01080007 (2) CITY OF C4Jt'j RTIINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21865 HYANNISPORT DR BOB GERE MASONRY 01080007
OWNER'S NAME APPLISSATION UBDTE
CALLENDER E D 3 AND MARILYN S 480 CROSSLEES DR OS/ 01�201
PHONE: (408) 972-1285 SANITARY NO. CONTROL NO.
z ARCHITECT/ENGINEER:
O O BUILDING PERMIT INTO
U BLDG ELECT PLUMB MECH
GJ L___I 1� L_I
LICENSED CONTRACTOR'S DECLARATION
o y' 1 hereby affirm Inat 1 inn licensed under provisions ofChap«r9(commencing Job Description
F_I_, wimSectian'I )o n}of the Business andPmfessionsCade,andmylicense
� itmfmuraa G
Licemu CHIMNEY REPAIR
w 3 u y Date S DECLar
u.O ARCH,,he uSDECL
F� �
understand my plans shall be used m public
trete p O Lmensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Canoacmr's License Law for the $6980
following reason.(Section 7031.5,Business and Professions Cade:Any city or county.
Y r which requires a permit to calumet.alter,improve,demolish,or repair any someone
-Pon'to its issuance,alto requires theapplicant for such Permit o file a signed smtement
that he is licensed personal n thex,mviirms of the Contractor's License Law(Chapter 9 oC a, r Valuation
(cammeneingwith Seedonalwo)ofDivision 3ofheBpFines,mdProfession..Caae) �i-j , '35 h m 8,.(h?Oey , ,[ ; 7i :'
o that he t. xempo therefrom and the basis for the alleged Joyrom it.Any violation -' -"
-ufSect ]036.5 by y ,larm for a permit subjects the pPi nom a civil penalty'
:or not more than fiven a ddollarsfs5din 101APNPbTAMATION +) I., Occupancy Type
❑La,awneranheproperty,many employees wanwageaaxtarn,aleamnamadim, — HIMNEY REBAR & ISTRAPS
will a ss and Professions si he structure,T e'I,mat intenContractor', i er offered gar,am apply ba , 514 — FINAL PLTWg1�cn %mtQ�Pd6 io - -
'Business and property
Who
b Code:The Contractor's Licence law does not apply m m LLtYGd sNl4B ❑5
0 and
ragproperty em builds or improves n such impr who does such work himself
a th gh n l employees.s provided thin h' p menta tintended _ 1
.:dhp d f 51e fL h th b Id n8 p i old [fi . . - —_ _—_ .. -_ _ _ _.. -----
completion.
the bile will have meb a fp ng that he did not Wild r
improve for purpose f sale.).
. ..DLesdame,.fdrepra,amy,
construct the poSect(Se.71.414,BusinessI lyed pProfessions i Cade:)
ade)wThlmvmestmfoer ntt
s
License L tl tapply t rtfproeny who builds p thereon
a d lhv,cot for hP lis w th a comanclods).ficamed!parroment tN
_. .—.__ kc:.IP11
�
_ ---- - ------
Contractors License La
❑lam ex< pt
'
nAcr Sec. B&pC for this
=
0re, DateJ
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under penalty of pc jury mit or Ne following declarations:
D 1 have and will mainiain'a'Cenifcaie bf Cbnsem to selGinsire for Worker's
Compensation; as provided for by Section 37W of the Labor Cade, for the -
per once of the work for wbieh this permit is issuW,ip},
e and will'ma w nWmkersConipejisationlnsurance,asmqBimJbygliti.h
3'100 of the I$hir Cade,far the performance of the work fog which this Permit is
r's�Compensation .P 1 y N t r did Policy number 3 My W'rk
<, , ..I
'CE TIFICA ION OF EXEMPTION FROM WORKERS'I ` " iIs .! .. ' .IN \141 k, +.q. '
COM PENSATION INSURAs 1'
sectmnrecd not the completed the
IS
High)tor less.) P Permit is for one hundred dollars
V
,. Icetfythan intheperlbr poet r bulk farwhichN permitis is veeI .�;.� U t H,, II' -,:rt ----
shall not nploy any pe n m any'ma r w ,m becom baa[m Ne,Workcrs t
Comcensauon Low, fC I'lom'a.Dote '
Applarion
NOTICE TO APPL It,art,making this C o _. n-
____.
II Exemption,You should
become Subject to the Worker's Compansdtinprovisions of . ..
the Labor Code,you must
0 O forth rh complywith su h p sions or Itis permit shall he deemed rewketl _ _ ___ _ _ __.__-_ .___.._ .. _, .._. . .__....
.. . .._ . ._._ _.. ____.._
CONSTRUCTION LENDING AGENCY t•` ! I `
'1 h reby ❑'rn that there' constructionleading ug y f r,he cerfom
Q.Q.'Q .Led Name ce „'w, a- t
of the k f hick th t s"ssu d(See 309] Cry C)
�.�,Z Leader's Add
V 01 certify Nat 1 have mad this application and son,that Ne above information is
Inrcci.y agree to comply with all city aace5 and county ordinand state laws relating
obuilding co t 'cu n and hereby nothoote p .ematde iy city to ant pan
} Gi7 the - p penYt .peer proposes,
E. G (W j B too d [y and Aaph mlesS lheCry f ctilseninZ
h li b Iw< me eta deepens wh h may n any y I.",said I/IO
V z Ctyy n equ �c Ilheg got itis t '
"'+ APPL U7 W p` MPLY WITH A N'I'OINT"
sdu I o O Issued by: Date
S t rnpp C o• nr ,• , i',Datel
Re-roofs
�:tl HA OUS'MATERfALg DISCLOSURE '
W II the pylic Tutu 'bti tai g cecup t t o h mII h dna mate'nl _ Type of Roof .. _ - . .. .. ,--_. -------
as defned by\heC pert Muti ip IC de Ch pt 912 rid th Heahh
ad Safety .) -
Cad Sato 25$3e(a) ; 1 - ; r s _ '- t •' , i.
°Ye n 1 All roofs shall be inspected prior.to any_roofing-material being Installed T`
Will thepppc t o f r build g p nt use eq pm nt rdemeet which If a roof is installed without first obtainingan ins tionI'aoree to'remove
emth Nos oat inn is ideti dby@ Bay AreaArQualtyAl wg merit pecc
all new materials for inspection Applicant understands and will comply with
°Y all non-point source regulations.
I ha i d the h ardour ma vial «y ;rem nn code Chaprer'69-5 of the
Cal foram Heulih&'Sof Cotte Sections 25505.255}3 and 255341 understand that
.. . _...._ __... .. __..... .. .... . .. . .. _. _. .... .
'if th dosnt moil 'eat h 'i into it p-n ib llyi maty the _ - - - - '-
of T f e"kpti ew to musthe. tp r int ante fa en r t of
a Signature of Applicant_ Date
D -" - . . .
at 'oraat .eo f ate, All roof coverings to be Class B of better -
-_ "OFFICE. . ..._.---- -. . . . .. ..__._... _ ._.. . .. . . _