02060172 (4) CITYsmt.o c PERTINO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS. PERMIT NO.
10471 STOKES AV JONES MASONRY 02060172
OWNER'S NAME: APPLICATION SUB DATE
ROSA CROSBY 1058 DELL AVE 06/26/2002
PHONE: SANITARY NO. CONTROL NO.
4083777512
O O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w G BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
m z I hereby Iran that 1 am licensed under Job Description
O ln_G y a provisions of Chapter.and(commencing
p„ft, loon section 7000)oromida,3anne Barhea dProfexsions Cade.and my license BUILD OF BRICK CHIMNEY.
g it m fon rarer as err t._ �`
t�3`E G License TEC L,. a 3Q p 3
am - Commnm _
i 1 ARCHITECT'S DEG ION
S—O S 1 understand yy'Ala hall be u as pu rets
d to T f t, �`7 ' O.,-
ad n p O Licensed LicensedPromodb P
c o(ay OWNER-BUILDER DECLARATION
I hereby amR,m that 1 am exempt frothe Contractor's License Law for the
F Z Q following reason.(section]131.5.Businessde:and Professions CuAny city or catmy
$6000
E s o which requires a permit to construct,alter,improve,demolish,or repair any structure.
nord,its issuance.also requires the applicant for such permit to file a sig,ted sutement -
Oar he oliceosrA pnesupnl to the providum of Contractor's License Law(Chapter 9 rI{ Valuation
(commencing with Section 7000)of Division 3 of the Business pad Professions Cure) �' •a •
or that he li exempt theiefmm and the basis for me alleged ciemp,bn.Any violation j
-of Section 903 L5 by any applicant for a permit mbje ca the applicant e a civil penalty
of not more than five hundred dollars(5500) 101 APN P ATI ON Occupancy Type
C L as owner of the rickety,or my employees with wages as their wile compensation. 112 - CHIMNEY REPARL STRAPS
will do the work:and the structure Word intended or offered for sale(See,70ad;- - - - - --- --
'Business and Professions Coi The Contractor's License Law docs not apply to an 514 - FINAL PLIEd4MfWW6fW&ns' ` ” •�
owner of prorcny Who builds or improves mason,and who does such work himself
or through his own employees provided that such improvements arc not intended or I
...offered for stale.If.howeve.bi,building .. prov in if sold within one ... -... ._......_._... ___ .__._._ ___._...._.._.._
or trden of ro year of
completion,the owner Willer will have me burden of proving that he did not build or -
r
improve for purpose or sale.).
I
❑1 ser fie mjm P(Sec.7,am endow lye t i g nhr sofa Contractor
catsro FB13OY fit [i E® t
consumer a prosect(Sec Ito a Buser . d Professions Cole)The ve tractors 1�1��III Gr16a ,
License Low Joel oatapplyr-sac t,an owner with
property who builds seimprove Wrenn,
-_and whoconunens for-such projene with a comenorfs).licensed pursuant.to We. _.__ ___ .._ __... ._._. q
. — C larritorr License Law. 0-
r'
❑1 am exempt under Sec"" ,B&P C for ma on
- .,, .. ..
I.
OwnsrDate p
.
WORKER'S COMPENSATION BUILDING
1 hereby Oft m under pe,uhy of perjuryone of We following declarations:--
C 1 have rind will maintain a Certificate of Consent to self-insure for Worker's
�-_SComPenation, as provided for by Section 3900 of the Labor Code. for the
_ perfo,mmme of the work for which his pem,it is issued..
°1 hove and will mainuia Woiker'I Compensation Insurance,us required by Sterna
3700 of the Labour Code,for the performance of We work for which this permit is
issued My Works/s C mpen ton Insumtrce c J Pol cy,number ate.
c_ _. 'proobt�6`s�
CERTIFICATIONOFE%E ION FROM WORKERS' t T fes' ..�'�. 'U44 lit/
COMPENSATION INSURANCE
t_ (This union need not be completed it the permit is for one hundred dollars
IEI00)or less.)
1 certify that in the in in any
of the nark fur which ubj coot rs issued 1 -L
shall not sinn Laos
i pertain in any mdnncr m as to become subject m the Workers
Aomrenatian Lnwr or .Calili,mia.Date
'OTICot
dice
NOTICE TO APPLICANT:If.is Commroutiotill pr visio so ofExemption. .youmost
become subject m the Worker's Compensation provisions of the Labor Cale,you most
Qou should
0 fnnhwi- comply wish au<b provision-ur thio peamit.hall be Deemed revokeA.
> .1 `'•ffi -CONSTRUCTIONLENDING AGENCY 'I '
y > 1 hereby write,that mere i-tissued sea "7.ng agency for the perfonnana r v
ofnd work for which this permit is issued ISec.IOW.Civ.C.)
0. .-Lender's Name _
Lender's Addicts
.•
C.1I certify that I have mad this vpplicaion and xme thatthe above information is
iorren.I agree to comply with all city and manly ordinances and state laws elating
Q O
building B t i rt by' mt a eP t ave'of this city In fie Aon
} Tali theabove d save,
property for i rc T purpose,
-
[.:•. 6i (W) g ct J npe Jkeep harmless the City fCpcn oug'nn
s udgmoce costs up nwhich y n any Y' c g ince,said
.0 ,Z City ll sy D(Dfh goading ND WILLpermit.
PPLIC TL\DC:RSTAYDSnYD0.'ILLCOMPLY0.'ITHALL\O.Jr,�af n`r` Issuedb :/� Date
Sign ppidicantlContrecmr Irl IDate Re-roofs
H
HAZARDOUS MATERIALS DISCLOSURE _
Will m prlt f t- 'lding p i IS r h dl M1m Nous ra t a _Type of-Roof..
as❑fed
Cisection
W C(coat M 'pal Cod Chart r 9.1 a d th H hh and Safety ` c
tl< Sect n SSJ:(al ^�,, i„ s _ I j :• �.'. a 1
°v" �AII roofs shall be.lnspected,prlor_to.any roofing material,being installed, ,
0.'n the applicant room m Wild gocc pant use equipment devices when ~If a roof is installed without first obtaining an'inspection, I agree to remove
h rJ it contaminants t. defined by the Bay Ar_u4Y Quality Management
emiti vet - 'S� all new materials for inspection. Applicant understands and will comply with
°Y . . 9N all non-point source'regulations.' „
1 have read the huimdous materials raµtironents under Chapter 6.95 of,be
Cebfomia Ncoliti&Safety Code.Sections 35505.'_5573 and 25576.I understand that
—if thebuilding does not currently have atenant,that it is my --
ccupum the r quiremen mon beton prior to issmnce of a Ce ficue of
-. Net,
_Signature of Applicant Date _
lone e u ori J agent All roof coverings to be Class `B"or better
OFFICE .. _
• I