02010071 OF
CIBUILDI G DIVISSIIONyOPERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
7842 FESTIVAL DR J K MASONRY 02010071
OWNER'S NAME: APPLICATION SUB DATE
RIOFRIO WILLIAM M AND RACHEL T 521 S BASCOM AVE #A 01/16/2002
' (408) 287-2398
HONE: SANITARY NO. CONTROL NO.
COO ARCHITEC ENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
y i c IJ I—I L -1 L-A
LICENSED CONTRACTOR"S DECLARATION Job Description
K� 1 hereby affirm that 1 am licenced under provisions of CM1apa.'r 9(commencing p
t:eq wimSection 7000)ofDokma3 flM1eyy y`)Pmfc,.ionsCode,aD ,,,teen CHIMNEY REPAIR TO ROOF-LINE
in full force enJ t. `Er �[ (/6
z a Licanse Cmc .a `C- T Oil O
Data�i S DECLARATION
C CLA
A S DECLARATION
to 2 1 mtderwmd my plans,ball he u,ed as publle records
:i E59
p C Licensed Pmfessional
c OWNER-BUILDER DECLARATION
1-C' 1 herebynatio.(gra that 1 1. exempt from,he Contractor's Coo License Law for the
F a a fallowing manna.(grain.]o3L5, t.offer.
. and nse.demolish.
Cade:Any city or roomy $1500
"Y x C which requires n perms,la wreathe,ober,improve,demolish,or repair Noted any aeumure
a3. 'trio t , al reg es the pylic tf bIt fl aLvI,mem
,halt licensed pursuant to the provisions !m Contractors License lv (CM1 p¢r9 epi �( Valuation
(cm '_g th5 fo ]fNNb fD' u iof,M1e Businee.a dP ofessions Code) l •J y31912 d:'76,:7G',jU V-.i 1',,' 1 1�`e,:
or that he is car opt theFcRmn and the basis for the alleged esemp ton.Any vi.elawn
of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty
or rte,tame foam Rva hundred dollars($500). - 10f PN qt'OftDATI ON Occupancy Type
°1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and,he arucfum is not intended or offered for sale(Sea.71 l
Buoresq and Professions Cade:The Communist's License Law does not apply to an 514 - FINAL P1313}&TO lbIt RK&s
owner of pmpany who builds or improves thereon,and who does such work himself
or through his awn employees.provided that such improvements amwithin
not intended r or
-
offered for sale.If,however,the buildin "- tis,o1J within doe �� f
gnnmpememcn yeldo ._." :,v,.
completion,I.,the owner-builder will have the burden of proving that he did not build or ' - '
improve for purytne of seal'
°1 s f th p Pcrf 1 ivelY co I g with licensed terminato to _ --- "�
terminal t th Project(s ]Oqq B ncd a d P ns Cox! The Co nroc,
License ta due t Pply t f Pro R h builds reproves the eon, `
and ho c t ct f r ch Projects
o1 cu th t n (s)['a d pursu ,to.the _ ...
Cmnu trot L c tw /5s�'J,�) /y1 -
,. °1 mn enempt under Scc, to ;B&P C for th c or
Ow,Kr - - Data / j
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of Perjury one of the following declarations: `f -
I have and vill'imintain a Cmifcam of Cancan,ao o1f insure for Worker's
pensauom as provided for by Section 37M of the Labor Code, for the
peff mmnce'of the work for which,his Peri)is issued.
1 have and will maintain Worker's Compensation In>umacRaS required by Smsion- •-1
3 of the Labor Code for the performance of due4cek f'which his permit is
rssu d My W rkels Compemauon e
c -rand Pol y numb, rt:\�
Cert, -
``II
CI RTIFlCATION OF ON P WORKERS
. . _ COMPENSATIOATIO N 1 SURANCE
(firs"swoon need nm W completed if the pe 't- for one hundred dollars -
(E100)arless.) '
I rarity that in the Performance of the work for which this peorm,is iorucd;l - - -. - '- -t f ' "' - •-' - - •-
shall note ply -y pe n any manner so as to become subject m me Wcif `
Compensa'on Laws of Cabrt m a.Date
Applicant
NOTICE TOAPPLICANT:if,Co pensationis Casim., f1 Exemption,youshould
.
Z Wroma subject m the such provisions
Compensation provisions of the Latif invok you must
z O
forthwith comply with such''rorisians orthiz perm,oboe,,be seemed revoked.
Z .___ _ . . .. . .
CONSTRUCTION LENDING AGcNCY
I hereby IT that
mo a c .t cfon lend ngigan y far M1 performance
of he work for which rale permit m s ed(Sec.309>at'iv.C.) /
y e ' snder's Name•....: .. _ ._.
= Z lender's Addrt _ --
o I ceartify that I haver d this application and sum that the above information is
kT+ E. a rzaa.I gree to comply,wnh all city and county ordinances and state laws mlaing
V m building automation.and hereby aumoiRb representatives of his city to coal,upon
>1 W me above-mamioocd pmyany for an'Nown purpose,.-
yP., (We)agree to rave,indemnify And keep hamlcssthe Cirybf Cup,rum'.ageing
V]' liabilities•judgments,costs and expenses which may in any way accrue against said
V 7 Airy in UNDERSTANDS
of me granting D this perms,. - r 1 /
APPLICANTUnce of me mmingo WILL COUPE,N'ITH ALL'NON-POI T' 1 IV '/O
_73
Sf R F. ULATION /'; O/�j�/ Issued by: Date
1-"
tgnamre of Apronall ti nlrccmr Data Re-roofs
HAlfsl I RIALS DISCLOSURE
HOlI me applicant Or future Wilding oc up in(storc or braille hasedoma mala nd Type of.Roof
as de0nad by the C rsim Municipal Cod Chapter 9 12,and the Health and Safety
Code,Section 25532m) � ,` --
ea
°Y _.All roofs shall be inspected pnor.te.any roofing,material being installed.. .
" thf,cPplnta ts b lg by d,
In,.,a qts i Q t devicesManagement
ge ich
ent If a roof is installed without first obtaining an inspection; Pagree'to'remove
mi,brooderscontaminants definedbthB ArcaA
,°Y all_new materials for inspection. Applicant understands and will comply with
- all
non-point source regulations. -
1 becalmed the h d us mamrials q 'remains under Chapter 6,95 of the _
Cahe buil Health&'Safety Cod;Sections 25505,'_5533 and 25534.1 understand that
if the building J,ks nmcumntly have a tenant:that it is my rtsponsibiliry to notify the
occupant of the mquir en¢which must be'a ct'do,to issuance of a Cenifica¢•uf
�.
Creation,
cm .
`Of� Signature of Applicant Date
" Carae,oraam iced.,a. Date Z All roof coverings to be Class "B"or better'
.. .. .. .. - - 'OFFICE .. .. ..