwtu,Coat
Sq. Ft. Floor Area .Valuation
' (somal lie isexem Section7000)of renand(le basunlof the Holmes,and Pon,Any vi Cale)
ordinal he is exempt tang al,m and the basis for the cis the exemption.Any l",con '
OF ScI inn 7031.5 five
hu d red dolt for a Permit subject the applirannn n civil Penuhy
' orsmsmrouuhat Rvohsttareddnnl.ra(,p5on), _ 'APNNutnber
❑I f(liep pny, y cloployeas With gc their pnsatoc '
will do the work,and the structure,is not intended or offend for side(See.7044
Badness tad Profess ons Code.The Ci mbotor s Lmenee Law dtas.not apply to an - E hired Inspections
owner of property Who builds or improves thereon,and who Joss such work himself
or through his own employees._provided that such improvements art not intended in -
offemd for„ale.If.however,the building or hnprovemcnt is sold within one year of 305 — FRAME
sample non,the owner Wilder will have the hurden of proving that he did not Wild or
imposeft purpose or sulci, 307 — INSLILATTON
01 rt (if the propertyanal"elusively cant g with 'licensedcontractorsm 601 .— ROOF TEAR' SFF .
Lt t thep J t(See 7044,Ruan : l P positions Coca:) rnae swat rr,
rot - — ^ _
ie,.a Law does apply to, no nl property who ba Idv or nmr ve m
Iheun 6022
1I.ad wlio contests for ouch in,gccrs web a nmmetnr(oylisenaea burs....... tome r'a ROOF PLYWOOD NAIL
ENS .
ComnmInf,hicease Law t' _r •6Q3 ^-- ROOF .BA-
TT,
❑I.I'll s,emp.wderses.. :n,e<re[or this action 604. — ROOF IN—PROGRESS '
Owner Dme
WORKERS COMPENSATION DECLARATION ' CC '
I barely aRnn under Penalty of penury one of the following declarations: Ir�INALEO .
0 1 have andrill maintain a Carfificane of Consent to elf i slim for Wo'laW,
Competition)., as provided for by Section 3'/d0 of the Looser Code, fm the JAN,2
psf i e of me work for rl whch lh (' s..ea. .
FJ I li,11a unitwlln5 t' W )o Cn so,ittion hounince.as manned 1)S tan _
3]1X1 Ih 1 nk Code,f N pull the k r 91 tl':P 't is' t _ BOOING
.es ) My Wokcr Co p I Ina ueuase tdr I'ynashots ttr y .
Carrier. _ tM•lYiCRh IsilicyNa:
CERTIFICATION Olt EXEMPTION FROM WORKERS' - -
COMPENSN'IONINSURANCE '
(This section need not W completed it the permit is for one hundred Jo11trs -
f$I00iOn leu.. - -
1ceniry that in the performarm or the work for which this permit is issued,I
shall not employ any person in any mannerso as to become mm m hjc [lie Workers -
CornlwnsmionLawsofCukhonia.DBm
Applicant - - „
Nil'1CIt'fO APPLICANT:If at e....also,Ili,Cempiene nl'Escaptinn,you.A ild - - -
has : h3oto theta k ,C own t r .:
' roof da.Lama'Gds you cast
Q 2 fn th l comply with h" ':Inns y nl' prunt shall W deeced invoked
z ..
E~" CONSem is a ON LENDING AGENCY
as 1 hereby which that them is a construction
sued(See Iemdng agency fir the perfonnunce .t
0. of the work for which this Permit is issued Iso.Jo9r,Civ.C.) _ f
0. Q Lander',Name r
D Z Lender's Address
-
U (certify that l havereaJ this appliemion and Stam blithe above information is t S
Iz Pcone[..I agree m comply with all city and county unlinancea and state haws relating '
U Io building amarunion..md hereby unlhnrim mpresenmtives of.his city to enter upon -
�y r� @t abo o-mrnfionul property for inxPccr.on IF narrow'.(We) b- i am fy� Ii I .!d Cty lChen'ry g .t '
In IL hil... 6 t .t: 1 "sans od any in any 'Y c F all -
• U Z
City in eonoo,,rea of garntin,ol d permat.. {' t
'+ APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT t, ISsaedb Date
SOURCE EGULATIONS / Y•
fL� � ..
Sig roof Apphaant/con6
trecter date Re-root's •.
HAZARDOUS h1A ALS DISCLOSURE
Will y t applicant Continue.Muni ipal Codec Capt same r 9,12. d the Wmmnan Safety 'TYPC Of Roof
C de,SeJ io the32m)? Municipal Gyle,Chapter 9.12.and the Health and Safety,
' Code.Section 25532(x)4
17ve, ' - All roofs shall be inspected prior to any roofing material being installed.
Will the epplaaal srtmre haildingneeupant nae egsimsant srdelo'o which - If a roof is installed without first obtaining an inspection', I agree to remove
e. .l -I mP t llal by the nay Arca A 'Qw I'ty Munugoment
• • O t . • all new.materials fef-inspection: Applicant understands and,iillrcomply with -
❑v r�N11all non-point source regulations. -
I have read he hicerohm,muter ds no orrome,under Chapter 6.95 n1 the I California Health&Safety Cods,Soctions 25505,25533 and 25531 1 understand that
_ if the holding Joe.not earremly have amnunuhm it i,.ny responsihilityut nsnifythe
cacnlvm of the reyuiremems which must W met prior to issuance of Cenincam
GCCtiplacy' gnature of Applicant Dateg
Owl� T o -AL1 roc coverin s to be Class"B•' or better
(Iwnar muhodmJ agent - Data All� -
t ' 'OFFICE - . t �. • s, -