02020055 CITY
OF GDIVISION
UPERUNNO
IPERMIT 'CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: - APPLICATION SUB DATE
O OUIN H M AND MACALL STER ARI 108 FRANCISCAN DR 02/14/2002
'HONE: SANITARY NO, CONTROL NO.
(650) 222-2860
O O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
5tn zU IU r_I f-1 u
c 5 u b LICENSED CONTRACTOR'S DECLARATION Job Description
z:0 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
_ fa wimSenion]01ofDivision3o(IhBusinessandPmfcs>innsCWe.andmyliccnu CHIMNEY REPAIR/STOVE INSERT
xs y� is in full force y0d�e(e,
x O�u Da¢nuO�Cla/ss�y�SP[-`�yl� ConLie.racw' C /� C
. yLLom '-- " �JARCHITECf S DECLARATION J FINALE®
3 1 understood try plain shall Feused as public rccoNx
ta�6�
s.
s.a.()() Licen.seJ rrnfessional z) 2002
Xo OWNER-pUILDF.R DECLARATION JUN $ `k
-vs1 hereby off rte Thai 1 sin exempt from the Contractor's License Law for the
t K a fallowing reason.(Section 7031.5.Business and Professions Code:Any city or county
SO
which requires a punnit to common,alar,improve,demolish,or rapur any structure
a3:!E t rt n alsoreg uh ..plicate for such count to rile evgnW statement- ____$3400
- --- --- -- - - --
hat-Iiiie oficenned puisuon)to the provisions of the Comments License Law(Chapter 9 .rx S Ft. Floor Area, p•t t�t Valuation
(commencing with Section 700BB, f Division 3 of the Business soil Prafessons Code) ., ' ' { I 1e.:!' ,4'•.L4.)1`4'
or rust he s exempt therefrom and the basis for the allege)exemption Any violation 3.5 •0 3 012 L"O 0-
-of Sac,inn 701.5 by anyappliesm I.,.permit o bjens me......can.tos civil penalty
iofmd more than rxa hundred dvnms(s5Um. APN Number ;: ,• .- Occupancy Type
❑1,as owner fthe ..,arm tela m wax.x us llonwle conchwant 101 — FOUNDATION +
property, re employees with E P
--will Nc work;and Ina ode:struTre'is not or's Lice'eofferedLaw forsalemn(Sec. 1.a,' -- - - 1
rt o r,o and Professions Cade,The m e,heor's License Low does nm work
li o en
a
wrier of ho,own who .,re.or improve( such and was roes such work nded or 514 - FINAL P
or though his own en 11 y ..... led(too aueh nprm"mm, I jutended i r
-:
improve for
Ne owns-hale.).will have the hurJen of proving that he Jitl nal build or
improve for purpose of sale.). I
].as owner of the property,n4,Business
sly c cY g with licensed eon meati m
icewm the preen(Sec 7040 Business d e Professions Code)The improves
Contractors
License Low does .f apply m un owner of property who)buildslice or Improves thereon,
and.who comrects.for such projens.with a romrucmr(s)licenud.pursuam.to the. .._____.__ ___._...__,..______....___..._._.._ .. ....._..-.__.. _.... _:._a..
L
El I..ori icca
❑ oro eLaw
x sit o a 1111' ' r' ` ,B'@ P C fonhis reason +I`
Owns
E S '�RI'Dald
ENSATION DECLARATION
(" 1 hereby affnn under,parody of perjury one of the following declarations:
/ - 7 1 have and'will meinuI.a Cenircme of Contin to selhimme for Worker's
�...� Compenxetion, es-provided for by Section 3700 of the Labor Code, for the
- performance of the work for which this permit is issued.,
_ ❑1 have and will maintain WmkaI'a Cum.Pluraln In_sumnce.-ss¢quircd by Section
37M of site Labor Code,for the performance of the work for which this permit is
issued.My Workers CompenmJon lnmmdce carrier and Policynumber are:
'-- ;t35"4t' �iv rrohey�,N.Jpp,��-'150Z4(p2-�oZ . tir'1. xYY: k._(tA ,+..tenn_ xxlr,
-CERTIFICATION OF ESEMP' ll FROM WORKERS" 1-•a \ ice. R t` E ) c, t a IC Y v�.i.t El.x't.
" COMPENSATION INSURANCE ` " ;
'•Pt:.`' (This seciioa need'nm be completed if the permit is for one hundred dollars _ -c\ .`:It'I.• f
kll)(Br less) ,
r. 1 c n toy arm the perfo n sneamn,a work for whish iters permit is issuW'1 - - -- I s,f , +.t,.I et>• '"'` -_ _ -
C Composition
of inion employ any Person n any moaner xo as tb'hecome subject ra the WnFkcrs
Cortipeiint i'n Lews o(Cvlifnrtii,i:Deter'
'NOTICE TO APo'he Workers far Compeolatioing n s Coons of of Exemption;,you ould
hour 1
becsime mompinthe Workers Compensation Permit shall the Labia Code,you mast'
z 0 forth Ih mplywith such provisions or Nu pcmn shall bed d mocked,
"CONSTRUCTIONLENDINGAGENCY '
1 h- by off.that them ';n.wdlon lite g gency f the performs e _ ,. ..
L>a_Ahthlip rmni issued(Sec J09] Ci C) .._ .__.... _. .. __. _.__._....__. ._...._
of New kfor hie
Lamina Name - . '-.. _ ___.. .. _. .__..
Lc der Adtl s
�.0 i cemfy Naol have rcaJ this oppliwt nn wJ aims Nm the above mfmoauon is,
fs+g[r c°^qct 1 ogres to comply�wiN ell city vnJ moony nrdinencm and ansa laws relating-
.Di(, no building'onatmdibn;and hereby amM1orizc'represrnmlivca of thio oily rn emerupon
the above-nmminncJ property for,insPcction purposes.,
'We' gtti'm IWemnify ahJ keeph IsilheCryof Cupenino:lgiinm
LF.ai W 'ab I I 3 dgme, x, n s J ex uses hi h m y in tiny y occ a again.. aid
V 4 -City c en o n n sa mw O L
SOI RIC „i$NN S LL COMPLYIWITH ALL NON-I�INT Issued by: Date
Re-roofs
C nvmre ll A t c .� SDI CI..SDRC
r � P
H A OU A
„ W Il-he
e lievm o h rb build ng occupant nae or handle hazmdou noted.) Type Of Roof . _ ..-
C defned by tit C penuro Mun c p I Code Chep¢ 9 12 e d the Health end Safety
ode O°Yes Ion3533]I(c) I Y Bi st f, t V. I'lt A i'1 t /('{ x a I y I ; a( x,'dl :1
All roofs shall be inspected prior to any roofing material being installed. _
I, Wdl to,appliiniorfum boldingxcupsm use equ p to d cca, h n If a roof is installed without first obtaining an inspection;4'agree to remove
eon Mzaro r
dmmamiant asdfined by theBay Area Air Quality Managment
DIsWrt g]�a all new materials for inspection. Applicant understands and will comply with
°v` i C'°;do I all non- oint source re 11 ations.'
r,.' .., P B ! ;.trey.,.. - L - - -_
I have read'Ne ha tloos erials requirements ander ChapI,i%.95'ofthe
Cel'a is Health - afro e: e 1 s 35505,25533 and 255M.1 understand that
e vol,
. 'sI„ .. .IQ gid ,as o nil I that it is my mm
responsibility the _ ___ ...__... __... . _..
an m xhi 'met prior to issuance of a Certifies¢of
eat.(•' 4102 Signature_ of Applicant _ Date
... . . r,,.., p ,
;owner o,out i "me All roof coverings to be Class `B”or better '
OFFICE