02010087 OF
CI BUILDING DIIVC'ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10080 N WOLFE RD STE SW3 MAS APPLIED CONSTRUCTIO1, TECH 02010087
OWNER'S NAME: APPLICATION SUB DATE
MENLO EQUITIES 2241 CALLE DE LUNA 01/22/2002
S PHONE: (408) 987-4970 SANITARY NO CONTROL NO.
Q re0 O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
he u- BLDG ELECT PLUMB MECH
IJ U I ..I L_J
LICENSED CONTRACTOR'S DECLARATION
Z y z I hcren (frm that 1 am licensed ander ns or Chapter 9(commencing Job Description ww,, //��
iz—e Ya provisions Per a �',M/"!��®
„tp; wimsauonnwd IT ovist°nJannfBasmfstand vrotbtsm�tscadaand myrante TENANT IMPROVEMENT
Y I J
.,in full for and fRcCl.
n a< License Cln. Lic.0 7306- �Z
W. D"`��- Gontmelar MAR 14 2002
n G CHITECT'S DECLARATION
ON 4 k I undcruand my plans.null be used as public Iccords
DoLicensed Professional
Dat I as.BUILDEromDECLARATION BUILDING
UI DING
X,9 F—' 1 hereby.(Tient that 1 1. exempt from the feWirms Car License Law for the V L. 1Y117!
5 z< lauowmt sawn.(semon 7031.5.Raceme and Rofcssions Code:Any city or county $340000
,,E. wMcn 9 � p �,� � t n - p d r.n p y.,
ca
3 prom t : Iso q Ih ppl' 11 ch pc li fl 'g J.t 1 mem __
rachire
that hesl'tt ;m! mistimadiflud,prov. s of had C umeme,License Lit (Chapter9 Q ,�•p�p�,�sp�y.-pS� .. ... .—._...__.- __ . ..._-_.. . ... ..
(com hong with Sec, d")of Division J of the ens nes d Professions Cane) r'' �;,31%:h UYYY.l.,V,P k'1'.i, Valuation
fir that he is emna'a thcrefloin and the basis for the alleged eaemptioh.Any violation
of Sermon 703 LS by any applicant for a permit subjects the applicant to a civil penally
:ofOut mare than five hundred dollars S500), 101'1PN DATION Occupancy Type
❑I,as owner of the pmpeny,or my employees with wages as their sale compensation, 102 - PIERS
will do the w.,k.and he.Irnemre is not intended.,.frena for sale(See.nus, 10 3 — UFER Required Inspections
Business and limitations Code:The Contractor's License Law does not apply to an q p �-
or through
...in of profanity Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided that such_mprovmnens and nm intended fir
—offered for sale:If however,the Nihim t u'Ed within one f - —' - '_..._. _-
g°Wide. f ro °"° 105 — ANCHOR BOLTS
semplve fie the ownerbuilder,will have the Nrden of proving thvt he did nm build or
mprove liar Parpnt<ar sme.). 106 - SEWER & WATER
s. oliasown&.rthe pmpruy.ame.cluat.elycon tmating-with licenseecontra ctorsto 202 -UNDERFLOOR PLUMBING
onstruct mm
e project(sec. Ilu4.Bascn and Professions Cade:)The Contractors 2 03 — UNDERFLOOR MECHANICAL'
Lion.Law does no,vp,l,to an owner of V,.,my who Ni)dl or improves hromp.
' .and who contracts for such projectswith a cootmetor(s)licensed"""m he — - 204 _'—UNDERFLOORFRAME
Commodes License Law.
❑lam e.ahapl under See ' '.B&PC fonhis mown 205 — UNDERFLOOR' INSULATION
Owner Date" 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB be OR SHOWER
1 herchy a1Rmt under penally or Perjury one of following declarations: 303 - ROUGH MECHANICAL
-1 ❑ 1 have and will maintain a Cenificate of Content to self-insarc for Workers 3 04 — ROUGH ELECTRICAL
.'� Compensation, as provided for by Section-37W of the Ube[ Code, for ,he
Performance of the work for%hien this pemtit is issued. 3 05 - FRAME
O l have and will rommain Worker's Cumpcnsmiwi Insurance,as requited by Section 3 06 - HOLDOWNS
37M of the IwNr Code,far thc petrmritanfe of the won for which this permit is 307 - INSULATION
issued.My Worker's Cn p i Insurance er and Policy number are -
N' 308 , SHEETROCIC
ec47iq Y& 'tGVII//1Palley ry /S :2 '
CERTIFICATIONO EXEMPTION FRO WORKERS•, ,•309 r �"EXTER'IOR 'liATH
COMPENSATION INSURANCE " ': 3T0-- _ _
INTERIOR—LATH-_..... -- ---------- _..--.. .__....
.. ...- ...
(This,edimn necdmm be completed if the permit is for one hundred dollars 311 - SCRATCH COAT
BI00)or Icss.)
I certify that in theP tfarmance of the work for which thisperm,is issued,1
313 ._. ROOF •NAI-L . .. _....__.. . . .. ._._ .- . .._ .-.__.. .. -
'shah not employ any Person in any manner so is to become subject to the Worker:' 501 — FINAL ELECTRI CAL' ENERGY
Campcnsmlon Laws of California DateApplicant . .. .....502_ —.-FINAL PLUMBING- ENERGY —.- . —
'NOTICE TOAPPLICANfIf,aR king,h carateofE pia you should 503 - FINAL MECHANICAL ENERGY
becomesubject the Worker'sCompensation p ofthe Lard Cade,you mum
z � faith thcomfalywith np tun mthllnereactedrc ked. 504. .—. .FINAL ,BUILDING ENERGY ,
F � CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL „
I he .by ffirni that there nal elo ding ugen y for the performance
of the weakfb which his permit is issued(s 3097.Civ.C.) 506 GAS TEST
� Q -Lender's Name '. .•. .._.._� .. .. _ - _ _
P z Lena Add 507 FINAL -PLUMBING „
U0508 508 - FINAL MECHANICAL
F., 'c'ommo.1 agree to comply,wnh all city and county atamaaes and state laws relating 509 — FINAL GRADE
. Q U to Wilding o.1 ction a d he by ammo s octica.minoves of this Oily t tar upon
he b v tht d,I ,chyli r spaeu r
p po 510 — FINAL PLANNING
L•" /] liablltWJ)dg tts,cs, ndn penes whand ich may inhi�anybe Cay scc pengainst sale 514 — FINAL PUB IC WORKS ��11
V Z City in iomscqtimxfducgmitim,of this permu I V v
APPLICANT UNDERSTAND NO WILL COMPLY WITH ALL NON-POINT Issued by: �s Date
S TIONS.�
�r, F _:22'0
/�ignawrc of Apv!. HAZE RDOU d IA I " ;");Dint Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the e locant or
ruu. . at.m.arc. or handleZ.:u
vdoaSal Type of,R. oof
ai defined by the Capenino Municipal Code.Chnpm9.12.and the Health and Safety tCode.Section 85321a1?
-•• - ` ..7 .I
O.Yee'
..� :•'' _.-..Al1.roofsshall beinspected.priorto.any-roofing.material-being.installed.
...._-
Will the applicant orfuture building Occupant use equipment ordeviceswhich If a roof is installed without first obtaining an inspectiori;'I agree to remove
mit Monaco,air cnntmninams as defined by the Bay Arca Air Quality Management
'District? all new materials for inspection. Applicant understands and will comply with
all non-point source regulations;,. - „• „ ,
4.�LCaliforria
1 hn`e read me hazardous materials requirements under Chapter 6.95 of the Heahh&Snfny Coda Smions 25505.355JJandZSSJ4.1 untlermandthatbuildingdont nm currently hove a tenant,the,it is my responsibility to notify theant of the requirements which must he mt poor to istr nee of a Cenifcaie of
nSignature of Applicant Date
lf nathorimd attar Date Al] roof coverings to be Class "B" or better
- - OFFICE .. .. -