00070012 TY OF
crBUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRI3SS, . PHRh11'I'NO.
OWNER'S NAME: APPUCA7lON SUB DATE
2 RESULTS WY SOUTHBAY CONSTRUCTION 00070012
PIIONE: SAN1 I'ARY NO. CONTROL NO.
GROSVENOR 511 DIVISION STREET 07/05/2000
O y RCHITF,CT/ENGINEER: BUILDING PERMIT'INFO
w e (408)379-0400 BLDG eLrcr PLUMB Mltcu
i w 1'_l II 11 1=1
e h< LIcENSED coN'rRACI'OR'S DF,CLARATION _ Job Description
1 hereby affirm that Ian,Iicemed.soar p...sme,of ChaPmr 9(cmnmencmg
F,yf—ce wish Scmiin]1NNq of Uivixinn3ofine Bueinew and Prnlaamn.v Code.nvJ n,y benwe
w a ikinl'ulllms,mcleflecl, a�1Lp.IJ
,ieensc CI _ uc.a_ IVVII 11 .
k o u )nle T b��• Cnntrannr_
aa LL p� AI<CIIIT,,.,,S 000I,ARA ON
S i
S I oq'i—laml my plan,.,shall be used a.pamtie ro9onl, T. 1. ,
u�+ o o Licen.aA i'rufcavional
OW NI1H�b GIhD1:It Ir the CoATION
IKu II by II Ihrl p,I d C t'Yor Lur.w Law In, Nc
!'Z r fnlln , l (Seen 7031 t il .. .s I I t s C-0 Any city oumy
whchor Prnti o....oni uter. P demolish, y.tructure
ce 3 !mono h suance alsom4 v the'pllee tI hp, mill file .t tcmenl
- mat he is racnwdin .nado,neprovu oEric Contractor,License Law(Chapmr9 Sq. Ft. Floor Area Valuation
(co ing with See,ion 71kNB of Il v n 3 mrhe Bruins,,andm
Presionx Cale)
or that he is c.empl,hcrefmm and he basis for the alleged cxennumn.Any violation
of Section 7031.5 by any appGcam Iia n pemni,e.bj.,the aPPlicnl to a civil penalty
of nal more man five haadred dollars(sego). A PN Number Occupancy Type
01,as owner or the pmpeny,or lily empl9yce.with»ages as their sole compensation, $6000
rill do the work,and the structure is not intended or offered for sale(sec.7014,
Basins and Professions Code:Me Contractor's License Law does not apply to an Required Inspections
lirs of pri Who build.or im,ower, bercon,sad who does each work himself 35720042. 00
through his own employees.provided that such impmvemems are not intended lir
offered mor sale.II,however.the building or impmromem is sold within one year of
icompletion,the owneoh filder will have the burden of proving that he did not hand of
mprove for poll,woreale.). 101 — FOUNDATION
01.asoWnermmepmpcoy.ran exew..aycommermswith licensed comector.to 102 — PIERS
,nelet the project(Sec.7M3,Business and Professions Cwle:)The Contractor's
i
rvncense Law does not apply to an owner or property who builds lir improve.thereon. 103 — UFE R
and who contract,for all, projects with a commemu
rts) licensed perwamr ,the
Comma.uaenac Law. - 104 — REBAR
01 ant esempl under Sae. .B k r C rot ods ruses
105 — ANCHOR BOLTS
Own" wuaKlacs cnmrrnnnoN necLnleanoN 106 — SEWER $ WATER
I heo,by at'Orn under peiiallyol perjmy irut he tblliwnng declamrm,v, 202 — UNDERFLOOR PLUMBING
❑ I have slim will nntimain a CnrlBc;;te if Consent In.all-imams fn Wukers 203 — UNDERFLOOR MECHANICAL
Cmnpcnwrlon, is hmoidcd for by Scerloa 3700 of the Luhnr Com. far the
ped asnceof[at w,irk for of,,hthis armilisissued. 204 — UNDERFLOOR FRAME
xhm'e and will mainwin Worker's Compensation lneamna,as required by Section 205 — UNDERFLOOR INSULATION
3701 of the Labor Cala for the performance of the work for which this remain i.
issued.My Workers Con,pa'msalion lnemmnce carrier and Policy number me: 301 — -ROUGH PLUMBING
cannier: IrG '� I yNi.: �' I y$6te 302 - TUB & OR SHOWER
Cr:R11FICA'l OE �XI. PT1oNFHO}IWORKF,RS' 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE
(This eecdml need no,be complmed ifdlne permi,is for one hundred dollars 304 — ROUGH ELECTRICAL
1slnn ossa.,) 305 — FRAME
I venify that in,he perfommnce of the work for which,his permit is issued,1 306 — HOLDOWNS
.Hall no,employ any Peron in any manner w as to become subject,o,he Worker'
Connp,madoaLn ,ofewifomm.[)are 307 — INSULATION
Applicant
NUrIGIi TO APPLICANT:If.after making this Certificate of Exemption,)on should 308 — SHEETROCK
neeome subject to the Workers Congsnkation provisions of be Labor Cafe,you main
.O Ibrbwmnco.,nplyw,,h.u,hptoot.o.,orna,pe,mitshall re,declined r.oked. 309 — EXTERIOR LATH
F ^
CONS IBLUE[ON LBNDINGAGervcY 310 — INTERIOR LATH
a ^ 1 hereby at 0x,1 mere is a eorounction lcndmg agency fir the pcnbmnma
ol the work mor which hi,pe,mi(is i,.ncd esee 3097,C e.C.) 311 —
SCRATCH COAT
aq lender.Adda 313 — ROOF NAIL
z Lendcr'e Nrao,. u .�
U O 1 errlyma,Iimnemadmi,applicaliand latemald mWwriufmma on is 501 — FINAL ELECTRICAL ENERGY
LT. F. nmect.I ugmc.o cam..y with all city amt aoan,y ordinances;rod.rasa Inw,relming
OU to Mindingennamcaion.and hereby authorize mpre_,cwative,anhis citytoenter upon 502 FINAL PLUMBING ENERGY
y mearoxc-menrnonpropendemifypedkepharmle 503 — FINAL MECHANICAL ENERGY
F„ p„ (we)agrc m,ws,vert, or indemnify red barnlc,n the city of CuPenino against v
V] liabilities,judgmnns,lost,and expense,which may in any way aceme against said5�. — FINAL BU I LD i NG ENERGY
u z City in consequence of the granting al this Permit. o_`' —
SAO PPLIC NT UNDERSTAN AND WILL COMPLY W"ALL NON-Pi Issued by: frJ 1��—FTIhip] FI Ff TRif:ALDate —O (]
�!lef6o
Re-roofs 506 — GAS TEST
ltgnamre of AppoennVC shine)!' Date
Will,he iippli<numI.,..building
..,nD`Smeor handle M1maNaws mmerhal Type of Roof 507 — FINAL PLUMBING
as defined by the cost Municipal Code.Chapter 9.12,andme Health and Safety 508 FINAL MECHANICAL
Code,Section 255320):'
O Ye, 0N All roofs shall ZdMspect#ZITAppl to(DTR AC)(fing material being installed.
Will the applicant or future building occupant use equipment or der ice,which If a roof is insula wathqulftf�obpLnilIMplijoE+ection, I agree to remove
emit lamemoux air contaminants u,deEnN by the Bay Area Air Quality Management
Di.,rmf] all new materia§;1f4r itisp�Ctl'I ALp`rVbtV1f0ef4ar E9nd will comply with
ores ❑Nn• all non- Dint ,Daree�a
`s aliens.
I have read he h:,.ammns matc,im,'remdmmcnt..ahem Chapter 69 of the
Cul Rornia hy heath h SaL Code.Sessions 25am
505,25533 lad 25533.I 1 dvra, d rh,a
it the hui Mhng docs mat cur,canly havc a mnu e,,bat it N o,meponvhlldy m nmily the 7,1 0/QO
cunam 0 rbc requimmmux which must he met prior iv
cor suance of a Certaieam of _
O'vi,an".. Signature ol'Applicant 47 Date
Deane,or uan,m;am ngetn Dam All roof coverings to be Class "B" or better
OFFICE