01110079 CITY UIL DING DI�VISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
1 RESULTS WAY BLD 5 SOUTHBAY CONSTRUCTION CC INC 01110079
OWNER'S NAME: APPLICATION SU DATE
GROSVENOR PROPERTIES 511 DIVISION STREET 11/16/2001
CI
IONE� SANITARY NO. CONTROL NO.
! (408) 379-0400
O RCHHECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IJ 1_)
LICENSED CONTRACTO W S DECLARATION
1 bcnb rfirm that 1 am licensed ander f Cha a v mommencln Job Description
y es provisions o per gith Section 7000)of DOision3oftheBusinessandProfessfon.Cook.pnd/nylicense HANDICAP RAMP.
'n full force and CR (_/Oicen.a Clay Lic.M ��
Date '////,/ O-7 Contract., M _
LL a G ARCHITECTS DECLARATION /Z�
I understand my plain ahall be used as public recoM.v (Tp��-sLC/.,
1 SCO LicenaeJ Professional O -
LL OWNER-BUILDER DECLARATION
I herby allirm That 1 um exempt from the Contractor's License Law for the
t z a
hill.,in,mason.(Socenn 70315.Baines ane rroressinns Code:Any city or county $45000
Y x o which«quires a permit to construct.alter,improve.demolish,or mpzu any structure,
m its i..xa,C.alsort thea licam ba.men rmiuo file asp rad stammcm - - — ---- ---- — -- ---------
n .a gathn pp Ise g -p
thathe i,SlicenwitpSeeionolhe prf Diviin. the Conuamorsand Pr Law(rhaploy -• '�^a 3�iV• ,06 :4rtP6� >� 1' -1'• , Valuation
(commencing with 5ation ams and
Division 3 of ee lig&J limp Professions vCoot)iolation I.ll c �� y, rL�:' _\; .
or Thai he is exempt any cep li and the basis for the alleged[plication.any violation
of Seniors a in.,, iv any applicant for a Permit subjects the applicvm m a civil pcnahy-
or not inch than live naodnn aonans es50(n l O 16Pi9 N061b%DAT I ON Occupancy Type
❑I,as owner of the propenY•or my nnployces with wages as their sole compensation, 102 PIERS
-
will do the work,and the stmcutre is not intended on offend for sale(Sec:]044,
Badness and Profession,Code:The Comranor's Liccnx Law dun not apply to ua 103 - UFER Required Inspections -
owner of propcny Who builds of improves thereon,and who does such work himself 104 - REBAR
or through his own employccs.provided that inch unimocmeen,an not intended or
-offered far sale.If,hnwesn.the building .- t is sdld within one ear of 10 5 - ANCHOR BOLTS .. .
iomplei`Uf the owmerfbuilc.),will have the huNrn nr proving thin be did nm build or
mprov= parposeo 106 - SEWER & WATER
. -_. . . _-. -- ' 61, -
ns Owna-orthe};mlmny,ant-exclusively contracting with uan.sed rontmctors to 202 -UNDERFLOOR- PLUMBING :- 7
consumer the projoct(Ser.70cW.Business and Professions ended The Contractors 2 03 - UNDERFLOOR MECHANICAL .'
- - License Law d«s not apply n an owner of pmpeny who builds or improves Ihefeon.
.and who contracts for such projects with acommctm(s)licensed pu,aam to.th, -. 2 04 - -UNDERFLOOR-FRAME--
Contractor's License Lm
01 pat and " ' ,B&PCfore red 205 - UNDERFLOOR' 'TNSULATION
Date / 301 - ROUGH PLUMBING
`� RKEIi'S COMPENSATION Df:CLARAT[ON 302 - TUB & OR SHOWER
I herby olRrm under pearly of oerjary ons ohne roBowing d«mntions- 303 - ROUGH MECHANICAL
(r I have and will maintain a Certificate m con.eat m,elf.msan for workers 3 04 _ ROUGH ELECTRICAL
Compensation. as provided for by Section 3100 of the Labor Code. for the
_ performance of the work for which this hermit is issued. 305 FRAME
❑I nave and will machin Workers Compcnsaaion Insurance,as required by Section 3 06 - HOLDOWNS
3100 of the Labor Cone for the perfoorrance of the -work'for which this penom 3 0 7 - INSULATION
sued My Worker'i Compensation I.r��n e d Policy number am -- _. ._,- _,- ,co,
• - - 308•-'-;, SHEETROCK "
PnlicyN 2�3 itZZZO 7 Y1 t'- t,v. t t•
ICE' KTIFICAIION OF EXEMPTION FROM WORKERS' t 9�v' e•3 0 9t 0!"EX'TERI OR `LATH
-:--, „
COMPENSATION.INSURANCE. ...... .. ......
- — -310 :;INTERIOR -
-' Qhis scaiion need not k completed it the permit is for one hundred dollmx 311 - SCRATCH COAT t' �
(E100)or less.)
313 - 'ROOF' NAIL - ... . - _ ...._.. .__. ...
1 certify that in the a in any
ronof Inc work for which anis x.an a Wcake 1 - F( k t
shall not employ any pcnon in o. manner m as m become subject m the Workcri 501 - FINAL ELECTRI CAli' 'ENERGY
comicant. aw'.ofealifg ia.DateAppl _502. - .FINAL PLUMBING. ENERGY
NOTICE TO APPLICANT If.after making cis Cenificme of Eaemptio......lould 503 - FINAL MECHANICAL' ENERGY
O Gbecome subjectome Workds Compensation Provisions of the Labor Code,you most
forthwith comply Lapin such provisions lir Las permit shah be deemw_ ked. _ 5Q4. ,-, FINAL BUILDING ENERGY . ._. _ .
tz— � '• ` CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
"1 hereby affnn that them is a Comvuaion lending agency for the performance - I
ohne wore.m�wmchthispermilieismed(sec.3ml,r�.e.) 506 GAS TEST
f11 0 under'.Name- - - . .. _ .. _. .... ... _-
a 507 - FINAL PLUMBING .
�.z Lancers Aaansx,. . .
U0 I card y That I have cease this application and stale that the above information is 508 - FINAL MECHANICAL
cmmCt.I agree to comply with all,city and county;ordinances and state lows relining 509 - FINAL GRADE
O V 1.wildingconswction.midhenryavthorixrepacnmattivisofthisCitytoenterupon 510 - FINAL PLANNING
W the above-mentioned pmpcny for inspection purposes.
p., (We)ugreeao,wv<.indctnnifyand keep hamtlessthe City ofC.,riirmagainst 514 - FINAL PUB IC WORKS
IZ) firibilaxi c judgments,costs and asperses which may in any way accrue agalml said
C.7 Z mmnsequence of the greening of thispermia. )
•t CAM UNDERS SAND WILL COMPLY N'ITH'ALL N- •T ' Issued
�u Rec n.A rry d by: Date
--,.
S go e
ontractof J 1 - Re-roofs
' H RDOUS MATERIALS DISCLOSURE
W'dl dic applicant or future n ilding occuiumt two,or handle haitrd us naacfial Type of Roof
as defined by the Cupomino Municipal Cod p1 r 9.12.and the Health rad Safety ^ _• a f
Code section 2553201 t ^• :' ,^ .
_All roofs shall be inspected prior to,any roofing material being installed.,., _._ .._
Will me appftcant or future Wildm pant ave equipment or&,c=s which If a roof is installed without first obtaining an inspection,Itagree to remove
-rra hazardous air contaminants as def by fire Bay Area Air Quality Management
lobaC,l _ all new materials for inspection. Applicant understands andwillcomply with..
0 Yes 11Nn1 -All cion-point source regulations.
1 have read the hazardous aritaiials requirements under Chapter'695 of the
California Health&Surety Coda,Sections 25505,25533 and 25534.1 understand that
anebuildingdoesnolcurenllyh tenant.that it is my responsibility to notify lhi
oc sena of the nquinments n,sl h mei prior to ismawe of a miffd a of
"`3` - Signature of Applicant Date
/Z/ 6/
aa1 o d agent. - ate All roof coverings to be Class •`B"or better
r.. .. OFFICE .. -