00100102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: � IT NII.
1 RESULTS WY # 9 CONSTRUCTION SERVI ." 001001.02
OWNER'S NAME , APPLICATION SUIT DA'I'1:
MEASUREX SYSTEMS INC 454 DEARBORN PARK RD 10/1.3/2000
PHONE: SANITARY NO, CONT RUE,NO.
(650)879-1828
w O O ARCfII9'17CI'n?NGINEIR: IILU EIBU11. . I'G IPUMII INFO MECH
`0 J J I—_j I_I
S?j LICRNSEDCUN'rKAC10R'S DECLARATION
O Ihacn corm lM1w lain rrnmed nndn r ehnner`l l c,mmenen,. Job DeScri ton
yu Prnvn:unvn 6
V ._ 7(Koi n,n3onheBn,intsnna jn77de,pndmyliecnw TENANT IMPROVEMENT
6 y•"� i\ n(Ill fomI nm 1f 6 2
F. z< e CI:s\s I.ic.NT
F. L� S)pCaor_NO
w 3 u,V / ARCIII ETI use DI,'radw I PON
I nndersunJ'my plus.shall he uvvl m public arnNe /
a. oO leccnscd I'n,l'c„ionn,l j
a. UWNICIt-IIl11LDIIN UIiCLARA'rl(1N
w F—' I hereby affirm Thal I an,exempt front,he Cmancmr'..License Law far the
C�� following reason.(Set ien 7031.5.Business and Professions CCa1C:Any city or entry lie/
dF o whuh pC ill , t Il improve,d h repair y r mm
aim p r t L, r tl 'III II l it II ''g d'rt meno
n,nin licensed pursuant 1 [tic p , fthec 1 t I I (C pe,9 Sq. Ft. Floor Area ation
mom r ng with Section 70(10) r Division r f h Resins, td Pr .rk n-Code) 'U 54000
,,,,bar he isexempt thcrefmm and the basis for the alleged esemphon.Any violation
of Sertlont 70315 by an,y al,plied:n for a pemrit subject,Bre applicant m a crvil penal', -APN Number upancy Type
or not more hot five lrunimd dollars(55061). -
❑1.as owner ofthe protect,or in)employer,with wage%es their sole co e,so mion. 35720041 . 00
,ill do the work,and the aactur,is Bol intended or offered riot sale(Sec.]0W,
Boa s rd'111th„lo„Code, Ihe.Coamacmt',Lasa,:1nw does not apply to:n„ Required Inspections
t,ul Popery Who mild,o,imp...c,ihe,esm.and who does such work I....wil 101 — FOUNDATION
erthrough his own employer,provided that such improvements am not mmndcd or
offered for 1,1C.If,howmer,the buildng ,,impmvemta i,sold xithin one yen,of 102 — PIERS
,mpleron•the owm,.huAdv1 will have the Boma of proving that he did ion build or
improve for puga,w 103 — UFER if-1,).
01.as owner ofthe prnpeny.am«cwsively. curnme,ing with licensed contractors 1. 104 — REBAR
n,0wt the PrIjC,l(.911.1(r44.nosiness and Pmfe,fors Codef The Contractors
Uccn,\ea
l.awm,es nolatpry )an ownerorh
protect wo ha' o
tld. ,intpro.C, loolcon, 105 — ANCHOR BOLTS
Bad xho central,our.such pm,cas will,a contraclon,)licensed Prosttain m the _ 106 — SEWER R WATER
Comncmr\Liccme law.
❑I am exempt under Sec. .R&PC for m,mason 2202 — UNDERFLOOR PLUMBING
Owner woRKER'scnaPDate [ON DECLARATION
203 — UNDERFLOOR MECHANICAL_
n,ereby affect ardor pamillyof perjury one of the following declarations: 204 — UNDERFLOOR FRAME
❑ 1 have and will o rnin a Coordinate of cram. 1 to self-imam tot Wo kc, 205 . UNDERFLOOR INSULATION
Cmnten\winn, as proridCJ Ibr by Senrion 370) of the Lala Code. ler he 301 ROUGH PLUMBING
Cme,v,:mtt of the work for wM1ich thi,pem,il ix i>suml.
ElI have and will maintain N'�o��r'n Cmnl,en.ufion lnsutame.a,required by Semina 302 — TUB & OR SHOWER
370(1 oPCEWI
code.fit,me perfbm,nnce ar he work ler xhith this Imrnal is 303 — ROUGH MECHANICAL
is lie 1, .Compensation Insurance carrier and policy number arc:
304 — ROUGH ELECTRICAL_
CurrierPolicy Nn.:
IFICACO. TENSATIOETIONRANCWONKr:NS• 305 — FRAME
CU. I'ENSATIUN INSURANCE
306 — FI01_DOWNS
Bud not m,tleteA it to,Perni,kl'orune hnndrcd dollars
(s1001nr ms.) 307 — LNSULRTION
1 cenify that in the perronmancc of the work far which this pc,mit is issued I 308 — SHEET ROCK,
shot stn n una,any wr,cn iro,y oaantr.,,a,m we I. IAj n 1. he Woka' 309 — EXTERIOR LATH
coni'a\arum Laws nfcarmnh:,,Date
nt
NE
NOTICE TO TO APPLICANT.If alter making this Cenilicam of[amnptiun.you 310 — INTERIOR LATH should v
Z become\objetno the WorkersCompersatmnp,ov',ioto,Ulthe LadhrCar,you rbull ?11 — SCRATCH COAT
O O rorthwith comply with ouh pint.,rn,or Ilii.I",mir xhalI be deemed m,ol.ed. v
F ^ CONSTRUCTION LENDING AGENCY 31.3 — ROOF NAIL_
a ' heart fiffinnthat there isaconstruction leading agency Iheperfienar m 501 — FINAL ELECTRICAL ENERGY
R7
ti
Leader',
Name,Inv I Ivvc mad dr,is O,ra',issued(,Sen.3fN)],Civ.C.)
0 502 — FINAL PLUMBING ENERGY
Uren.
V0 1eon; happlk,iionadstarethantheaboveautomation1, 503 — FINAL MECHANICAL ENERGY
toF• correct.1agreem.....fywithallcitydmfcour,y„maou,,:.a1 law,relartng 504 — FINAL_ BUILDING ENERGY
O f..I :,,build It Comlraction.and hereby malraiec mpmwammllvel of lois oily h.Cate,atom
y meals,vrrrombaedper,iforinspectionpmpn,e,. 505 — FINAL ELECTRICAL
[r 0.
Wo agme to save,:iteinnify and keep harmless the City of Cupcnirragainst —
rn a:mirtie.,iadgnenr,costsand crten.c,whichOay'tn:mywayar"acC"o,,°111 506 GAS TEST
U Z City In"equcnecof of rhe panting of his permit.
APPLIR STANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: 507 — FINAL_ PLUMBING Date
TIONS.sg mrcoact„or u:nm Re-roofsI IAZARD)US MATERIALS DISCLOSURE 509 — FINAL GRRDE
nant n,ml w'dthng rwtapant nom m namlle na=dam„s materw Type of Roof10 — FINAI_ PI_ANNIhIG
perino deipal Cale,Chapter 9.12.and the ream,and Safes ,rlCode, 6,)'!O Ye, 0N AIL roofs shall bo-�i11s ccted�A(WkNanPlrtlii!cl �CiYU111HiiD ing installed.
Will the applivartormum building oceapartas,egai,mertorde,me,which If a roof is installed without first obtaining an inspection. I agree to remove
emit hamralnu.Bir annaranans a,dafned by the Buy Area Air Quality Management
ni,trierl all new materials for inspection. Applicant understands and will comply with
❑Yes ON. all non-point source regulations.
I none read the oanardous materiah requimnenl,under Chapter 7!15 of the
Calili,min Ilcalth&Safety Cod,Section,25505.25533 add 25534.I un tersmnd tout
if the huild'ng doves naom early bave a uv,anl.Ihtn it i.my reslen,.rihiliry un nobly the
a o e requirements 'both tnmr be sect prior in..mance rf a CenlOcme of
Kecurrrrn Y _ Signature of Applicant Date
(u t °i All root'coverings to be Class "B” or better
ulhorieeJ ngc Da¢