02090151 (2) OF
CI BUILD NC DIVISION O PERMIT CONTRACTOR INFORMATION:
BYtrtt"f!�TOE LA J K MASONRY PERMITO12090151
TPS't Y ROBERT G AND JOAN L 521 S BASCOM AVE #A APPLIC'IJ"/"T'(Y z 002
1 PHONE: (408) 287-2398 SANITARY NO. CONTROL NO.
I
o te0 ZZ ARCHTTEC(ENGINEER: a BUILDING PERMIT INFO
,rtC BLDG ELECT PLUMB MECH
Z vhi= LICENSED CONTRACTOR'S DECLARATION
o Inc,ebyaffmhe,lamf«n¢Ntad,, mvhbmofChapm,94ommencimg FIRE PLACECHIMIW'� !II� '�TLD
FmF with Section 70Nd.f Division 3ofthe Busina7d Proarsirns Cade,and my license
x f Lin lull f nd off ,.
rc0 i u LDicynle CI. - Ci C.
R HIT ECT'IDE���tttttRATION -1
1 inborn pia W mad!as public rem -
�} to
m
as
p O loco ui
s e OWNE ILDER DEC AT10
e w"-4 e h rcby affirm that I encmpt from
m the rxtor's License Law for me $6840
Za follow It men.(Section 70. .5,Business and Professions Cale:Any city or county
E x n which ircs a.it,, swat ul¢c improve,demolish,or repair any structure
c_ positions insurance.rdsorequiow Neapplicam fursuchgermiuo Tile a signed statement - ------ --._".-_
Jut M_I3licen{&I pdnupnuo thq pmyisbonoforb Conwc,ots Licenss lawlChaper9 ] OC a3• .5 ors Valuation
(commencing with Segiont7li0and the beiisoufine Business and Pii.AnansCNb) hlV:s) 4(b� '
or that tib i1 exempt thdicfrom'dnd,M1e hosts for the ellegcn enemp,fud.Any violation i
-of room
m than
five
hundred
lain fora permit xubjccu the applirnm m e civil prnalty-
;nrna,moremanmenamnreadogarefssm). I U i A13N WhibWATi ONP::.;aJrv' Occupancy Type
❑La,ownernfine prapcny.oron,rm,d...c,with wages rsmeiruJecamscovatioa. 312 — CHIMNEY REBAR & jSTRAPS
-4411 der the
work:'xnd'.. the ormum a is no,intended-or'offanal(01 sale(Sec.-7)447 b14 - F --- - -' --
;Businus aad'Pmfessions Cale:The Contractors License law does not apply to an i d 'ons;
owner of propeny Who builds or improves thereon,and who does such work himself
or through his own howeveret provided thin such imprmcmbnts orc not intended or
cRcrd for told:If.however the building e t,men of Prov a sola he did one Year of ,b,..,1l
completion,pair Noe cifWiWer will have the W Nen of proving that he did not Wild or
ui
improve for pugxne of sole.). �
-- - - - - -- --- -- - ---- ( �G�►I'�Bra[� - ---- --- - - --------„';,.- - -
Ol.aao nerof,he propeny.ruin ;hely con,m-1ingwith licensW commcmrs to
cont er the project(Sec.76th.Business and Professions Code:)The Contractor's 91^o :,cP' i•L' 'i.: \`..
License Law docs no,apply to an owner of property who builds or improves thereon, '
�' ..-and who contracts for.such projects with.0 commemr6)licensd prommeLto.the. . _
_..__..._-.--..OGI'..0-2-2002. ..----------...._..---.._ ..._-------'------._..-- --'
COntracto/s Liana law. .,
� ❑lam exempt undir5icf' ”" lB hPCformis,cason
owh«A' < Date, :n':'.. BUILDING
'a:[%:- '' °'"•"• WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of Perinim:of the following declan,iooe-
I ❑ 1 have and will maintain 6'Cenifcme bf Content in self-insue,for Wmka's
Compen.,tion,-as provided for by Section.3700 of ,he labor Cade, for the
_- performance ufthe'work for which this pem!it is issued„I,
❑1 h d ill mil , n W rk s Crimpe , Inzurance,av bottom by,5 jinn
37M of the alvo Code forthePeifoimance'of the work for which this permit,is
iss d My W k r.C i pen a 'In uratic miner and Policy u fiber arc
s P r o. i I)3 '.M1 s4 4 ♦ (T,1`n l s✓,!�,. ii1011
ri ❑ alt.IPICATION OF EXEMPTION FROMNOR KERS] a ,ff- .I\, •,S;i. �.t.L. T'rt:
COMPENSATION INSURANCE ^' _.___... - . . .-._ ...._. _,__. ..__--. .i____.
..a .v.... .. ... _.__._-
,o
t('mrssecaiin'he'd not bWm
ecomple, f the peft,s for one hundred dollars AI 1L",,-' > '.s' , 1;_ 'rJ'1❑ 1 i' �"
(31(Nry rlcsv.)
i„ 1 certifymat i daPer f a of the work for e whichthispemi sheW d I ).:"�!II:Mi i:`'.j LYI1i)i.a \ v Ir f K
shall oat employ any pawn m any man as m became subject io the.Workers
w
ANPlion sauo.Lasts of Cdlifamiu.Dae,"` "' " ""
c N(YfICE TO APPLICANT II u'r making ill,-;Ccnlea of Esenpnon you should
& n bjcinu the W d ce Codp,mn '
pros of th LaborChade.you most
D O fdvhwlh comply with such prAiumi,or thispeomi,shall IN,cheronalrc ked F'NtIr'COhSTRUCfION LENDING AGENCY
a > I h rcby IT,in th t di�eoaM,,Lh
construction1 ding agency for the performance
of the week for-which his Permit is i...ed fig 3097 C C.)
W .Lc deN5 e r . ._._ .__. ... ..".. ._-....-.-. __. - --
.
Lenecr Address
a -t' ti
I .,, . .. .
. "•C" :t
V D I c nfy
,hat� h .d this application state t that the bo information is
W'["r cit o 1 g t co ply. 1,h all city and county unucaarc, d state lawsrelating
�.f, iobu Id g , cit a EM1 reby eutho ze rtprct tiles of to -city it) mer upon
the above-mcnunneitgrope ry for inspection improves.
W'e)a rbc to save;ihdemnif . J
`,G:i 1 B Y'ann keep hhrmleis the City of CJpcnino againn .
tZI liab t e.luJgmepts cov,and ,Owv which,m y in anyway ."imt said ✓�
U Z Cny n conseq,b a of the nfng f sit pe t /k / /
API CkNT1 DE 5'r SSA\b HILL COMPLYNTrHALL\O\P I\T [sued b Date v' 1,
5(U CT E4 t 1 N s O 0, yi
s t rc rip I aide f .'. o t. Re roofs •4
HA RDOUS MATERI I DISCLOSURE
II the JPDI cent future W Id up tit.,re or hall h'vdom m¢' I
Type of ROOF,
Nbyth C n N me one pier 9.12.and he Health andSandy
Code Sion 25\3110) ❑No sf 1 .tate Z a� � 4�r1t ]� r.t et�I Y-�.{`t alirF,i if'L spy; 1
k All roofs.shall be inspected prior to.any.roofing-material being installed.
W lith _pplicaet o future W Id ng x v tit n.eeq P.. t a a awn�n If a roof is installed without first obtaining an inspection'I agree'to te3diove
em t harard colo n a der fined b ay Arca Air Quality Management
D mel all new materials for Inspection. Applicant understands and will comply with
.1Ik ore`3a, ,;; t r '*r all non-point source regulations{,.,). -ii ) L) f` `;h n,?
I hove read the hazardous mveria6 requimmenti under Chapter 6.45 of in,
California Health&Safety CNet Scnions'_5505,25533 and 5534.I mobodand that
-,ifthe builJingdoex not cur<ntly havea¢nunCthm i,ismy respo Y Y
sibila to ",ca tho -
ocaplin, f the conam dents which mcii ma prior to issuv,c f a Ccnifcam of
... '. Occupanc ¢,
Signature of Applicant ..-- -. _ _ _ _ _ Date_
Owner n mad:ma .,nm, All roof coverings to be Class "B" or,better
.
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