02030024 (2) OF
'CITY
I BUILD NG DIVISION D CONTRACTOR INFORMATION:
' PERMIT
BUILDING ADDRESS: PERMIT NO.
7607 PEACH BLOSSOM DR JIM KRAUSE ROOFING 02030024
OWNER'S NAME: APPLICATION SUB DATE
LOW DENNIS G AND VIVIAN S 2310 DIANA AVE 03/06/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 779-0704
GOO ARCHITEC MNOIHEER: BUILDING PERMIT INFO
12
u_ BLDG ELECT PLUMB SECT]
�an I I CJ L:_1 U
LICENSED CONTRACTOR'S DECLARATION
1 berm mon ma.1 ran reenxta toner Tena t<r 9(<nmmenun Job Description
iz—o Ya pnrvidtomn P e
•LC; with Section Business and Professions CnJe.and my liccnu REROOF.
idms,Clan 3q Coredann
nu m Lie.a T/O COMP . ADD 304 FELT &
rc < 1-ice _ s
:O a U Ua¢ Cnmrannr
V?LLARCM rEC]'SDt:CLARA'I'ION CELOTEX COMP. SHINGLES .
I undemand my plans shall be used as public records
7 i p O Licensed Pmfica,rm.I
' o OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
C?< following mason.(Section 7031.5.Business and Professions Coat:Any city or mmmy
Y o which requires a permit to conswa,alter,improve,demolish,or repair my structure
i 3 Pnn , 1 c Ira 9 ,h pylic f hpc niu fl g<d dmtemcnl -
Nulh I"c npdp mato" the p' mo f,h C , t,r'xL La (chap,<rq r S Ft. Floor-Area.,a•,`+ aDOn
(cora e8 ithSa, ] IofIyla Jf,hBure aMP fu"onsCoecl , 7F`aEre q'e �.. .. ,,.. ... $SODUJ
.11, In,
he,s tiempt-I reform mW lbe ba.. ! ,h Begctl raemd,nn Any viola)on
—of Section ID3 LS by an,.
ny applicant for a pormum ubjcals,he n"', i t m a civil of not into than five hundred dol mx(s5w) 3 6 AT11TV0 Occupancy Type
O I,as owner of the propcny.or my employees with.ages as their sole compenzatim,
will do the work:and the structure is mm intended or offered for sale(See.']ow.' 3 O5 - FRAME Required Inspections'G.
Buaima.4'nnJ Pmot fcsaians Cork:The Commnor'a License Law docs napply m un
owner of propemy Who builds or improves,berenn,and who does such work himself
or mroaggn his own empisyua.provided that such imprgvemems...not intended or . _ _._. 3 0 7 ____INSULAT.I ON.._._..._
';offered f f.If,ho the building p mint is Id Ih n one year of - — - --"--' - _ ---- "'--
completion.the urvitcolaulder will have the burden vfprovmg that h did nm build or 601 - ROOF TEAR OFF ' - -
improvefmpa,lowarxalt.). 602 - ROOF PLYWOOD NAIL
°Laoctthe Done PrSeeny,amexewdfss and Professions
mlhrenvThe(Commotato 603 - ROOF BATTENS :,:.,,":.r."�nl '4
S - _ conzwh she does n (Sec. to a Business and Professions Cade:)The Co therso's
License Law toesnmapply man owner orpropcnvwho balm.nr improved
, n _..._._._........._6_04._ - ._.I...-N._-.P..R..O_-G..R—.E..SS..
,,Una.who.comrasch.prujectd.wilh.a comm,,ors)IicrosmJ.pumt,m.the_
Com i License Low, A
❑lmxmpt under See BR .__.._.._.._ __.....,._._ ...... .
_- .
PCfor this reason
_ Own Dac'. ".
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury onq ofthe following declarations:- -
1 have and will imaintein a Cenifca¢ of Consent ,o self-insure for Worker's
Compemntan, es provided for by Section 37W of the Labor Cash, for the
perfomuaoue of Us work(or whim,his permit is issued.
�1 have and will maintain Worla is CoVni,ensation Insum e,c,' as required by Section FINALE
�
f'3]W !the Labor Cod f the(perform r t rk'f which this permit' A C C
IssrW My tb Inzumncec < Iia Pol y rax 6�B�.0
13
Lamer ERT1
I ". IFICATIONOFF.XEMPTIONkROM.WORKhRSI' ��� {� .�. ' _, ,, . ' ° • APR U 2 2002
..._._ .._..,..COMPENSATION INSURANCE_-",<,:,;_.__....r,.,. .___—____-_—.._..._._..__.—.—__ ._... _ ._..._ _ ..._._....._—.
.d 'I(1),is se<,ion'aeeJ not be cmnplelN if,he permit is Por one hundmd doll.rx 's ' ': '� 1,^"ll•'..'4. ' „
BUILDING
,i— Icemfy,thtmonn,he perforeof,h 'arrwhmnuet 't
hall n s employ y pe ny m ncr a
Applicant
I com
bee bJttto Inc Work<rs
compensation Laws nfC if aDme,- 11
.NOTICE 10 APPLICANT'If,after Making this Cesimmidubs Pciale:ushould
�- d• 'ons o!the lobo mev ou must
Z
forthwith c 1 with <h P o . d.
btton,e sub duo the Wod<r C sal n ro
1.imply �o thspe t hall be deem<amrokY
CONSTRUCTION LENDING AGENCY
he by affirrin,hat thereis-ac 1 no lending agency far the perfo ane ' l "
a 7 offfii work ficar,hich this pc t .ved(S -3097 C C 1
4n
L>J Q l. dttme
s Na "• .:'., e . ._, ._,- .._.-..
Under
'Ms AdI drgesr
I cnfY hall
II h d thispPc d ate NII ua
eis
f. cmmo, 1 g t ply ,Y d cc d [..a relating
i him.
ngc sli soflhisclytoent¢rupon
'he o , ed postprops'
of Cpennoegans,s worr s lheCly
h liab Il et 1 tlg ms: u d ualk f,s h ch m y any ay accrv< gains said
tJ z City traumata.9 ofthe g ,n8 Rh, pc , ""
APPLIQANT UA'UCRST/NJ� A "ILL COMPYWITHALLNO Po4T" Issued by- r Dale
SOURCE GU ION;
3�` /•0 Y
Signature of Applicant/Cov'v/%.nor -"•'° Date' Re-COOLS /
HAZARDOUS 1ATLRIALS DISCLOSURE �'
W n the ydir t f, c b lathe mcuP m st h win naivau6s 1 Type of Roof
: as dict, W by theCupersno Municipal Code Chapter 9 12 and the Heahh and Safety _
Cade sim nS321f1 Erle s - '�i- �' 1.
. i .':' - rill
.., I I s L _ n .,
r __ ,. _ . . , •„ .,,-- _All roofs skull be-inspected prior to_any_roofing material being installed, ,
Will the applicant future building occupant use equipment de cedwhich If a roof is installed without first obtaining an inspectiori,`I''agree'to remove
em t him ardous air contaminants as defined by Bra Bay Alma'Alr Quality Manbgemen,
osmm] ,., all new materials for inspection. Applicant_understands and willcomplywith
..
611 non=point'souice regulations.
�..• 1 hli a lead the haaardous ina,eiials requirements and Chap(r 6.95 of the
California HeShn&'Safety Code.Sections 25505.25533 and 15534.1 understand than
Jtheb Id n6 doe ,c nemlyh eamna t that,it my rc poo'h'llymno,ify me - -- -- -'k- -- - - 314 -Q 7 -
xc p nt of th r q" em' ch'muzl he ,p 1 rcsua ice of ni ice¢of
!. Occupancy .
9 Signat_ure_ ofAp leant Date
- All to
coverings to be Class `B"or better '
I rmthorr,c,age Dto.
'' —OFFICE...