02080153 (2) OF
CIBUILDING DIIVIISION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: , PERMIT No.
10301 VICKSBURG DR SECURITY ROOFING INC 02080153
APPLICATION SUB DATE
PHILLIP G AND EVELYN E 406 EL CAMINO REAL 08/27/2002
PHONE: (650) 595-1213 SANITARY NO. CONTROL NO.
�
O O ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
8s. LICENSED CONTRACTOR'S DECLARATION
z O L- I be ch ffimn Ina,1 am licensed under 'ons of Cha 9 c mmcrmin Job Description
oi_� ya °'° °"' No e REROOF
F<NC wilM1 Se`,on']UWIof DivisionJof lM1e Business d fessions Cree, dmy license
E,iif iamfalfPke ° e�� y� ��^ r� n t�
Liccnsa�nlu-= Lic.N —G I It—�II V L'�1'!-a1S
w0i 3 LL{-n A HITECI"S DEC TION
t-'°'O,g I urMersun my plans shall be uud m public rtcords
;E p
Ede,p iceLicensedd Professional OCT O T ZOOZ
OWNER-BUILDER DECLARATION
u'i`-` I hereby affirm that I am exempt from the Contractor's License Law county �g(y0L®P�(a
C?a following ream..(Section]UJ L5.Business alsoimprove,vet de io demolish.
Cale:Any city dcounty $8000
$ O when q no,alit, t t applicant
tforsu demmnh ore a sig anyxwdua
63$ phi t ts. rrce,al req m inions of rive Loxia tofile
aw(rte¢mem - .. . . -
Iharra I nwJh Sectio)tgsl,J:pfDionsof the C°nvacmrs Llacnulsw)Chaper9 - - - -.
rcemm is
with 7000 fDbasisoofthel ed! apeProressmnaeode) f, S; '36. �Of}.1@c3r a,�.T �y, Valuation
or eat he i5 exempt thcrtfrom and the basis fur,he alleged�empuon.Any violation
`� �' t ' ` "'�d'.'t
of Section 4036.5 by any upplicam for a permit subjects the applicant to a civil penalty
of trot more than five hundred dollars rs51aH). lO l ARN MlDbADAT ION 'PE:.A r:,c Occupancy Type
❑1.us owner of fine pmpenyormyemployees with wages a:'hall sole compensation, 102 - PIERS
wilt do the writ:and the,structure is not Intended or offered"for safe(Sac.-7044,- - 103 - UFER ,,
'Brsines,and Professions Code:The Commc,or's License Low does no,apply,o an Required Inspections) ,I'e ``
owne
rof property Who builds or improves daemon.and who does such work himself 104 - REBAR
or eyed for
his awn employees.provided that such improvement
mems art tw,imerMN or --_,
".oBfrea foTsele If.Hbwcvcr.the buildingor im Tovcmcm Ix sold"within one�-aFrof� --�-��-- --- - ----- 1 ------'----'�'-"------
P Yc - - L.1. ...---- S:,.r,.\.:, < ir,T},:;f W
,prove for da awe oriole.).
)have the burdrn of proving that he did not build or 106 - - SEWER & WATER
improve purposco '
— ------ -- — ----- '--- --'-- ' 202-- UNDER FLOOR -
El Las owner of the pmperty,am exclusively contracting with licensed rn mese min m R.'_f9".ri:"AR I`°it
r. _ construct she project(see.]B ,Business and Professions Cade:)The Contractors 2 0 3 - UNDERFLOOR MECHANICAL L;'' .Lc''I
- Incense Law does not apply loan owner ofll property who Holies se improves Merton.
}. _are. 'ear's License La.ueh.projeets.whM1.a,conaaeme(s)licensed puauant.ro.me. ..._ _. ..__..2 04------UNDERFLOOR-FRAME---
01amexemptenu sec "' 205 - UNDERFLOOR !-INSULATION
` ? " "a0ffiPC for this rtason
❑f am,cacmp,under scci ., ,• ,
owrr`a '`t .I lima - I "' •• 301 - ROUGH PLUMBING
'_WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
thereby affirm under penalty 303 - ROUGH MECHANICAL
_( ❑ 1 hbre'aod wiil'maintdin a Certificate of absent 5o self-msurt for Workers 304 - ROUGH ELECTRICAL
-pecompensation: as provided for by section 37M of he Lbr, Code. for he 305 - FRAME
rformance of the work for which this peemi,is issued.,r,.
❑1 bgve lord will maiton Wpe toke's Cbm1'itmom r<gmied by Section 306 - HOLDOWNS
37W of the Labor CW for he perform f the .&f.,which this Permit,is
307 - INSULATION
si d.My Workers Compensation Incur a cart r d Pol tie are
B 0 Z308------S- HEETROCK ="""'
c. ((. v _. u
l{I I RTIFICATTONO�EMlicYP FROM.WORR aS - 1 ' s�'\ r 305 'I 3EXTER MOR+ LATI-Pi
COMPENSATION.INSURAN[EU ) �^^tt //''' ,3-1,0—_ —
'• (Th ctn' d Ibe completed tribe parmtsr 311 1- SCriATCH COAT
steal Ie 1
l 1 . 03
VI cem y that in tpefunioncebf Ihrkfor h h,hs ,permit' cis. d I - -
shall sot employ'any person n any maRn<r so as to become subbject to tae.workers 501 - FINAL EliE CTR I CAL'r'ENERGY
compo, ,t„ I;aw.,ofcolmmiq.,oqle ' I 502_..-.-.FINAL,..PLUM13ING__ENERGY.._ _ . . .
FNOTICE TO APPLICANT If.after making thCertificatee fExemption,you should 503 - FINAL MECHANICAL' ENERGY -'
become subject,o the worker's Com,,croloon provisions of the Labor Code,you must
O hkhw;m comply with such provisions or this permit shall W deemed revoked. _ : 5 0 4 - FINAL BUI LD I NG ENERGY
RGY
e'CONSTRUTIONLENDINGAGENCY ELECTRICAL
F.VFINAL
I '-I
'll I batch,airma thin there is a construe) n lending agency f r thn performance
nbe omalkmt whichm x i cd(See'LN] Ci,C) 506 - GAS TEST
Qt-Q Le do N dm
- —507 = FINAL- PLUMBING.;:_
v 0 50 FINAL MECHANICAL'
IcnfY,h,ln dth pPbt d.ua+hrt the h < nf tmauona
idobuil I g toctin.a mall ebenyand Ire ordinances and state laws rtlmon 5 - INAL GRADE
'O CJ tobuld -a ,rued myform,pehorire etmo'u uummive.ofm city to nae upon 5 0 - INAL P &RKS
she M1° , ., d p.,.piny f_ aped P has -
,p, eWe)bjrtetosavcmdnfirs..... &ohm ayiiitiaCayc,mcaginstrto 51 - INAL B
fn liab 1p 1 dg_ ,e. 1 d Pe sc h h Y nY Y c against
V..Z City meo sed eofdr g n,ng.f , permit - 602 F IL
jgPPLICANTUNDF STANDSAND ILLCOMPLY WITHALLNOqh POINT'' ISsuedf - Date
SO C[' GUI. 1 NS,-1 /1 / ' Ls ,D
'sig cSS
4fgpplcu Contractor +�
Date t Re-ro s04 - 0 - RE
HAZARDOUj'M RIMS DISCLOSURE
I Nill the applicant or future Wilding mcups nt socre or handle namtaous mriteria .Type of Roof...
as d f cd tM1 Cupcmn M n c,P51 Code Chepw 9 12, nil Nc H hh wd safdY q,c .r.i m 7 t� >•'}0 , I f W .:1
cod s n m on 25332( 1 +
°Yes` ' " T All roofs shall be.inspected.prior,to,any.roofing material.being.installed ..._....._.
I,., ;;ryili.me,ppprcant or imum buiiding'eecupamu;c,equipment ordevice,which If a roof is installed without first obtaining an inspection,I`agi'ee'to remove
cm,hneaardous air con term ,as defined by the Bay'Area Air Quality Manajemem
DI-trictov fENo ,.. ' f, ..,,allnew materials for i.n_spection._Applicant understands and.will comply,with--
' ,. . '--all_'non-point source r rations - : -
,g I have d,h h to d s' men q under Chapter 6.95 of ma
Ralf Haaldr&Safely Code Scictilmes 35505 25533 and 2553a 1 understand that ___ _. `ad _ ^
if the herd Bdoe nrn Gu tlyhavenan nt d in Y po 'billy to nm fy rhe"" — - - _/- 1 - -
,dac pa 1 f,M1 quire n¢ h ch mu t be i no to is sarin or a CeniOcaa of - / "y
Occ.P Y.,,,la q
nature F Applicant
p recur nuq:m. tont. ,. ate, All roof coverings to be Class `B"of better II,
:.:':. , v_'.�.. 'i. • .. . '.. - _ .-_. .,. ._.•.. .. - _. . OFFICE' - ' --.._ . - . .. _