01050056OFFICE
CITY OF CUPER'1'INO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
H 1111.DING ADDREiS.
PERMIT NO
21880 RUCKER DR
BOB GERE MASONRY
01050056
OWNER'S NAME:
APPLICATION SUB DATE
MARQUEZ, VIC
4&0 CROSSLEES DR
05/03/2001
,HONE:
SANITARY NO. CONTROL NO.
(408)97271285
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ARCIIII FM/ENGINEER:
BUIL DING PERMITINI7O
Ii1.DCELECT' I'I,UMB MECH
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[CtIN'TRACI(IIP.. DECLARATION
Job Description
w1iicense
hereby nlllnn thm e I ^m Ilan,wsl unJur pruvi,ions nl'Cha
iI' d rWn lmany
Semum7.+
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REPAIR C-HIMENY FROM SHOULDER.
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Li"n%c Chas Lc. N
nn /J/�yfi for
�/ [Si—R(1 .SC%f yl' , '.(:i.nRA� I
I nndv,mud ety,lnns shall he use as public tsxu
OLkenwd Pndnsionm
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OWNiR.BUILDER DECLARATION
hereby alliret that 1 an. exempt from the Cotnreno,'s Licen,w I.— I the
following,Guam.(Soctlon 90.11,5, Ifu,inc„and Pool—ion, Cowl,: Any city% 1.... ty
Owhich
require., a peru ... vt con%met, alter. nopmvC, denolkli, or repair any .%uncture
—
priernettsiv,uance, olerequiresthe^,,.scam for suchpcotiuo Blcasigned s1. ont
That he iJiccnuA purtumun tM pros,,ion, of the Contra.cutin License Low (Chapter 9
Sq. Ft. Floor Area
Valuation
(a,mmencing with Senior TIOD of Division 3 of the Btoine„ and Poefic,ions Code)
Any
.T
$2120
or d n. be is exuntpt thcrcfmin Ilndahe basis lin the alleged exemption. violation
of Sedinn 7031.5 by nIIY ap,li, 1foraFeel mi. subjects the upplleata to a civil penalty
APN Number
Occupancy Type
of not more than live hundred dollars (SSm)).
01. ax owner ofthe pope.%onny. employees with wages us theirsule mnn,vcb velum,
35614026. 00
Required Inspections
will do the work, and the structure is not intended or offered for sale (sec. 7MW,
Law a col apply to an.
o, Lianw tine
nnxines, nod rmR�,n,m Code:'nIe Contractr
r of properly Who milds nr improve, Il,cicon, and who does och work himself
101 — FOUNDATION
or though his own employees. provided that such imps vcnwuls no, not intended or
offered for sale. If, however, the building or improvement is %cid within one year of
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312 — CHIMNEY REBAR R STRAPS
completion. the owncrbuildcr will have the burden of proving that he did not build or
itnp"t cat... pOro. ormle'1'
51.4 — FINAL PUBLIC WORKS
❑ I, u, owner of the pm,cny. am exclusively evanmling with licensed comrnmurs to
construct the p otec. (Sec. 7(W, Business and Professors Code:) The Contmcior's
License Law Joe, no. apply .o an toi of property who Milds or incl mc¢an.
and who contracts for such projects with a conmanorfs) licensed pursuant .o the
contractor, License Law.
0 I an cxanp, under Se:. . If & P C for 116, ":".a
Owner Dam
WORKER'S COMPENSATION DECLARATION
FIN ALE D
I hemby uffnn under penuhy of,erjur, one of the followiey decmranons:
I have and will maintain a Certificate of Consent to self-ineme for Worker',
MAY 18 2001
Com,cnsa.ion, u, provided for by Section 37(X) of .he Labor Cale. for the
R nce of the ands for eM1ich this perm:. is issued.
and wIII mnil,ltlitt Wnakd, Cmttpelwatinn Insnmme, ., regttirml by Section
this is
BUILDING
7( f the Labor Gala, Inr the wanumece of the w... for which periost
In%neaw'
issued Wnr Com a ntt Cama and P%oliy num e
cunic5%na /J�SY No.:J� O
pyll1'ION
C:HI IP IC ATI( NO PF FROM WORKERS'
COMPENSAPION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars
6100) lir less.)
I ceni ly Ihat in the perlbtninncc of the work for which this penned is issued.
,indl not cn,pioy any per acv n ms.mu,u to become ,abject of Iha Worker,'
Compccsali,m Laws of California, Data
Afr iernl
booCETO APPLICANT: If, after making this Certificate of [isemption, you should
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hwntesuhjc,, to the Worker', Compensation pro,nsof tire L^Mtr Code. you must
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fombwith comply with such pnry nt, or this panni ,hall M: dee Bad rcvnkd,
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CONS]RUCnON LENDING AGENCY
I hereby allitm that them is o construction lending agency for the performance
of the work for which this pvmtit is issued (Sec. 3097. Civ, C.)
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Lendcr's Name
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Lender', Add,,„
1 cemy than have rend this application and %rule that the aM,ve infontta.ion is
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cmrCa. 1 agree to comply with all city and county oolirunees and state lawn relating
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tomildibecnmtruction, and hereby cuunrim representatives of this city mcoter upon
ryt
the above-mentioned property for Inspmbn purpose,.
0.
(wa)agrvc In ac inJenndlym "ep hunnles, the 0ity nl Cupcnlno nyninat
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"hilitle,. Ju Flo at,., and exp nen w ch Buy in any w'ay accme nkat.% suit
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Idyl oc qucnm :f.hc of
APPLIC .'T U^' r USA' COMPLY VITR9N.PN✓
Issued by: Dale
SOUR, : F
Re-roofs
sill .. f AFI'Ie—tlmcounall Dote
,
IIA%ARD( MATERIAISDISCLOSGRIi
Will tM: applicant or future Fuildin,no,b om pore ler handle AmnNaos mlType
Of Roof
as defined by the C.,enina Murtwipa ode Chapter 9.12, and the Health mvJ Safety
Old, Scnion 2551 2(a),
O Ye, r No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or In Irth°illing.cc°pan. use eynlpnunlmdevice, whiCM1
If a roof is installed without first obtaining an inspection, I agree to remove
emit himoll air Conutntna Bas Jetincd by the Bay Amo Air Quality Management
all new materials for inspection. Applicant understands and will comply with
Di"noI
0Y" °
all non-point source regulations.
I have mud the h, Jou, d,d, ccl,nrcucul, under Chuptet 0.95 of the
matcections25505.2953Jend2553J.1
Culifnmiall'uhh&Safe GNC.SundcnuMmal
Ifthcmildin •, nut cuncnt ant. that it i, my tn>rytmibili.vw mend, the
i<,a:}�c��e,.e ler
tee inane the . Inn nriur n,
roan,'
Signature of Applicant Date
.7�/0
All roof coverings to be Class "B" or better
o, anrnnmon.e age. nam
OFFICE