00100112 crBUILDINGo DIVISION PERMIT
PERMIT CONTRACTOR INFORMATION: i
BUILDING ADDRESS:
7473 ROLLINGDELL DR WATER QUALITY PLUMB M"'t. 00100112
OWNER'S NAME: APPLICATIONS IIE
KOBAYASHI WILLIAM S AND LAUDI 1660 ALMADEN RD 1 1 7/2000
it
%IIONii: SANITARY NO. CONTROL NO.
(408)267-9330
BUILDING PERMIT INTO
re0 C ARCHITECT/ENGINEER; OLIK ELECT PLUMB h1EClI
2 1_1 r I''—1 IJ
F N 7 LICENSED CONTRACTOR'S D[CLARATI(lN Job Description
L_ I hereby:,Rrm that I mu licenud under pmvisltuns of Chapter Y(romnxnci
y F-s with Scdion]IN(B o(Drvlsinn3o the llusinesn mA Nofchxian`Cele.a.dnarise
analfine ' RESIDENTIAL REPIPE
z ¢ I.iccnxc CI::F� J F_ .ic.
O a O Date �p Cunlrano
FQ G ARCHITECT'S DECI c it Io ,
I understand my plans shall lin used as an
e c
oto
o Licensed Protrssin I,)
z OWNER-BUILDER DECLARATION
Wv I hereby of .that I ten Cseenpt fmm the Contractor'.License law felt the
following cut (Seen 17031.5,Business and Professions Code:Any city or county
2 D which rcgaircs n Permit To..... 1,alto.Impnrvc,Jcnudlsb,Lir«Pair any w...cmre
a3. primates i,,a: r.nlsows,iir..the applicant lir.sxcn wool lir file usigncd,eenenf
that he is licensed sursmnut)the provisions of the Contractors License Use lChafcr 9 mmSq. Ft. Floor Area Valuation
(coencing with Section 70(10)of Divided Bness
ion 3 of the usiand Professions Code)
or that he is excerpt fherefmnl and the husis for the Nleged exemption.Any violation
of Sec 911.11 5 r a by airy npplinmt fope...rit seehlnrx the applis;ene en a ervll "silly
of eel�nm...Jean We hundred dollars Wild), APN Number Occupancy Type
O1.to owner ollse prep<ny.ermy employees with wa8esas their sale emnpen.ation, 3593201.0. 00
vitill do h A d he I n irlunalud o, demd for 1 sue.71114,
If sir l I .: .t C I.Ih C u' , I I 'Ply ran Required Inspections
owner fplt pu.ly ran Wild 1 them d who does such stairs hi elf 106 — SEWER & WATER
or through his own couloyms.provided that such nnpmvancnts ate not nnendcd or
elrered for%;le.If,however.the building et improvenerl i,sold within one year of 202 — UNDERFLOOR PLUMBING
Ce
undount,the owncrbuildcr will Use the burden of provaided he did nal build,),
301 — ROUGH PLUMBING
01.as owner of pmlMny.nor exclusively contracting with licensed centracmrs to 302 — TUB S. OR SHOWER
License me does (sec, nay owner of and ertywhonx redo:)The eemracen, 502 — FINAL PLUMBING ENERGY
u if who
Law dxv ern apply man owner Lir a carte ro, builds or int inrvc Ihto the
Cnal rano um."ra fn,well pmjeefn with u eonnucmr(sl licaeaxl Purvuanl In the
mnmamr's Lh«nsc Law'. 506 — GAS TEST
01 am exempt under Set. .Is&P C for this«assn
507 — FINRL PLUMBING
llwncr Data
WOHKHIt'S COMPENSATION UT:CLAH61'I(1N
I hemhy eRr.n under smutty of,cul one of the following dcelamtiom:
D 1 have and will nelmain a Crtlellate of Cnnsen te,dt-insure fur Wtaw,', /
Cotnpcnsuliun, u, penvldcd for by Suction 3700 A she Lal Cock, ftu. Ilia
performance of the work lir,all Ilei,penton is issued.
1CC
1 have All
I s Cnmpenamion Insumna,an myuirtJ by 8<minn
pptu//��s'
d policy another its.
371N1 of t /tTclalEe(Iw punun:Z,n oI'Ihu xork inti which This permit is
'cauel. yYs'Cninl«ns :en lni'nliay{s r rme�1L�4U�amer— -/M 1N
CIiRTIPoCAn(IN OP Ii%IiON IN FROM WORKERS
COMPENSATION INSURANCE
(This section need in be armple.ed if the pemm is fortune hundred dtulWrs
($100)or less.)
I certify Ih:n in dee herb n emcee of the wa.k for which this permit is Issued.I
shall nor ell any per-sen In airy anal ,,as Ir secure subject w the Worker,'
Canerymwtlon laws tu1 California.Date
Applicant
NO)ICE TO AI.PUCAN I':If,after ending this Certificate of liaemp std.you should
bucolic subject In the Workers Cmrgruna:erten en,kions of the Lane.Gds,you at I
O c mrhwim emtyely who hue 1,provision,a,this pernil shall be deaned mvnlwd _
CONSTRUCTION LENDING AGENCY
a ' I hereby aline than darm is 31.4 ration lending agency far the performance
uI 11he work Err which thi,pe'ren is ioued(Sde.3lyO.Co.C.) -
y p Lunda',Nano
5 Z 1<nder'r Adl
U O 1 certify that I have read this application and state that The arose I fornattion is
4a —. lir uccT,I agree m comply with all city and il
cannly mJm
nces dud state laws mhdlog
O U tobuilding construction.and thereby un0mdec«peeum:lives of this City to enter upon
me aM1rve-memioeed pmpcny for trisection purposes. .
FE•e LY IWeI agree to rave,indemnify unJ Acep nunnle>,the C.iry of Cupemm�agamht
'A
� ��tseAs
'' U STANDS AND WILL C(I'MilAI LN(yy VQINq Issued by: Date
oI ',mltarr " err _ Dafc Re-roofs
IIA%ARDODS MAfEHIN,S UISCLOStar l
w5d y the Cueaem rn theremilling e.Cham,m«e.handle Heals aan mace Safety Type of Roof
m de Sed by Inc Cuseninn Muniein:d Crde.Chapter 9.12,and the Health and Safety
Cede.Section 255321x)'!
D Yes DNo All roofs shall be inspected prior to any roofing material being installed.
Will theapplaunlo.l'murebuildlngaccuponno,Cqunputudordevice,which If a roof is installed without first obtaining an inspection, I agree to remove
—Lit haze duus air comantinalus an definal by the Hay Area Air Quality Management
t t all new materials for inspection. Applicant understands and will comply with
�)n`El Yet 0 N all non-point source regulations.
have ad me hxuNnus materials regniremunt under Cleaner 6.95 of the -
California th&Safety Ccde,Sections 25585.25533 and 25511.1 undersand that
if the be gJr arm CurcnJY havcatenxnJ tient it is my responsibility mnotify the
rasa, II rc ,Is which enuxl he net Prior m isnu;nee of 1,4"t,bemd of _
Signature of Applicant Date
hey it and Dam All roof coverings to be Class 'B"or better
OFFICE