02030037 OF
TINO
CI BUILDI G DIIVIISSIIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1056 BUBB RD J K MASONRY 02030037
OWNER'S NAME: APPLIC99TION S B DATE
HELEN JARVIS/ EDWARD SILVER 521 S BASCOM AVE #A 03/ 11y2002
PHONE:
' (408) 287-2398 SANITARY NO. CONTROL NO.
z ARCHITECT,ENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
u�
n i LICENSED CO\TtAC"fOR'S DECLARATION Job Description
i Z_E 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P
retw wimSectianft7") foils,nn3oftheBusinessand PoclosionsCode.and myhceo. CHIMNEY REPAIR.
cy�; is in full ndeeee_ \1
Stena Lic(nsecl `� uc.rF yoYoflE TEAR DOWN TO ROOF LINE,
w DmcV cmuninaoT'1�R-- 3te1
3av ''rte AR HITECT'1DECI'.ARAT10N REBUILD TO CITY CODE .
°g 1 vaeerstand my plans shall Is,used as public recants
o`o licensed Pmressmnal
e OWNER-BUILDER DECLARATION
I hereby.(Sect that 1 1. exempt from the Canons Car License taw for the
C Z a following rtaOa. eros,to
7031.5.Business and Pm.de Professions Code Any city or roomy
I F G
which ts perm t m co w t h r improve.demolish.t orepairany structure
is.3� -trio t r e Iso q ' th pion tf such pertnnofle ii,i,iteentruccent
(cam 1 sW p u n thaprovisions 3 tContractor'sL .c fe ons(ChCoe) S Ft- Floor Areal?-, a r e
(commencing g "resect ]o midthe' s nor he I3 q s Gi Professions ;"P)"'i i �{ •k9'c'.'rt�. i *.1't, ?, ;e(ti,}s ' $19` '§ation
or Sec he 6 31.5 bi any applicant
and the basis for the alleged exempno o Any violation '
-Of Seniors]03 P.5 by any applicam for o permit subjects the applicant m a civil prnahy-
:of not more than five hundred dollars(ISM), 3 6 2VVAu3nb®r0 Occupancy Type
❑I,as owner of the prupeny,Or my employees with wages as their sole compensation,
-will'do'the'work,and The swctum is ,,itimenihd'or offered far sale(Sec:7]d04,"
Businessund
d04,"Busidessund Professions code:The Contractor s License Law does not apply toad
101 - FOUNDAT RaNired Inspections'
owner of property Who builds or improves thereaa,and who does such work himself 10 2 _- PIERS___
or through his own employees.provided mat such improvements arc not intended or
.-fifered floristic.It ho the buildimi'or iiihiininverrierit issold within oric' y aof -
cam l t n to ha un th b cf rt fp gmthaatbeor
Imn r p m r I ) - '110043 - UREFBEAR-R
-
---c
❑I,as Owner of the Propmr.am exclusively contracting with licensed contractors to - 1.0.5 _.ANCHOR- BOLTScandanno
and,who.ce t t.. Business and Professions who milds or The Contractor's
omarm far such o an owner Or property who muds or improves thenron, 106 - SEWER & WATER "'. •— ..
Contractors swam, (Sec.]pmlcns wnh.a convaaogs).liccnsed.puauanito Ne.
- -- ---202. _ -UNDER"FLOOR_PLUMBI'NG-----_..-_....__._._ .
cense w cel nest apply t
C 's License Ww.
olam enemp1nnam seg. '':B'srPefor this reaso" 203 - UNDERFLOOR`' MECHANICAL
ower' • Bale204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
,1 hereby aRlrm under penaby of perjury one of,the following declarations: 301 - ROUGH PLUMBING
J ❑ 1 have ane wlirmainmin a Cenifcme of Consent in self-insum for worker's 302 - TUB Sc OR SHOWER
1`
Compensation, as provided for by Section 37W of the Latour Code. for me
performance orthewarkrorwhmthisp mit isissue. 303 - ROUGH MECHANICAL
❑1 have ad will maintain Worker's Cpmpensmion laooance,as required by Section 304 - ROUGH ELECTRICAL
3]W
of'he
SLabar Code.for'flocpedoortance of the k f which this pe m t
My Worker,Campc t 1 ce a d Policy b< -
"-- 33 00 56'•`. .FRAME
MCHOEDO
WNS" _
tr s (tMFlCATIONOFH%EM UNPKUMWORKER I , " "" ' t ",r61307�= INSUIJATIONI(fA:
COMPENSATION INSURANCE.- ...� -. . __. ..30.8...'.= SHEETROCK .._.
hms.e tneednor b<complmcd if the permt is for One hundred dollars
(SIM) rill.) , 309 - tEXTERIOR LATH' '
- — — 3'10- •INTERIOR=LATH
i c n fy that in the peHb ce of the wark for whish tens permit s Issued,I °" •• '-� -
anau t 61 y any a y 'a so as to become subject m the Workers 311 - SCRATCH"COAT ' '"'''" ' -,'i t 'L
Compensation Laws Of Colimmia:Deonner
Apps t - ._ ._.._...313--. ROOF_NAIL.. ._ _.. _.... . .._ _... . -.
NOTICETOAPPLICANT If.after makingth Certificate"fExempt yo should - --'-' --
ZbecomSb)ectt-thWokrCompenst
p niosoftheLmCorey rout 501 FINAL ELECTRICAL 'ENERGY '
O arc kd Z ritos cis roves ons or th s
502---- .FINAL PLUMBING_ ENERG}
'f CONSTRUCTION LENDING AGENCY
— -
503 - FINAL MECHANICAL ENEf�GY
C ,> n I ncr or - th rte netted l e'n agm y for n p rfnin,ank ., y
W anis ak( whichmso ;, Issped(sc3o9T�y.c) 504 FINAL BUILDING ENERGY'
-LendvsNme
Icnde Add .. - _ _ _ IC
505 FINAL ELECTRAL
1 certify Inat'I have read this application and stag tmt the amve information is 506 - GAS' TEST .
LTsrF ConeetIagree to,comply with all city'and county.ordinances andstate laws relating 507 - FINAL PLUMBING _
V to building omswction;and heieby Authorize i licesentativesaf thi"u,memarupon -
W the amve-nKauonedpmPenyfor inspection purposes.
.,, 508 - FINAL MECHANICAL
[}..0. f W<)ag t ve r d rtwfy and k p hated ss the Gty f Ctipen no against
m City f ares wse n y"n nr w y gat est sale 509 - FINAL G E
V Z City Ivequ ' STAND Ing AND,
L t T _l
SO R CANE ATfSTAND$AND i41LL COMPLY WITH ALL N N POBJT'"' 510 O(`- N NG l/
SO rrse RE gTIbNS � Issued
�. Dat
ygnam IN AVPII<antlCanvacmr•, ". ... . "•...••... . . .Dam .
HAZARDOUS MATE ALS DISCLOSURE - - Re COOT$
I. ied t the bppl d m r f rare m Id ng ce Cham tore 2 handl hawd us m to 1 -Type of Roof
sdef dbythCpcn MICod Cnpt 912 dth<H ❑ha dg fry "" - -- -- — ' - -
Code Section❑ 25532(.1 r N r t ! - -^ f i I�. ai s al t ti _ ,-'` .... .
- s -'{' '` __All roofs shall be Inspected prior to_any roofing material beteg installed
wnu i,ourounm !^tetemlinedbythe muAa.Air t ee icesemnt If a roof Is itisialled without first obtaining antinspec[ion;•'I agree to remove
erns t M1a tl nu is i Qu t ry Management g
(� D sine .. _-
"-' q cots ones all non-ole[sourcirre ulatlons Applicant understands and will comply with
❑Ys P: . ,.:gP PP..
n Y eYA A
'I:In read thalbrznidous mar cels rt u rc e Chaps 695 of the
California Health&gaiety Cade,Sect ons 2550545533 and 25534,1 understand that
'If themod gdeesnroIcomedy heveatenum thus ary o,minsblty tnotify the '-' - " -- - - - - -- - - --
Ocopes rtes Of the q me is h h must M t p t sh1.at
Signature of Applicant Date
Kda%iarriudbcrizWOtsio o t .- All roof coverings to be Class "B'or better
-OFFICE' -- -
- _ - ... • i ' i i Ill