02020020 NO
CITY ILuNG DIVIVIs ON CONTRACTOR INFORMATION:
i PERMIT
BUILDING ADDRESS: PERMIT NO.
7630 KIRWIN LA JONES MASONRY 02020020
OWNER'S NAME: AIC O Uhl A
MORWOOD BARBARA S AND RICHARD 1058 DELL AVE dP ����28(Sa2
PHONE. 4083777512 SANITARY NO. CONTROL NO,
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m' BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Z!01 JobDescri tion
p ZIhcrcby oRnn Hallam licensed under provisions of Chapter (commencing REPAIR CHIMNEY SHOULDER.
PSC Secti.n]0110)ofDivisionlof Ne Bu' ess and Prolessions Code.and mylicense '
full force nnJ effect. jai.
O w O w:esu Class ', tic.a 3nv3s
am s emracmr /Y diedd
3 0, ARCHITECT'S LARATION
h t=' 1 understand my plans shall be used as public records
u°1 6 O O Licensed Pror<ssiawl
a.a.R OWNER-BUILDER DECLARATION
1 hereby drum Thar I nm exempt from the Contractor's License Law for the
following reason.(Section 7031.5,Buenos and Pr.ressiano Code:Any city.,county, $1975
A O which require,,a pe.i,to,mw
os,olio,improve,demolish,m repose any stmrc
ctu
se prior to itsissuance.also requires the applicant for such Proud to file a signed statement .__---
mad hstslicensed purpuan(mdo,provisions of do,ConuactolsLima.Law(Chapter 9 I r a Valuation
om�epU eaeeipgwinsapona ).romismn3.nh<BlinetadrApr�xionxe.de)
or that hemphherefmnl'a00pp00nd the basis for the all7,ged exmnplinn.Any violation
-or on9031' by anyun fornpemlit suhj.ms the applicsm too civil penuh
torour.tmmeNan five hundred
rcadaliars(ss(g). y 101ARNNPI*FDATION r ... .-.D Occupancy Type
°I,osowneroflhe pro,anty.or my employees with wages ax their„ole compensation. 312 _ CHIMNEY REBAR &''STRAPS
-will do the work;and the ods:The s not act's Lim Law dor sale(Sec 7044;' -'-'-' --- - - --- - - -- ------'---
tB er of and eny W ons Cafe The Cos there s,a n:u Law doe,,not apply m an 514 - FINAL PLI ITIfed�(s LGGon$'•1 -. ' f:
owner of proany Who lot'. or improves thereon,and who dos such work make!or
or through his own however
provided Nat such improvements is sol are ria intended or _ _ .
-bR A f 7sale:IL bdwever.the buJd n4 or amprovemem a sold wnhin one Year of”-"" "—' "----'-- -"-_-"""' '-`--"-'-" -"
cdplt ,Ne awter Ambler wll have the lwrden of prov ng that M1edid n.a hmMor
improve for ryupose of salc.) I
- ---
Ol:asownerofthe m n arae v _.._.. -'--"----" --" '
P Pe Y ,,clue Aly comrofessi with I l Th Conran to - L 1"I
-
construct the prosect(Sm.Ito a Business and orry who builds
Code)The improves
thereon,
License La dao not apply l n Disc f p pent'who bu Id ' pros thereon '
nd wh Drama.f r inith pnjecis with.a cora mur(s)limmest,orman,,a.the. __._ -------
'
Contractors t troc<uLa --- -
°I maze pt nder5c 1 A B&PC fonhsmson L: .... •1Or
Owner
! WORKER'S COMPENSATION DECLARATION -
UI hertbY am.umer pc,dry of IKrlury ane of Ne f II InB declarations:
❑ 1 n4-and will Andin,iin d Cenifcdte or comm to self sure for Worker's
C-soperamaim, .1 p Wed for by Ser .a 37M or the Labor Code,-for the
- _ perfdrmauh'of the work for whin his permit,is issued..
"-
131 hava sued will'aunmain Woiker s Compensation Insumnce,ax mquimd by Section -
1700 of the Labor Code:for'the Performance of the'wark for which this permit is
i N M,W rk 9 C tap l e Ins ce 'and P cy numbe re
..., .... : ....-.
JJJJ4Ja •.•-._.
1 Yt. k•h!. •if tltJ 1v'
1 t,CTRTIPICATION OF EXEM ON FROM WO KCS— <_{- `' a .%;. .g iJ1: :,'; Q 1' ;.-:a °S..', e.
-'` COMPENSATION'INSURANCE FF a/d A
nn need nye he c.mplemJ irthe per:sit I,for one hundred dollars
'ICM rt'Nat Ne pi'rrrf mine hhe wokf wblhNr. pml is a. JI -�- -- - - - - - - -
sh II n t en 1 arson n - Workers'
p y any p an mad er a to become subject to
ApdnsaCon Luws of Calllorn a Date " '-
NOTICETQAPoitin oT:IYaf6 making Nis Cenifcsm of Excmp,C yooutoula
cz beco o subject to lh Works/s Onions a npromit sill e, lab re,m you must
c Rlnhwnh c ply ith such Provisions o Ih s permit shall be deemed rc oked
-V] 'a ' 'v`CONSTRUCr10N LENDING AGENCY '' •- - `al
tea'_' 1 hereby aRtrm that theta/ 5 ronstmet on Icndmg agency for Ne pe fmmaae
i
W.ti of the dfor hichNepermt - ssued lSec 309],Cv C7
,._._ ._.__.---- ------ ..._,._....------ ---.� . .
._. Z
V I cenirY Nm I have rid tha aPPhcmmn pend sate theuhe above in(ortnmio.is
Rt'F. co,ien,;bagree ao comply wish all city.phJ county,pNinences and stat.laws miming
QiO to building construction;and herenyhuah'oriz.iipresenwlives of Nis chy to enrerupm
W ah h e me t sed p npeny f nspeum p po s. . ,
y. We) gree m av ntl merry and keep h mlesuh C ty f C p rtino gram
y li b t s sudgmegts sae and experu hmh ay n ony y
mm a Bald
t,1 z Ctyy n n y rte fN ggram ng of th p t ' - V v
- SPUACAMr UNDERS TA:NDS qND WILL COMPLY'W'ITHALL HON-POINT.'
st GRCP R icer, Issued by: Date
ignamm of APPhcanatCo tr i C::' '-"(a'.•. ..,_ _..Z.Xne,,y( Re-roofs
HAZA OUS-MATERIALS DISCLOSURE
'.; ; 1 the apbmnr&Naito,Wilding occ pan,star orhardlontatimmonateral Type,Of ROOF - - -
A;Jai ed by th C p rano Municipal C le Chapter9 12 and the Health and Ssfery
Cafe Sat.n'2551 (a) , s - 1 "k;1 } r A s
°Y. kr tz,4"P n , 1 t( a 5 t All roofs shall be inspected prior[o-any roofing materia] being installed
omd-us a hwnor future bird e - ... - .
w PP' g occupant use equipment or which If a roof Is installed'Without first obtaining an inspection,::['agr@e to'remove
cont h and s J conn nam as defired by the Bay ArentAi,Quality Management
District? all new materials for inspection. Applicant understands and will comply with-,
1°Yes n 1Na. --
all non-point source regulations -,
.b havetieod the hazard;,,tame Iscg6i,,mens under•Chapaei 6.95:of the
Culflornia He611n&Sakty Code,Sections 25505,25533 and 25534.1 understand that
If the building s dos not cannily,have a tenant:et r is myssuance of a to notify the' -- -
fOms,nan y.Nb iequire.1- which maxi be tan press,to issuance of Certificate of
Signature of Applicant Dale
o er ra No,i: to Drag All roof coverings to be Class "B" or better '
- _ .._,y: r . . --OFFICE-- _. __. ...._ _ .... _ .. .---.. .._ .. ..__. . _,... ..