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01090110 (2) CIBUILDING DSIONO IVIISINPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 7505 RAINBOW DR JONES MASONRY 01090110 OWNER'S NAME: APPLICATION SUB DATE KIM 1058 DELL AVE 09/25/2001 a .PHONE: SANITARY NO. CONTROL NO, 4083777512 GW O 7p ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MF,CH r,u LICENSED CONTRACTOR'S DECLARATION 5 w z 1 hemb (fine thm I am licensed tinier f Chapter 9(cummco6ri Job Descri tion iZ—O Ya Prov Pameo P B r whhsecBan7Bomarumiamn3nnheBusiness and Preaamnacme.and mybttn CHIMNEY REPAIR FROM G OiJND. is in ull forte and crt ssII i O W u M.,fClass L2"s Lie.0 q o? Da¢ Co lrr nl 4 3 u ri, ARCHITECTS DECLARATION n 0 g 1 understand my plans shall he used as public records i r 7 c o O Licensee Professional OWNER BUILDER DECLARATION 1 herby affirm that 1 am exempt from the Conwctai s License Law be the t?a following reason (Section 7031.5,Business and Professions Cade:Any city or county 2=A which rearme,a Permit to cons $4200 truct,alaimprove,demolish.impve,demolish,or repair any structure a3� —0-It issuance,also hes the. listen for such lm file.signed aatemem (comm cingwit pSection7th!pit Diiisinr Ne Ce Business Licencelaw(OwlRcr) r a, Valuation trommeerisewiresecean7fna)drhe baron3ofeaBnslmummnot eros.sten) t'f,Til� �l3����.tQ�•it.1 T;S, f !.('`+ or m.i he n exempt Nerermm and the bates.for the anege9 dempdod,any vmmtmn f of m nrcmanlove v n 70314 oany applicant for a Pmrit subjects the applicmt to a civil penury orhot nlmenunarcaannar.(aSBm 101p`PNl0i�t)ATION Occupancy Type ❑I,as ownv or the progeny,ur my employees with wages ss their sole compensation, will do the work,and the swetute is not intended or offered fm sale IS=.70414, Business and Professions Code:The Contractor's License Law does not apply to an 514 — FINAL PMdIt1Yr@d WIQRK13tns' owner of progeny Who builds ter improves therm.,and who env such wink Mmmlf t or Through his awn however, Provided that such vement mems are not intended or -cHercd for sale.If,ho builde w l Wilding or improvement of Prov n sold within one year of - vian,the owner-builJer will have the burden of proving that he did not Wile or / improve1asneer ofthe .. ❑1:as owner of the Progeny,am exclusively d Professions ns licensed contractors Contractor's m , Licenconsumuse the does project face Ito a,Busowner of and arty who Codep The Condictio, 1� and who ca does not apply to an owner or progeny who builds seimproves t a the < O and who contains for such WalamI with a comrstor(s)licensed Wnuant to the Contractor's Littnx Law. ❑tom exrmPt under tees. - � � :B&P C forthis rtmon .s'l" . ". • _ - O.;. Date WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury one of the following declaatiorev ❑ 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compemmmn, as provided for by Section 37M of the Labm Code, far the perfits cep of IW-work far.vhich this permit is issued. s1 have and will maimI. or the Pe Compensation a work(r hick thi by Section oared of y Worker C«I n for the Performance to the work which this garters is issued MY Wordcrr;Compc t insurance.rear and Policy number arc: cgrrm r `LmC 511 0 �.\ , 5 1 Policy N W C l R O 13 I l 4 0 m i" CE FlCATION OF EXEMPTION FKOM WORKERS t- '_i-s S Ys .f. i•' t� . COMPENSATION INSURANCE (TTis section ncN am be completed if the permit is far one hundned dollen (SIBBI«leu) _- 'I certify Nm in the pvformantt sof be work far which this permit is issued.l •. shall not employ any persm n in any manner so as ns come suhPn,rude Workrn' Compensation laws ofCabfbrdia.Hale, i�—ref i Applicant NOTICE TO APP LIC ANT:is Compensation this Citrons fof Labor iode.y Mould " becomeh comply the such Compensation Provisionsof the Labor Code,you must Z 0 foMwiN cote ply wit.such provisions or this p<mtit shall b<dttmcd revoked. F CONSTRUCTION LENDING AGENCY, I hereby uHie m that there ika emiswctimi lending agency for the performance of the work for which this permit is issued(Sec.3092 Civ.C.) - QLender's Name' . . ' - ' .. � . 0.' Lender's Address' U"C> I unify thatted l have sethis application end Itme the the above infasmetion is W Fa comet:I agree to comply with all city and county ordinances and state laws relating Da f,,,) to Wilding construction:and hereby aurhorim representatives of this city to enter upon _ Ne.Wee-mentioned prepeny for in.apection puryases. , 0. (wej ogee m save,indemnify and kap hornless the City of Copertma ag.irm W liabilities,judgments,costs and expenses which my,n any way accrue against said ULZ City in consequence of the granting of this permit. r SOURCEAPPLICANT UUNDpER�fSTANDS'ANDWILL COMPLY WITH ALL NON-POINT Issued by: Date SignomwillTdme pepplHAZARDtmc Wilding11.1161 O •, Date Re-roofs " RIALS DISCLOSURE - ' - occupant roue«Hanel hirardws rrmuvnl Type of Roof d f d e. io Ne Cu«n M ni pal C Ch pt 9.13,a d th Neallh etM SaPory I cm' ov.,z553zO rl ; a. .,i � '.,°, ' � ` S !'ti \art '{';p,t�er ; ,• t'',. ; .i. - All.roofs shall be•inspected.prior.to any roofing material being installed. .. Win he aPprraat ow to aipre a!ter aevicea which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air ci morrorin as dd by the Bay Arca Air Quality Management e District? - r all new materials for inspection. Applicant understand_s and will comply with 0Yca, No all non-point source regulations. I hirii""I the lietmdous'materials re,mr mets under Chapter'i of the California Health&Safety Code.Sections 25505,35533 and 35534.1 undersand Nat . Here building does not currently have a tenant,that it is my responsibility to notify the cupmii of the rtgoir cats which must be met prior to issuance of a Cenlficate of _ °rvp""y 3 _ Signature of Applicant Date d' l L All roof coverings to be Class "B"or better « _ Ownter mAhmind ager Date - I OFFICE . . .. 17 „. 1 I .