02040037U
t<
I vtFu
:Yf
:OptF
33 LLy
.LLOa
�m
t-Za
he
3.
Z
z2
Z
a>
a�
U'C
is. F
O�
} fz
Fs�
U:Z
a
CITY
I
nuaDING ory SINN PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
6390 MYRTLEWOOD DR
LEON MASONRY INC
02040037
OWNER'S NAME:
APPLICATION SUB DATE
VIERRA KAREN L
240 MOSELLE CT
04/09/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)365-1660
ARCHITEC (ENGINEER'
BUILDING PERMIT INFO
BLDG ELECT PLUMB NECH
u C-1 L.'7 l_1
LICENSED CONTRACFOR'S DECLARATION
Job Description
Thereby affirm I WI 1 am limnxd under provisions of Chapter 9 komme„cing
with section] for -orae eau an nlre.sionx Code.and my license
all for d eat. �'
2 °> L 3
CHIMNEY REPAIR TO FOOTING.
Lin
icense Gla — �,
Date n
ARCHITECT'5 DECATION
unden,an y planssh sed as public records
on
OWNER- DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city wcoumy
which q parent construct. II Improve demolsh o reps y waurt
$5000
prior toe a ce al requiresthe pal am for such Permit to rile aged statement
1111_.__ .. .------------ -_
00.00
F r ngCp�a 'r"
Valuation
thath s,dp rsant to the prh'.r sof the Comraaor's License Law(Chapter 9
(cam snywthSoc, 70yiofDivision 3of,he Btsinesspei Pgfesvons Code)
ye❑
I !'f3b71�( b25 VU' 1' I•.�
or that he k exempt Ihiicfmni and the bwvia mi the alleged exemption. Any violation
...
'
- of Section ]031.5 by any appli a h for a permit subjects the applicant to a civil penally
:afash mare man five bordreado0ars(5s0o).
p�❑��p�
1OlAPN P'UUNllATION
--•' 1`'' Occupancy Type
01. as crofthe progeny, in, employees with mvges sa lhelrmle cumpematinn,
CHIMNEY REBAR
"
514 - FINAL FiJit Sued WJ5M4�ns' ., .� ..
will do the wnrkfund the svamurc'is-nm Intended or offeredforsole 1&c: 703q,12
Busiam and Prakxsimss Code: The Contractors License Law does out apply la an
mune, of progeny Who builds or improves dime , end who docs such work himself
or Through his own employees. provided Ibar such improvements ere not intended w
offered for ink: If; however, the building or improvement is -sold within one year of
._- _._._ - -' - --"" '--� - -- -- --- '_ . _-1001.. 00.00.. _. 11 _
'-'
'compmi th rM1 IJ ITh In mrd fp glhlh did tbuild a
Imp, f pry . of )
I cors 1
co l a er f th pmpe. 7 i lith 1 The
construct ,he prosect IS ]Ubu B d P fc. .Cal ) Tha Co tat
:d
' � ; , t -
ro .
W d a apply, h
4d p pent hob pro tt 111to
. v t
A
�®
licensed
projects .with a <onwg1 Ikevsstl.punuam to due
who fa.s. with du
and. ho co
.. .. _. ��- _ _
License
Contractor's License L w. .,
I
G l stn Casa[,,, anaersec. til .'.. :I3&Pl: far thiare'
APR 12 2002 ,'.�.....::,1;',
own ill nate
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under malty of Iserluly one ohne following declarations:
BUILDING
❑ 1 hare and will maine.6 a'Cenifca¢ of Consent mself-insure for Worker's
Compensation, as providedl for by Section 37W of the Labor Code, for the
performance of the work for which this permit is issued.
01 have and will maintain Wurkerh Compensation Insurance, as required by Section
37W of the Labor Code, for the pu&-orree If the work for which this permit is
Is�d My W r1, 'sI Cn p at,.. Ins ran c d Policy number ore
-
t it
'CERTIFlCATIONOF E% ON FROM WORKERS
.. COMPENSATION I -�J .a
•-•Sa
1001._ ... _ 0000 _
he BeIpNC� 6
(xJ (}
(Thstsen of need not he co nplc¢d rime penult. far one hundred all
s' l -! {
(5100) I -.)
'h.
.: 1
f� I cell fY That In ,h pcdormreac of the k f s In' Ili pc n Is Issued, I
•,
.hall' not employ any pc wn in any manner m as m become subject I me Workers
1 1, q ,
' ' -
Compensa,ion Laws of Calilbmia, Dale
. p 'I - - 1111 ' ::..
1001.._ ... .. 1100... 0011.. 11110000 _ 1100 1001 .0000. 1100 0000 0000. 1001..._
sM1ould
NOti,.ntTICE fOAPN LICANT. IL after nwk ng tbs Cmit¢u¢Lf E empuon. you should
become subject m the W'orke'rs Compensation provisions of the Labor Cade, you must
forthwith comply with such provisions .,,his permit shall be, deemed revoked.
CONSTRUCTION LENDING AGENCY
1 he by Ism ihIIll a .Alm dnfiIgen yr the perfurmance
of the work for which this permu s issued (Sec 3097Civ. C)
- Under's Name •. I_ .. -..L: 1001 >..:_.. o.. ..001.0.
Lenders Address, t .. •...
t _
.. ...
I eCBify that I have rad this application sad stale Ihat the above information to
ordinances
s testing
comply with all city hen county mdativess and catty Iowa relating
nall. 1 agree city
agree to
m
.II
to huikliI o hereby c representatives this city law. er
me abnveanen' ed to y for mspcnion purposes.
(We -gree lm x.1 lad, oily andkcep hamtIe,Ilc envoi Chkithiiii'mosl
litialitie 3udgmcros, rs'an <x s whch may in any way acnne against said
City onxCQuemC f Inc NIa ptmlll.
Cr ICA. a ERS .'D WILL i PLYP'ITH1L NT
` °"
I$$lledb r` Date
y:
kCE' L NS.1
ign re,or Appiican t I - 'I .' .. "/ I. me
11 H DOUSMATERIALS DISCLOSURE •'
Re -roofs r
..: em r tare building w ha t lore 2.n tll n 1
Will the aPPic
.Type of Roof
Health an Safe
ai def red by ,h C pen M c p Chapter 9.12. ❑ theH hh ntl Safety
ip ry
Code S a 2553 (7 I t In c
❑Y ry ,, ,i 1
p;
All roofs shall be inspected prior io any,roofing,matenal being, installed.
h app(, n,otfuI bat g p , use esin , devices nm
Will Ili'
If a roof is installed without first obtaining an inspection; I agree'to remove
i, h ,ami cam m rant. a ed by the B y A A Quality Management
Disrm
all new materials for inspection. Applicant understands and will comply with
r 0Y N ..
T t
...-_ :. -
all non -point source regulations, ,1 11
1 hasel read the hot, doas matenalw o,timemcno under 'Chapter 6.93 of the
2 etd 25530 1 enders, ad that
lis a H ahh&' o ly Code.. s 25505that 35533
Calp
f the Id g4as curtcnJy hay! cis , ,ha, t x my m I ty ro unify the
hi ,`y ran be mel prior mJssugryCyy C f¢a, f
am m of Ne ircme
r
Signature of Applicant Date
{
All roof coverings to be Class "B" or'better
ro mo, eddge Dple
1,„
OFFICE