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DNPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
10955 N TANTAU
01040124
OWNER'S NAME:
APPLICATION SUB DATE
HEWLETT-PACKARD
04/23/2001
' PHONE:
SANITARY NO. CONTROL NO.
CZ ARCHITECT/ENGINEER:
BUILDING PERMR INFO
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BLDG ELECT PLUMB MECH
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CJ L" -J L_J CI
LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby affirm that I am licensed under proakions of Chapter 9 (commencing
with Section 7")of Division 3 of Bu.sines. and Pmfe..ion.cddee. and my license
CELL
TOWER FOR SPRINT
,in lull force anduh cf-
I D g� /
License Lic. 8
Dam Camnnor s
n ARCHRECT'S DECLARATION j" Lrt Vr i
g I understand my plans shall be used as public records
oLicensed Professional
2. OWNER -BUILDER DECLARATION
affirm
1 hereby arm that 1 aim exempt foo the Continue,'., License Low fur she
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following mason. (Section 70315, Buxmi and Profession, Cele: Any city or county
l S O O O O
which requires a permit In conoract, ulmr, improve demolish, or repair any structure
e
w prion i its issuance,also "quit"theapplicant for s,rh,wroon,, filo.- signed smmmmnt
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n �`(�ji{�`Is�p {meq
(.f�4;`. ^36%F/,i V:4•§4r:'UtVOji, �,IA� {�'p'
Valuation
- th&hgls:Iiwnmdpii,cnl mthbpovoons at the Cnuo ucmrs Ciccone[.a,, Chupmr 9
([ommoncing with Sevlon.70W) of Division 3 ofthe Busincy and Professions Code)
or thin he ii eumprtherefrom oad the basis for the alli8elf uemptim. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of nor momthanfiehundreddollars(s500).
101 APN} £fATION
,
; '- Occupancy Type
01. oxcrof the property, or my employees with wages as their sole compensation.
will do the wors; and the structure is not inteMal or offend for 'sale '(See, 70al.-
'Bosidess via Pdifcsxime, Code: The Contraction, License Law does not apply to an
103 -
UFER Required Inspections'
owner of property Who builds or improves thereon, and who does such work himself
104
j
REBAR
m through his awn employers. provided that such improvements are not intended or
orcgMfon sale thcb nn:sola chin ddeyear or
'mmpinmm
-
105 -
_- __ _ - _
ANCHOR BOLTS .
wnawevec
have t
me owner builder will have meburden rproving that hdid nmt bamm
.'+•,.'
improve for purpose of sale.).
106 -
SEWER & WATER +
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❑Imawner or Na emptily. wuM1 li[ensM contractors m
----.2.0.2....-
UNDERFli00R PliUMBING'-- - '---------' ---;... .._---
...
Business and camra[mra
the project (Sec, 71. a. comer of and Pofcshons code:) Theimproves
License
License Law does not apply,p an owner of proonle who builds be i thereon,
2 03 -
UNDERFLOOR MECHANICAL "
C .tend whowith a.comracmrfz) Iicenxed.pursuanLm the
,parma
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._. - 204 `-"
UNDERFLOOR -FRAME ----------"—'-" -""'- - -
escomarepets License Lasuch.nmiats
Committees License ww. , , .
Gla e.cmptunde Sec. 13&Pcmrthis match
0
205 -
UNDERFLOOR''INSULAT•ION
ow r " D te' "`
301 -
ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 -
TUB & OR SHOWER
Ierebyammtunder senailyafpertirypneofinefollowing decimations:
303 -
ROUGH MECHANICAL
I hirc'ana will ri mon a certificate of consent to self -insure for Workers
304 -
ROUGH ELECTRICAL
Compensation,aa, provided roe by Section 37W of the Labor Code. for the
performance of the work, fm which this permi! is issue,.,
305 -
FRAME
_ ❑ 1 have and will maintain Worker's Compensation Imnna e, as required by Ser ion
306 -
HOLDOWNS
3700 of line Labor Crich, for the rarmame of itp worn for which rtnu ix
307 -
INSULATION
issued. M W icer' Cot pts. a°msuran[e[dr aPmicyn.mbrare:
r am:
Cerriec �` Policy Nn.: rFKUM 80 y'.� VS / 7
- * 308 „_
;SHEETROCK ..............._.--.__:.__
E
CERTI EXEMPI'IONFROMWORK
+309
•-EXTER`IOR' LATH"'
..
. ,..._.se .COMPENSATION INSURANCE .:.. _..._... ... .... ...
._.._—_-.. -----
fThis chm'.'eW
' 6oi be completed if the permit is lm one huMmd dallan
311 -
^14'C^1C.ICn,\Ijl
SCRATCH COAT
(Sl Wlnrlcss.)
ehi threTperrt aacc-f rk foM1f th 't "z ed
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• v 313-' -
.I.
R
ROOF,
OF -NAIL.'. �R -
"E"NER
n'
sh II
temppa son to ay man r as to becwne object othe Workers
501 -
Cs Ali•�
FINAL ELECTGY
^ope nyum Lw�grcatdDe ''hto
.. e .. .. , .. ..I
Applicant
-�-- ---502----
503
-O
-FINAL PLUMBING .ENERGY ..
FINAL MECHANICAL ENERGY...
ai'ICETnOifYthgthnais.
ampe
k
.c
shato, Code,
acentric pub[ctm0a, Workurs Connpcnsvon prov of the Labor youmutt
jrormwnncamts_ywnnxuenprnvixn,nsartmxpermnxnmlxaamedeevaked._
_ 5.04_.._-FINAL..BUILDING
ENERGY ..._.._
�CONSTRUCTIONLENDI.YGAGENCY
SOS -
FINAL ELECTRICAL
Ihcicbyaffirm that them is6'construction lending agency for the per(ormv¢e
of wo,hfo, which this Permit is issued is .v 7, ei.. C.)
506_ -
GAS TEST
i Lenders Name ' . •.... _..,. - _.. ..
Leaders AMrc;x
507 -
FINAL PLUMBING .
508 -
FINAL MECHANICAL
1 arr ify that I have read this application and state the the above information is
amma.I g t[ mplym u ay d y, a , d late l mining
509 -
FINAL GRADE
tobuilding t d ndh by. nallbuiriiie mpmtkcsof this cityt ter upon
a he n rl 1p coyI nation pr,i'
510 -
FINAL PLANNING
(W 1 g i d nfy d keep hnlesnhe City of timm"
o bablt jag, �. e d xpenne n n aynany yac eagainstsaid
514 -
FINAL PUBLIC WORKS
.. Cty onscyucnw rte g ming m"hos permit._
APPLIC NDERSTASDS COMPLY WITH ALL NON POINT
Issued b
Date
S 'GULATIO.' p
y'
Signature ornppli[anucomiacwFt ': 11
Re -roofs
1 HAZARDOUS MATERIALS DISCLOSURE, ,
Will lKehImlicart or r t building occupant store or man, ha mR s mammal
Type of Roof
a refined by the Copen n mapal Cod Chapt 9 rid th fl ahh and S.fety
C 1e. 255320
I S.ls
t'h.i� f`, A. t'y
n .�I,
❑Y.
s'..
roofs
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be.inspected,prior fo,any-roofing material being_ installed..._
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Will the applicant or fat ure building oucapeon,use equipment or de, ices w hich
_..All -shall
If a roof is installed'
._
Without first obtaining an inspection; Pabree.fo remove
cmi hazYrdous aircontaimmumv as ,dined by BeBay Area Air Q fi M mmaremt
District?
all new materials
for inspection. Applicant understands and will comply with
t oyez
all non -point source
regulations:, r' -d 1 .. .
1 have mad.the hanNmn materials mquirememx under Couple; o 95 of Be
,
California H.hh&Safety Cods. Ssaitin, 25505:35533 and 23534-1 mobsismad that
' fthe building does out currently h tcn3.nEdmttis my responsibility to notify the
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occupant f theq e t. h e el pn , m marine of Ccol ficam of
Occ
r
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Signature of Applicant
Date
All roof coverings to be Class "B" or better ,
o ar marivaagen, tq �
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I OFFICE
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