02060129 CITY UI DING DIIVIISSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10300 FARALLONE DR GRIDLEY COMPANY 02060129
OWNER'S NAME: APPLICATION SUB DATE
OLDMAN MARK S AND EILEEN R T 19 S 3RD ST 06/20/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 374-0900
O O ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
z S 2 LICENSED CONTRACTOR'S DECLARATION lb Di
O z_h o I hereby affirm oDescription
that 1 am licensed under provisions of Chapter 9(commencing p
F=tw, with Section) )of Division3of,heBueinejandProfessionsCodgandmylicense MASTER BED/BATH REMODEL (ADD 432 SQ. FT. )
p Y f,,j full re B t. ✓Y�,
rcoaU Licc L x
p ARCHITECT'S iicATI
1 understanda,nd my plans shall be used as puNfc mcoNs
z°° Lieensed Professr°nal JAN 0 9 2003
OWNER-BUILDER DECLARATION
u� 1 hereby affirm that I am exempt from the Contractor's License Law for the
C Z a following lesson.(Section]0315es
.Busins and Professions Code:Any city or county $42128
which requires a permit to consumer,alter,improve,demolish,or repair any strucstructure.ctu �
i 3.n prior t at ss ,also req stn PPI' tf such pe it to file a signed sutemern Bul
!hath sl' nutl puh hnl`'Thep i'io of'he C trathUcenu lww(Chapter9 i S ` 3s6Sa ptOpl�Or AI22t ny ,��,'yy' ( Valuation
(cum g 'th Sen n7000)of Division Sof the 6 c pardP fe ' Code `f y,,.t.,. C�`30.V 41 oU '.r A:. Cl
st that n n exempt therefrom and the b far the alleg>i xemptj Any I t on 1
esf Sad n]031:5 by any applicant for a permed aubj"the applicant to a civil penalry-
,of not more than five hundred dollars($500). All
4-"••:� •� � Occupancy Type
101 — ATION
❑Las owner of the and
the structure my employees with wages us their sole le(S ensatien.
wusinel do she andPrx:ssionsede:Tisnor nJedorse offered Law foes no applyec. to an 103 - UFER Required Inspections '
'ow s a e f Cad Th Contractor's o o e t ,ply m an
mw f p pony cr l Id. of .....ct h ch muchimself
.,ith mply the provided or such
ldts t meyearilled of .__.._104 .-._REBAR -----_.--_._- -
orf r Bron sale IChowcver, will (ding or burden
of Prov is sold within one year of
improve fir"eowncurviddcr will have the burden of proving that he did not Wild or 105 - ANCHOR BOLTS
improve for puryou of salt.). '
106 — SEWER & WATER
— __, T. —
❑1 rnAepmec.7 a . urine la efng inrhcenudcContrmt r, 202 — UNDERFLOOR PLUMBING " •r "1 __
nstmcl the ors no(Sec ]to a Business and Professions Conic)Thr Contractor's
FundWhLawd«snotapplrmancormofpropertywhoblidsor seimproves!heron, 203 — UNDERFLOOR MECHANICAL`-`
-.end wM10 convects foesuch o t .with a commaorts)licensed pursuant.m.the _..._-
204 = UNDERFLOOR .F.RAME :—
5 Comucmr's License Law. ,., (n, _. ..._ .._.. _. __ . .. . . ..
pr ja s
❑IamexemptunderSeo ;" ` ,B&PCfor this reason 205 — UNDERFLOOR-'INSULATION
C Owner WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
-I hereby affirm under penalty of perjury one of the following declarations 302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
t ❑ 1 hale and will mai num d Certificate of Consent to selr-insure for Worker's
*Compensation, as provided for by Section 3700 of the Labor Code, for the 304 - ROUGH ELECTRICAL
Performance mf tly, .rk mr which this proms is iysnm.., 305 - FRAME
❑1 haveard will ai u n W ie Compe 1 runt req rat by S (o
3]0o r does labor, cmc re to peAormam< f m work rn n n this perms t 306 HOEDOWNS
iss d w der Com penal' In.!mm dPnl<y b re: 307 INSULATION
c. S..I:.f,SHEETROCK -7:�.a, ,
C RTIFlCATIOY FE NPf10NF OM
NLE.I EARS LV f `
COMPENSATIOu hNSURANCE f' 309 ��EXTERIORI LATH°' -
' (Thi, �ct on need not be completed ifnce Permit is for one handled dollars
310� .- INTERIOR LATH , :, •., ,;,.
(rico) rleaa.l 311 — SCRATCH COAT
I nrrmar nmperr° rd. kr' M1ntht'penot . isanee"1. 313' ROOF._NAI•li—. .. __ . . -. __ ..
Compel 1 ata min ben°°`.` n"`tt°°r`w°'k`t 501 FINAL ELECTRICAL ENERGY
Cnm smion Laws of I f m a. oar °
Apps`°°`. —502 - FINAL PLUMBINGENERGY.
NOTICE TOAPPLICANT.If,ofmr making this Certificate Exemption.you should - - - - ---"--- -
ZZ beeomesubjatmtheWorke(sCompcnsuuonprnvisnn:1ofiheLabor Code,yn...... 503 — FINAL MECHANICAL ENERGY
Q forthwith on wish such pmnisions or lhla permit shall be deemed revoked.
�
- — N — — 504- — FINAL -BUILDING -ENERGY-
CONSTRUCTION LENDING AGENCY
f•" - IhembyaRirmthatthemi1.constrain.leading agencyfar the crfnrmamen 505 — FINAL ELECTRICAL
yGof the work for which this .it is issred Sec.3097,Civ.C.l
Lender's Name-_..._.,.Pe e .._... 5.06. _—. GAS TEST__ .. .. ....__ ... .._ . . .
ress
r� Lender!«nfy that 1 have read this application and ntnm that the slater inf _ - - -� -.--
u C 507 — FINAL PLUMBING.;;,
❑..E, Fin t.n g r <omplr he a rut o ri county mortuaries a.t t laws er !nab 508 - FINAL MECHANICAL
0 W con I -ngc r exon Jh prat rah r representatives of this city to enter Pon 509 — FINAL GRADE
>.-W rhe b x t ed.p, pen pc u
mza rraak purposes.
,tn ctyercp<n-dag,da 510 - FINAL PLANNING r _
A OF I' dgmen .c xpensev Which may in any%ay arcme against said 514 — FINAL
UZ city q nr " Tim p ,t, C WORKS
APII \DIR IVILLCOMPLY WITH A.LN 0.pp1,�T r'
- Issued by: Date
.g^t ( PPI r i
_ HAZARDOUSMATLRIALSDISCLOSURE �t
WRe-roofs
'
II lhd'Pprca t f r re W'Id' g« pat !oro° handle ab mate'al _ Type Of Roof
N P It, .. ,All roofs shall,be mope "__. ... .. _•-.. . . - .... _ . ._
us d f m by!h C pen o 4f n osl Cm Chapter 9 I and lhr H ahh d Safe ty yp
Cm S ton25532(.)?,: /�7/`j\
❑Ys
cted prtor_to_any roofing material,being installed. _
Will hircon m f b 'ice ng <p a u.e egit nt d res winch If a roof is installed without first obtaining an inspection, I agree to remove
,.it h ab air tom m na t az defined by N Boy A� Quality Management
Dntnn❑Ye Ivo _ -all new.materials for inspection Applicant understands and will comply with
. . . ... _
all non point source regulations
have rem the ' ztmaactionsq,25533a undo C.1 ma 6.95 or tote 't
ifm if.
Hearths n t y mono ho5at it
y mlint al !understand lhm
lith 1 gdasn t an seumwm rhatl s my rc p t'b sty mnotify the -
cu a r<qu c is h cost be t Prior 1.issuance C ificue of r/r -Oce el
_ GI (72
Signature of Applicant Date
0 -'hos ed agent ate All roof coverings to be Class "B"or better
OFFICE .