02030074 (2) CI cut DING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1204 BRET AVENUE ADVANCED ROOFING TECHNIQUES 02030074
%VNER'S NAME: APPLICATION SUB DATE
NIADER, MR. & MRS . 1179 MYRTLE DR 03/14/2002
1 HONE: SANITARY NO. CONTROL NO.
(408) 249-4937
❑ ARCHITECDENGINEER: BUILDING PERMIT INFO
aZ� �1��� EJ PLUMB
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LJ MFJ
❑i LICENSED CONTRACT'OR'S DECLARATION n� nafN ��
v❑ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing 41,tl Vie i pq
w,r with Seclion7").fDi,i,i..3.fthe Business rid Prokrsiom Code.aadmylicense REROOF U[
m full foreyane efr«t,
a
:?z ca< LiaenuG� SUILDIN
,U Date� Con
I d-1 ARCHITECT'S DEC 1ATION
�Y demm�J my plain shall be usctl as public recnras
i e,O C Limnue Prhfeseiawl
o LL OV ..BUILDER DECLARATION
1 hertby affirm bar 1 am exempt from the Commctor'a License Law for the
f-n a following reason.(Section 71315,Business and Professions Code:Any city or county
$7000 f e which requires a permit to construct,alter,improve,demolish,or repair any swaum
i 3 mallet I a 9 provisions
ilio tl hoe It is
mallets rlicensed pnuaou she Aro s fthContractors Ltt La ( Code)
I•,r_ Y-9 li I.Rf6� <'g•,O; Valuation
(tom gx,lh$he iama)of ON i Ethe51e5and lProfessions iGCde) g L--'Y Y .�U� totil-ztt .+
or Ihm io is exempt therefrom and the basis for the subjects
thalleged p mans to Any violation
-of Section 7031:3 by any applicant fora permit subJcca the applicanuoecivil pennlry- 1
,if not mora than rye hundred dollars($580). 3 0 r 1PN r �,fE �'.,;:- .. Occupancy Type
❑1,a`nw'ner of tile property,or my employees with wages as their sole compensation, '
"x111"do the work:and the smaturc isnot intended or offered for sale(Sec.76 , -- - - - - - - -- -
Business and Profc..ions Code:The Cono-aanr's License law does not apply Io an 601 - ROOF TERNui Inspections; -
owner of property Who builds or improves thereon,and he does such work bimulf
or nhrough his own employees,provided Inas such improvements are not intended or 6 02 — ROOF PLYWOOD NAIL
or
f rule I(h - the build.' - ._..— ___ - _ ROOF
_ ...._ _ __
s v em is w, ,n Re 603 — ROOF BATTENS
completion the owner W'laer will have me lumen nr prop mg mall he die not build or
intprm,firom sa'ammic.)' 604 - ROOF IN-PROGRESS
❑1,as ownerPr the Property,am Ba,iness d Pole ng with idenxe,construct the project(Sec.Ito a owner o and Pity who b Code)The improves
thereon,
- License Law does not ripply m an owner th.contractors)
who bunds se improve thereon. "' - -
:, ,end who.conoacts forsucn Prolcas with a commnogs)licensed pursmm to.Ihc _ . _ .._ -_-, ......... ..... __._. --.._ ..,
._..r Con tractor's License Law. 4
❑Iamexempt undcrSec: ,B&P C for this meson C'-
Own Data
WORKER'S COMPENSATION DECLARATION
1 barely aNrm under penalty of perjury one of the following dmlarelions:
_, ❑ I nave and willmaimain a CcniOwln of Corrosion,to xGin
lsure for Worker's
--'� Compensation, as provided for by Section 3700 of the Labor Code, for the
perfomtnnce of the work for which this permit is issued.
❑1 have and will'maintain Workers Compensation Insurance,as requimd by,Section
3700 of the labor Cade,for the Performance of the work for which this pemdt is -
'sued My Workers Co f n 1 urat rid Poli y mha
CERTIXEMy> tNFROM WORKERS S, e l�s ,a_ l�A", 1 S '. k\t,i. it,
'v...
COMPENSATION INSURANCE
"t not section need not be completed if the permits for one hundred dollars .., d($10t)tole".)
Ic nfythtothson in eofth ' krFwhich u ct I ucd:l '- - ' -
Coro l employ y Person f y rte S a m bccon,a subject ro the workers _ - u =
Corona scion laws of Cahfome DatApplicanta
NOTICE
roOAPo ICANT If.the Workers Crermakmglnis provisios theof of
th Exemption:you should
-- -
hccame comply the Workers Compcnothis Permit shall bar
labor Code.you must
zfonhwnh comply with such provisions or This permit shall be daccod rtvoked.
r ...
F;y CONSTRUCTIONLENDING AGENCY -
a ' 1 h by whi this th c u,d(S lending agency farth Performance'
Lend r x Name which this permit issued($ IPB7'Civ C)
CL. 0 _. _ — ... _..-- — ' __
�.z'
Lende.aAdercsa ., . .. ,
U
c O 1 ceriify that I have read this application and ,air drodur the d tat information school,on is '
li Er 'collect.1 g con r comply with ell city and county ordinances and state laws mleting
fJ mbuildmg constrvction,and M1erebyaeation puposes. fives of this city mcnrcr upon
rW that above- emioned property for mspcni ,pdryous.
Ila. creme:indemnify and keep hunnak;ithe City'of Clipertioo igeinsl
rn city itica,judgments,ends and expenses which may in any way accrue agaimt said
U_ 'y Ciry in co ncc of the' mi ng of this pesmiL:" •' ` '•
APP in NT k ERST $AND h, COMPLY WITH'AlL'I INT". 1 .
ZS 11 ERE un .-, Issued by: Date
one of AMlidantrCnmrwmr•^,... r� .. . .. - .Date'-.,' . Re-roofs
FiAZARDOUSMATERIALS DISCLOSUREWill do '
the Cv pfName building rort or handle'ht.awmocs material ,_.-Type OfRoof-
as claimed b> ratninoM pal Code Chapter 9.12, ad the Hatt adSafety _+•"_- - -Call,Section Sect 25532(a)l _ - .-tit r 1 ' -
OY ! 17N 'f n.. (,t r f 4 , '}' 7 t 1sE r
Ali i-69shall be inspected prior to any roofing_material being Installed. _ --------
I
- zad pcamen i I rth lgngoc e t u eaAi o dtournamnt If a roof is installed without first obtaining an ins eetion,:
emit hazardous air comam llama as dcfinee by the Any Arca At Quality Mwagcmcm g p I agree to remove
Dlrhia I . , .,, all new materials for inspection. Applicant understands and will comply with
Calif. e s ON.- all non-point"so rce regulations.
❑Y
hares do man rials g'irearri uncle Cn phe 6.95 of Ne
Safety Code.Sachems 25505:25533 and 25530 1 understand that
-if fine Wil ag Joe not avr t eve a at thin it is my responsibility to notify the
oceupw Of,h,or uim=1 ch mdxt be'met prior hl is...ove ol'a Ccrdfieate of '
Oc,upa a.. . ( _..-
- - � Signature of Applicant _ Date
,—" wne Iqm i agem,', All roof coverings to be Class "B" or better--
•- int . _ .. .
i.__ _. OFFICE. .