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200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building SEPT 2008 B718 CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION DECLARATION OF CONTRACTORS SELF-CERTIFICATION QUALIFICATIONS FOR REVIEW AND INSPECTION OF SINGLE FAMILY DWELLING REROOFING WORK This form is to be completed by the licensed roofing contractor participating in the City of Anaheim Reroof Self-Certification Program. Contractor’s Name (please type or print) C-39 License No. Contractor’s Mailing Address Phone Project Address Fax Permit No. Licensed Contractor I hereby affirm under penalty of perjury and under the laws of the State of California that I am licensed to perform reroof work under provisions of Division 8, Title 16, Article 13 of the Business and Professions Code, and my Class C-39 license is in full force and effect. I further affirm that I have reviewed and understand the requirements of 2007 California Building Code Sections 2308.10.8 (roof sheathing), Table 2304.9.1 (sheathing nailing) Chapter 15 (roof assemblies) as adopted in Title 15 of the Anaheim Municipal Code and that all self-certification reports submitted by me will be based on the code requirements contained therein. Contractor’s Signature Date Property Owner As the property owner, of the project address noted above, I have read, understand and agree to participate in the Reroof Self-Certification Program. I further understand that by participating in this program, my reroof project will not be inspected by a City of Anaheim Building Inspector. Property Owner’s Signature Date Print Name