02050080 CITY OF'CUPERTINO'BUILDING gtylstON PERMIT' CONTRACTOR INFORMATION:
BUILD( DADDRESS:� PERMIT NO.
1085,6"BROOKWELL -DR ' LEON MASONRY INC _ ,'.' .; 02:050080
� C`E1E'CHARLES E AND JANET C 240' MOSELLE CT A��fY° alRS2
PHONE: .- (408) 365-1660 SANITARY NO. CONTROL NO...
-0..Z ;AltcgruiCr/IENGINF.F,R:, _ - BUILDING PERMIT INFO .
'Wt O O_
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Zx a✓�.�pt.ml 1rI`ao oam}olffC',arNQIO1rnhRaLTOR5 DECIAoA �Cmylicrnse '
_Job Descr}ip"'
llonT q t commencing pmo,
fChIter9( CHIMNEY RBPAIRTfle sandr .. ._
ccs .Li<nmC cp
-OeaC'•-.D tai -
1 40 GMHLC'I"5 RATION
g I a der.mod Amy plans shag M axed s hlic records
i p O ,Licensed Professional
' o ,.' .t .:OWNER BUILDER DECLARATION ,
,11 asI hereby,af on(hal Lam exempt from the Contractor's License Law for the
rpil5u;ng rtuon.(Section 1031:5.Business and Professions Code:Any any or count, -. __ $2500
F x O ,which requires a permit to oonslma;alter,improCe,demolish.or repair any structure :.
63 m -
-thnt he is license
I p _ aorto the provisions of the CronarSion's License La (Chapter9 Y.s r 3f�gg-�'1.(}' e�a r ..- -.. Valuation _.
(commencing 'th S«g 1008) rD 'ton 3 of the BusinessdProfessions Code) r'• s �, rY t
o,that he n exempt tharefmin and thc.bas sfor the alleged exemption Any violation s
„ofS ct ]0315 by anyapplicant mu
for a permit the applicant t civil penalty "'' -
_rrotmor men pen dred dollm asoB) 10IAPN iBOUNDATION ,. ; Occupancy Type
't of owner of the property or my employees with wwages as theta sale compensation. 312 — CHIMNEY 'REBAR `&' 'STRAPS' — -'
will do the work.and the structure-isnot intendcd'or offered for sale(Sec 1014, 514 — FINAL PTI%� Q �'
"Busineas'and Professions Code:The Comm,tor's License Law does not apply to an ns''U> P.
aw
r of m,by Who builds or improves thereon,and who does such work himself
at through his own employees.pownded that suchmpare not intendedmayor,
w
. ';off d'fo-sale.If n wevar,dM1e building -p n s olJ lh n year of _ ._ _ ..._.. .. .... .... _ .__ ...-_... ... _. ..... .. _-__. .._.
cornplatior,the owner bmlder will have the burden of proving that he did not build or
improve foe puryose of sale). - _ '
s i I a f the p pe dyamexclusivelycontracting with licensed tractors to _ -- -"
contact the p )ect.(Sec 10Gf Business and Pooliti Cade)The Commences
t
Lioorae Law does not apply to nerfpropert3 who builds or Improves thereon,
and -ho mmcts mr.s.ch pm)ccta with a.commeor(s)(ceased pursuant to the . . ..._ ._.
a,Lac, _
; plham mPf,IrtNScl y B A,P C forhisrt
vson r '
gU1LD�
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nEi ikhkHL!-a �1 r.Dai to - .-.-
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I f 4 WORKERtS COMPENSATION DECLARATION' - +-••-+ . . '
Ili rtby Rander nakyof,erjur,macofibefoNa mg dedamuon.
will mammin'a'Ccnifiamc of Consent m self-insure for Worker's
:' r' Compensation, as for by'SmJan 3100 of the-Lzbor Code. for the
performance bf the work fo1 6-r which this permit ix i1.ssued. ., '
❑1 have and'will lnoinialaWorker's Compensation Iosumnce.-as required by Saha.
000 f th Labor Cod f dh perlorm c f th ark f -wh'h this permit s -
x d k r C t 1 ur d Pol y' h "
o
No
11 CCRT,FlCAq 10N OF EXEMPI'IONTICOM W K RK S { j', ,t D t. .• i,t„ r.� �',v t ' "
COMPENSATION INSURANCE
�) {Th ; tonn J dbe mpletc I'f th permiris fm one hundred Dollars k ' ".l -- --- --'-- - -
:(5100) rYs..)'; ,. � .. _ I':•
Ien fy ih-i in A perf f ih k to
h h tbl petro a issue) I
_,.,.
shall of employ any pe in any manner so as to become objectgo.dhworkers' -
CompenmtionlawsofCa1ilifomia.Da¢ "
.Ncome AFFLICAN WoTI'aft aktga.CertificateafEempd tin.yen should
mulct
Z become li b) uo the Mockers Co ns s g n pa . s of a I,nbo Code d. tbtin '
Q forth th mihply wish ch p vis oa or thisp rm .hall be tl ed evoked
a � •-^' CONSTRUCTION LENDING AGENCY � ' - to-,,-s t-j -
-^ 1 h by ffirm that dh o<onmma on lend ng agency for he penormance
of the work for which Ili permit s issued(Sec 3097 Civ C)
0. Q [lend sNa
Le6dor's-Addre 1 7 - _ .. ._ ..
VIZ +ita`l + !f•tlntl h"n"s s b '
Q Ser 1 ttmfl that I it,a read this appl cm n dad d tc thio therfl,ase information is - • ' .y^
.. ..
(r 3eorr nil sig tq comply Itrall ty ndCuntY d' Ce dstat la 'relining t
04U gob Id np connructmn,and haebYainhd x reprtsantatives ofths any to enter upon "-- '
itis bo' m J property forpenionp in
[., 6i '� (W - edcrom rdk ph ma the Cry of CLpn'no.,ain't
N liab'I t 1 d e t,c as a
xP sexwhich' y n any Y against said
U Cit c mace oft bond ofihispermiC - -
1; TUNDER STANO NO WILL COMPL li'NON''OINT
e .. REGULATIONS ,. I Issued by: f Date
.signature of , pica moor ".:"... ..„ - " D. e Re-roofs
ZARDOUS MATE' DISCLOSURE
we the ppl cam Whim,tore bd Id g occupant store o handl nastac y s maternal T e Of Roof
e
of ed by the C pen Mu (pal Code Chapter 9.12 d theHealth and Safely
yP
.Cmll Section 255321.i - ._... .
❑Ys x.13'('
All roofs shall be inspected prior to any roofing material being installed,
,e ,�; wumeapplcad mddrenn'Im�goccupantuacegmma.t de.ce.which If a roof is installed'without firstobtaining,an inspection;-I'agreeYoremove
sit bamrdou f conmmma t `deo d b3 do B y Arc A quality Management
District?oY g /No _ all new materials for inspection Applicant understands and will'comply with
c: "alt non-point source regulations - '
0
ha a cad dhe hazardous maienals requirements
under Ch pt r 6.95 of the "
i(o is Jt ae overtly
ions 25305.25533 and 25534.1 undersmnd thio
if the "it un ces not rtentlY have a tens .that id is my responsibilitymnofify the
'.ocrnp5rid ghc reamn no which me met prior io is. ane a of a Ceni,cam of "
Dao
•� - s' Signature of Applicant
_. . . Dae
-?;: '; D n umn. .5 Date All roof coverings to be Class "B"or better
OFFICE _.-�`. . .. _ .. . . ..