01080112 (2) OF
RTINO
CI BUI DING DI SSIiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11000 MARIA ROSA WY LARRABEE CONSTRUCTION 01080112
OWNER'S NAMES APPLICATION SUB DATE
JAMES D. CARROLL 3275 STEVENS CREEK BLV, #10208/22/2001
/ PHONE: (408) 985-4121 SANITARY NO. CONTROL NO.
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Q O O ARCHITECDENGIOEER: BUILDING PERMIT INFO
0❑ BLDG ELECT' PLUMB MECH
6 i W
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LICENSEDCONTRACTOR'S
under DECLARATION Job Description
I so✓: 1 hereby alarm that ren licensed under pro.Pal of..Chapter Code.and mmecense
„E, wimfati°newd fee,. on3°I'thcdusineswmdProfcssionsCade.andmylicenm SUB-AREA VENTILATION FAN.
in full force J ellen.
1's se rc a License Clas z G- Lic.x
'O i Date�1 Cornmcmr ^�4 :av(w,T a
l 3 0 in ARCHITECTS DECLARATION
g 1 undemandmy plansshall he used as public re...N GI�IIALEa
_ r YV
I o o Lmenwea vrofesaional
OWNER-BUILDERexempt main
SEP 1 O 2001
1 hereby uses that 1 1. exempt from me ContractorCa Any c law for me U L
L: following mason Permit
]onstr Business and ve,deioliCode:Anycity structure $1000
luz§
a3� 'prw p itmq construct.
tP� at to Ychpcls g P - - - "_- .. - _ - ...... ____.__ -.__._.— _...._..
which req R p P Y uc
I t ace Iw the 1 it t Ile red mm t" - - � -
mqt h(jl n d suer t to m m o sof me Central x License Is ICs 9 t p Fp j:��ar p,�g Valuation
(cam ,with Secton]Br()of Division J if the Buimss eRpfessans Cad) y?�i o'n13'�,p't'pt b)2r:y ,6akt vim... _
or that he k nii:npt Ihcmfrinn and the basis for the alleged e:empuon.Any violation
-of Sl]031:5 by any applicam for. .it subjects the applican,to a civil penalty-
ofact more,banrole hundred dollars($500). 304'PNll ELECTRI Alir` " Occupancy Type
01.an,ow net of she property,or my employees isim wages ashen Wale comperaaion. C11711 _
-
will'do the wurk,-and me structure is not intended or offered fair sale(Sec.7GI,L t^ 't'l ,.
Business'and'Professions Cods:The Central License law does not apply to an 505 - FINAL E8F7>(IntW[Jd*iFStions'
owner of pmpeny Who builds or improve thereon,mW who does ouch work bimulf
,i vel fa his own employees.provided that such improvement.rt not one your
or ,.
oRered fur sale.IL however,the building tis sold within one- of ' _ . . .. . . ..... . . . .._ "_ .._ ._ .._.."_ . . .". ..... ... ... .._.,..__
g°r improvement of pro Year
completion,pu owner-builder sill have the burden of proving that he did not build or
improve for purluse of saleJ.
_ O Las owner of the prep,.,am exclusively d Pmfting with licensed contractors is t'I ut"
r.
Liana the pmjeo(Sec.]1113,norm,o and er,who
Code:)The Convenor's
c r ,
License law docs not apply m an owner th a com who builds se Improves thereon,
and who contracts foo such projectswith o cummcmrts)licensed purwam to that
01 am
Comment's pt un,e law;,
❑lam exempt under Sec: ,.. .Rik PCBar this rows Il•i' i.. 17I'IP ilt
owri'7—
WORKER S
WORKER'S COMPENSATION DECLARATION
11 �I hereby offrtm under penuhy of perjull of the following declnmtime,
A
01 have and will mainmin'ti cenifcaie of Coal In self-insure for Worker's
1st Compensation. as provided or by Saxon 3700 of he Ivsor Code. far he
performance of me rod fw which this permit is iasued.;
❑1 have.nd will maintain Worker s Compensation Insurance.as require by Section
3]00 of the'Ln1wr Coal for req performance of me wmk;fw which his Permit is
iud'd.My W k C pe. 1 n 1 : c c e Pob Y hu r., y--
-' �Tn�'EtFurJAI!` 'PnreyN 1262R41_w" ., , rk a) 1 e. .4 t —il t;lit
11, CERTIFICATION OF.EXEMPTION FROM WORKERS'r;- ' `y•� L: 'j �- •s I'�,
COMPENSATION INSURANCE :dv _ ___ _ .____._ ___ __ .._..
(Thssenon need nm be complacd if the permit is for one hundred dollars 1 .f ____"_.—✓"-- - r'd e, - - -_i)L alri l4-
.p 1 I«spie imm perl,any maofmd' k,f ecome m. fill p' rieW
shall not lima Laws person it any manner w ns m bu'°mc subject m me Workers
C°pli Sino inn laws of...., Imia.Dam
NOTI t __ ._
'NOTICE TOAPPLICANT.the Workers
Co making this Certificate ofE pt youshouldmind � '�'
subject m W rk p C ,Pen.at p of the IoM Ce you must I
QOhinh mc �ply 1M1mil p ship ret hill lxd emNc ke _- - -_
become
Fi • ' ' CONSTRUCTION LENDING AGENCY
1 h for
oR th t pe n.d t lend'g Scop f @c I:rAormance h
ofsher',Not which ihv permits owed ISec.309).Ci,.C.1
Qlindcr's Name -�. -..-+ .. ".. . .- :..0 dL.0"..:"_ '.._ .... .. . .". ._. ..._____ _...r .
a' Lender's Address"
U 0 ,1 ecnify that I save read miw nPplicuti°n and swm mm the above nfnmulion is'
Ins'Ly coats.1 agree to comply with all city and county ordinance,and stare law,relining.
Q V tobulMlc-menxwniogand hcrcbynmction uposentmivcs ofmi3 ciymcma upon
me ebovWe)., eta prep,.for indlionpurposes.
r y I We)agree to Waver indemrdfy atW A<ep harmless Itie Ciry of Capetian alienistsid
h liabilities,judgments.costs and expenses which mag in any way acerae agnmat said
y..Z Cil in consequence of the grenting of thiipermit:"' " '
APPLICANT UNDERSTANDS AND LCOMPL ITH ALL NON-POINT• ISSuedb , Date
REGULATIONS. Y
' ' z��.
si of Applicennc 'i Re-roofs
HAZAOUS MATERIALS DISCLOSURE
w a nsa aPpucnm rota Wada g issecial tam or haia l ha:ydwt mat al. Type of Roof...
adf dbym Cupcn Mn (Code Chaps 912 and this Health rdSafety ,• - `g:. Tl fi}:�:s✓IS•'"" rs' s"r?•`• ,y tl "
code Sell 25532(a) t- 'SIL t. i Is - 1 - .L c
❑Ye,.' - ' �; Nall;; All.roofs.shall.be.inspected,prior to.any.roofingmaterial being-installed.....
Wall m applicant nt future building' by e m eequipment a which If a roof is installed without first obtaining an'inspection;l'agree'to remove
emit tin rd ono t os of d by the Bay A a A Q I ty M age o
Celli, t all new materials for inspection. Applicant understands and will_comply with
°Pall non- oint source regulations:,
P g
1 have read me hazvdnux marerials reymrcmcnutundcr Chapte"6'.95 of m<
6141 mla Haulm A Safety Cods.Scoions 25505,25533 and 25534.1 understand that
ifine buiWingd°cs vowupcmly base.boom.that it is my msponsibility to notify the - . .
°2cupam of the quncmc tI which'md. be t po to i"moseerdsicertifficittrof
^ °p`°°'"` Signature of Applicant_ Date _
u :r oww;B , d " All roof coverings to be Class"B"or better
routhmOFFICE