02080005 (2) OF
CI BUILDI C DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10300 FARALLONE DR GRIDLEY COMPANY 02080005
OWNER'S NAME: APPLICATION SUB DATE
GOLDMAN MARK S AND EILEEN R T 19 S 3RD ST 08/02/2002
HONE: (408) 374-0900 SANITARY NO, CONTROL NO.
W❑O❑ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
be BLDG ELECT PLUMB MECH
wt I'--I
in 2 LICENSED CONTRACT S DECLARATION
z w 1 hereby rr.n that 1 am R«tired un f Cha ler 9(commencing Job Description
❑Z—p ya `SDE L p g
wims«tlon7 on ftheeur x,aa rare a cude.anamyueen REVISION--IN HOUSE USE ONLY
--ado Li<cw °�:'° ue.a (ORIGINAL #02060129)
Dat Card
ARCHITECT'S DE I
vt g 1 understand my Plum shall he used m public rsoNx
tical i p O Lmcnmd Professional l/. (>�
c o OWNER-BUILDER DECLARATION
m I hereby.(Sinn that 1am 1. .Butor s an the Conmaor s :Anse law for she
C?< following rcawn.(Soden 7031.5.Business and Professions Code:Any city or county
5a ❑ which requires a Permit to consumn.altcr improve,demolish,or repair any noncom
m
y�ie —pno,til mst L
aIC also RQYresthaplAkant to,suchpcard,so file aug1YaSl ,
l ate
_ Inzt Ire{s r vxtl pu,suLlt t9 mF pryssy m of the Conmctats uttnse law(Chap, 9 S Ft. Floor-Ates. .
leo mecingwithacne ,7n)ofD' sion3oftheBn#essandProfessonsCod ) (:'(„!_'y(' a9 iia. t.v `s?lils�; aluanon
or that
he x esempnhcrcfmm and the bass far the illegal e.emjRmh.Any,solation
of Saca°n 7034.5 iv eny epplic l rota permit wbjat me applic.m m e civil pcnilry- '
tot nut marc man five nuoaree ashollar((side). A N Number '<r^;r��>
j r : Occupancy Type
❑L as owner of the property,°r my employees with wages as their sole compensation•
-will a°me worlr,end me moctme is'mR intended or ofered forsale(Sa:7D , -'- ----- -- ----------_._-- ..._..
tI 0I - FOUNDATION
easinliti.nd Professions Code:The C°mrestas License Law dues nut.pd,m an 102 - PIERS Required Inspections"'<e:-d'117c
owner of progeny Who builds or improves thereon,and who does such work himself
or dumugh his own employed.provided that such improvement ere not intended or 103 - UFER
'�pifirrd torr ialef ICtiowe4ef:the building or iinProvimens is sold within one Year of ___._ __ - --
eample ion.the over-Wader will have me burden of proving shut he aid nil Wim or 104 - REBAR �'!d'.I*.;Is:;^. 0`a Po'_v;
improve forpmpoarasale.). 105 - ANCHOR BOLTS
dl:aowneproin proposy,am exclusively
and nuacungwith Code,Th mnvacmrs to T06 -SEWER--&- id's-:no Ft;�su' 2FC.-----
construct she oejen(So,ppl Ito a,Business and Professions Code)iThemproves
Connaaor's ,t tit `Pew
:d -=' and,al Law doernot applymanowner tha.cPennwho buadeseimprove.merron. 202 - UNDERFLOOR PLUMBING "-- .
_-and wno.comncu fw.a.eh,proj«t.wuh.a.contiacmrts)licensed pursaanxmush...__..--_._—._2.03-- --UNDERFLOOR---MECHAN"I"CAL`-----""'--=
0C ntrumrs License V
1 am exempt undds f +) :.” ,Barer m�,rcaon 204 - UNDERFLOORS FRAME,rr'Ii
,:,.,=, :•I:n>,;t... •:, ,I:. • c.:•_,r.,n'.t..r:.,1 205 - UNDERFLOOR INSULATION
Dasi'o•...me
` tLl,,,"'WORRER'SCOMPENSATION DECLARATION 301 - ROUGH PLUMBING
^' Inerebyarm under Penalty ofkpry'one ofthe following declamuons - 302 - TUB & OR SHOWER
B I L'aia Winrlrli;lidn' -Ce irciietofconkni'a self-insure for Worker', 303 - ROUGH MECHANICAL
tre Compenwtioq as work for
forwhich
byslandon-3700 of she labor-cnae; for me 304 - ROUGH ELECTRICAL
Cmint manm'r,die work foe whim shas ec,mi,lis&w<dl t,
❑I n a Rima w rte Compensation 1 race a,"armed by Section 305 - FRAME
3100 of to IOW Cad f m pert a c of Ili '- k f h ch th 'pp f
aLa Myw ker eo pent I " ea a aP l r mW 306 HOLDOWNS
n N 7 1 3 3OR-I = INSULATION tt -
r G,RTI,GATT NO %EM 1 FROM WORM BRS 1 0 1308 -t'SH'EETROCK'' f lf-';� . V'l�ly^•'k)-
w -M .1= COMPENSATION I SURANCE' }9 L ---
"t ' -309' EXTER'IOR`J�ATH — el�; rk liDtl � f)
' r.ffh ssat on tial o,Mc pined (sh pc tis rot one hundmI dollars - _-.. —
. . -
)sioo) 1 310 - INTERIOR LATH
311===-= =SC--BATCH 'COAT `
'r 1 ceNfY N,'hem pemonna c of m wo,k'f hick inn perl.it ' iss d 1
Cain t.shpt r' Y P< anY n o a io'bm me bfea t m work rI 313 - ROOF NAIL`q.°�- 'l lis ! .!.I!.11Ic' ,•s._I
S01. FINAL_.ELECTRICAL_.ENERGY-FINAL
omp et L
Ayph t - _ __ __ _
WOTICETO APPLICANT If aft mak gmsC<n fcL fEx mqo y hold -' ;
Z becomes b)auo m wuch p c ns. I pm r o t anti lane cod y m i 502 - FINAL PLUMBING ENERGY'
O O Sean lin -ply' Ill suchp Pr°rm Permit WU he deemed ked ___ 503___-F.INAL,-,MECHANI CAL_ENERGY _
�r?'I L - mIoNSRtUCr10N'LENDwc'Acervcr "' 504 - FINAL BUILDING ENERGY " !`F'' ----
ai.' 1 hetebj 0'nn th t mere sliver o I d' g ag m, f th perfurm5'fe - r s
M r of rh ark forh ch thisperm t
is issued Se 3097c C) 505 - FINAL ELECTRICAL ' 'rl'
7 z Leede Atldrcrl 506 - GAS -TEST ----
- 'O 507 - FINAL PLUMBINGrI!)I'f"t
!comfy thin 1'have mad this application and nam that the above information u
Itr.LE. "oriecW agree m comply with.[[.city and cougryyordinu mar and stem laws relating 508 - FINAL MECHANICAL
to_W'M g tiucfon dl by moria p 'utivca fm'.city to enter upon
W me W n t nam rt par p w , 509 - FINAL GRADE
' Oi a Peg- to a I 'fy and k ph 1 ss due of Cupert gnat
rn 'Cab ' pg c t neer«h n y n any y e against said 510 - FINAL I NG
y"'.4 cit drmixpmu 514 P F A WORKS
DY WILL COMPLY'WYTHA L� OIN7""
Issued by: Date
$igpL A lice. nDm. I;+i- Re-roofs
- FiAZARD0U5 MATERIALS DISCLOSURE
W II me ppl cant or f t m W id,ng a up t t or hart I n ardou mate il
' Type of Roof__defed byth Cupen Mun<paiCode Cheptr912 M,h Health dSafry '- - - ' - " - __*_•-- ..
Cade S ton 25$Rpl t - r�•,,. s q:r I s ' t - r.->4 Y _ _ !i;l^.�. tf• -
I ❑r '7 k'�.4ON f ' Pei 1^i 1 il� � - r f { I. t'. x..• . Igli,. ,.
All r ofs.s,hall be inspected (tor to.any roofing material being.installed.
.' Will the pplaa t futurer Wilding occupantdevices - p - ---
s p n mine t n rn If a oof is installed without first obtaining an inspection I lggree.to remove
emit hazallou mm a t defined by sh Bay A Air Quality Ma g nt g
all a[eria] for inspect Applicant understands-and will comply_w![h
❑r
oN :! ' 'r, r' � gll" �p'oi [s' r e regu�ahons'
1 ve maC the us mrialsi rcqu rcV.n d r Chapt '.695 ohm
C lif m N hh&. e Sitcoms 25505 25533 d 25533 4 tandth t
up.W d s t IY tenant thin 1 n, y xpoas b l ry t n hfy a -
9p t n W pt pn i Issuance C- fi or - - -- (•
b' Si attire of nt
----- - - --p _Ica- ^ Date
g --
�! All roof coverings
gs to be Class "B"or better' t
rt
.• _ --� -,_ j. .__.... OFFICE -
suss. _ _ •t C. _ ! '.4„ .. .