02070177 (2) OF
CI BUILDING DIVISION
NO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7856 MC CLELLAN RD LEON MASONRY INC 02070177
OWNER'S NAME: APPLICATION SUB DATE
LESLIE LINNETTE 240 MOSELLE CT 07/29/2002
PHONE: SANITARY NO. CONTROL NO.
aOO
(408) 365-1660
µt ARCHITECDBURRING PERMIT INFO
ENGINEER: BLDG
FT PLUMB MECH
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0 S',Z LICENSED CONTRACTOR'S DECLARATION Job Description
=o I hereby aRnn thm 1 am liccnxd under provisions of Chapmr 9(corr,meming p
withsar n] 1 fl)ivislon3oftlicl7uxin fessionsCode.andmyu«nsr REPAIR CHIMNEY
wx�� . . rants a �g 10 2339`7
6 Licca L c.
r'Si 3 u H Dat Com
FIN Oa CHll he use DEC 1 f
� , I u Jerson y plans shall be used as public records
�Y
ou i p O Licensed Prefcssim it
z OWNER-BUILDER DECLARATION
cit e w 1 hereby affirm that 1 am exempt tram the Contractor's License law for the
Micron,reason.(Section 7031.5.Business and Professions Case:Any city or county $1500
f tz-OQ
which requires a perm t t c nsimetIter improve,demolish.or repair any dramatic
�3 m, oto is s uanc alw rt the lie rf ch rmitw B4asi and sum t
marhe . i -J' nanft9theprovisions
,ra n. fthe Cot tisUcerse Lpr 9 Valuation
co rancngthSenwn]fltp) IDivisionJ ftheB sinessandProfemionsCod) Y• dl
or that He is exempt thiiefrom and the bass for the alleged ercmpdon.Any vtolaion
of Section 9031.5 by any applicant fora permit subjects the applicant to a civil penalty ,y
of not more than five hundred dollars 13600). 101 APN PHS5ATION t' "'1 ^o Occupancy Type
01,as owner of the norm employees with woes as their sole compensation, r
P"Pe Y YemP Y 8 P<nsa _ '
will do'rhe-work.-mad'the stmcmre is nor intendedoroffered for sale(Sec ]014- "-' "-' "' " 'r - -' --'--- --'--" _
Business and Professions code The Contractor s License Law does not apply in an 514 — FINAL PU��� 6R�f3ons^`• D`
owner of property Who builds or improves thereon,and who does such work himself
or through hisCal own employees.providing that such improvements is sol wi not inmndcd or
'bRcrcd for Cale:If.however.the'buildin arim-o-meat is sold within one?or'"._.-._.__..._____._.__.___.-_�_._..._._.._._...__. ...._._.__._.._._._-___._._____....___..___.__._..._.
efompletion,the owmrbolder will have the burden of proving that he did not Wilda
improve for puryose of u1a)
:, L as owner,of the propenY•ran exdusively comractinS rim greased camnetors to fA.It Ni s
_
construct the project(Sm.7064.Business and Prefessions Code:)The Contractor's 1117 I �,,, , E.P.'r 11 CJ:: `SII':"
r License law does imt rapply,such
man owner of property who bunds or sepurseimproves thereon,
f. _ and,.tt&,Licinc for such prolecu.wiN.a,comrmtortsl Iiccnxd.Pursuentto the __.__-----.__......_._.�_..____._
- Contract asi Llcenx law._ 77 22
O1 am eaemp under Sec."''n• �':n" "'•'`' ': xx ,W&P C for this reawn ,�. L:f:'•,O:rv!;fil•.
. . AUG
Owncr::,,r-';+'.,11sn .r ...:.Dura•' . .,
S COMPENSATION WORKER' NSATION DECLARATION 'a DING
r- . BU L
a I hereby M.uiker penalty of perjhry are or the following dalarations:
❑ 1 have i4d will maintain'a Cerdfime of Consent to sel6insure for Worier's
Compensation, asprovided! for by Scotian 3700 of the labor Code, for
-_ _ performiance'of me work for which this pcmii�is issued.,
41-11- 1❑1 have i ii will maintain Workers Compensation Iniumnee,az napdred by S«tion
3700 of the Luix Cbde;for the performance of the workfor which this pubbit.is
6sued My Worksli C ,seniiation insurance tamer and Poly number are"
0. t
1 \Y 111 l 1 tP
�( CEBTIPI A ION FE] TIIOON FROM WOR RS 7 to ray :ist l,'1 1;Y6 1 •{{11
11
mom yC - -v
COMPENSA ON IN RANGE .rr,. _ ____.-..- -.__
(Th:ssLtlotineed not be'cnmpincd ftsf-cpennit is fib eiundr dollars - v- f�F` `'t' '�•'['i I :s.
IS NO)or Iss.)A. '
n:f tht m Ih perf rm of the ork f h h thit is is cd;l - -
'fi II riot employ any person to any maroer s"as to becconiubject to the Workers
Otannienimitind lawxMCAI l me Dutei
r NOTICETO APPLICANT If after making[his C n ream
s d y,oyuo ho Id
Obecome sulaimt t me Work,",C rape a u a provisions of Cis
forth th ply with such p o this Permit shall bed deemed reoked
1• `� ' '-
ZZ�+ _.- . _ . .- _. ._. ._...._ . __........_. .,_ _ ...
_ _.__.... _ _,..-_
yt31 1 , "CONSTRUCTION LENDING AGENCY "; ' .I„rI
I bratty iRrm that thee ;a conritmacti6so lending-agency f the,,performance ” f 't 1•
of the ora for which m pc t sued(Sec 3(19] C C) - _.._..`._ . . ...
Name-!-
Z;)-Z sea Ad
s 1 rectify that t I have recd this city
application end sumances bad a above maws belati is
Rr U •torten.I g me to mmpl with all city rid county ordinances and sum laws rr it as
Q.V to Wilding c dbertbyouection pupmse,imtiueso(miacitymenmr upon
,the ebo(We) i J ° by for,ins ismal keep
purposes. _-
. (x. � e t e:anal"ify st, keep hen.a the way a me ag i against
z liabiliticx.' dg ,costs and expeme ich may.in any way eccme against said
:[ V:Z City in ase nae of Chemin permit."'
llit
'APP UNDER. ND LL(' 'ITH'AI:N'O.N- IST" Issued by: ! Dffie
_ - S - RE t L N Y'
of antrCo or Re-roofs
HA DOUS MATERIALS DISCLOS
wn the
it &future bac Idin meti,rard'some or handle lixiiarldiii,mater .-Type of Roof
rChapter ._ .__,_ ....�,,,,�. M _,_.....,.......,...._
a.d dbyth La I..i Mums ad 9.12. dtheH Ira ial Safety s L aril t l till
cad S❑Yn2$372`11IiYf Nn ' 1 r" , ( it 11 a.k A� IsJ t,r?C.
6 1k All roofs shall be mspected,pnor,-0,any
_roofing materia]bein installed.__,,,,,__
c, twllth apelcaa(ar f ngmcup t equipmento devices rich If a roof 2s Installed without first obtaining an inspection Iagree.to remove
mads loan,,ar fined by the'Bay Area Air QhucfikryM -agement
D strict all new materials als for inspection .Applicant understands and will comply with .
oY I "°' all non potnCsource Regula ions ; ,r)„
I. 1 rcxdI a m
hxmrd u aie'min mgmrcmems under Chapter 6.95 M Ute
Cdlifo" Heal Safety Grde:Smt 505.25533aM 8534.1 untimairdduti . .. . -
...ift told nil at rthat l is my mspo iblty to.notify the'
p n 1rhe Sr2pir'rm hich'I i Fc i prior m i an of a enifcate of
Y Signature of Applicant Date
... ...._...._. _ .. - - _;.. .._ . .. .
".i nor uthon.q All roof coverings to be Class B or better
' ,;. .. _. ..Is It
ICE .__._ — _._.. ._ _ . ..._.... _ . _ ..... .. ... .
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