02010076 (3) OF
NO
CI BUILDING DIVIISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6
OWNER'S NAME: APPLICATION SUB DATE
HONEYWELLS MEASUREX CORP 511 DIVISION STREET 01/17/2002
PHONE: SANITARY NO. CONTROL NO,
(408) 379-0400
E ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
e y Z LICENSED CONTRACTOR'S DECLARATION lob Description
Z-8 1 hereby aRrm that 1 am licensed under provisions or Chapmr 9 Icmh rei
Ht withSalf«70001ofDh'ision3oftheBaim s ndPr°farmonsCIq
ode.andmine c T IMPROVEMENT
Y m$3 in full fore- d ellen.
te0.a'i u ,Einsc cl Lic.xIq
SS 'Xt Conner� ;}�
t,3-.LLO HITECT'a Dn fmblk ' COM .0 -OH
y g 1 understand my plops shall be used m puhlR records S
rO O Licensed Professioml
(ay OWNER-BUILDER DECLARATION 444✓✓✓
1 hereby alRmt taut 1 am exempt from the Comment's License Law fm dba
t: < following reason.(Section 7131.5,Business and Professions Codc:Any city or county "
FFG which mquirea a permit to connrun,alter,improve,demolish,or repair any awctarc par�Cp� - , $10000
pnwmusissuance,alsorequirestheapplicantforsuch ttopfleasinedsure�nt t t s-�k35'/'L'OQ412s'.'1OOf' -rea-
5 111dtIIfItIIRaYdpJRYanllelflePro\'IgnnSOfdKCnnfmClnr6LIIXR5eIJWICna erg y, 00r - -. ` -- --Valuation
Pun g
(commencing with Sectim.7000)of Division 3 of the Business rid Professions Code) fir illx .1
or Nei lie ii exempt therefrom and the basis for the allfsed exemption.Any violation `
of Section 7031;5 by any applicant for a permit subjects the applicant to a civil penalty
:of hot more than five hundred dollars 15500). APN Number . . Occupancy Type
❑1,d owner of Ne property,or my employees with wages as their sole compensation.
101 - FOUNDATION
--will ne she work, ad ssion% ode:Tharachim is nos intendedLice afflmdLaw foe snot Bac.7014,
Downer of and Profeuio b code:The Comracereo License Law does not apply to an Required Inspections'. .:P
owner of property Who builds or improves Hereon,and who does such work himself 103 - UFER
°r through his own employees.provided Out such improvement,are not intended nr 10 4- - REBAR- ---- __--
completion,
for atheflf;however;the building or improvement n sold within not year of - -- - -'--
Icompluioo,turposervbale.). lhave the burden afprovingthat hedid notbuild or 105 - ANCHOR BOLTS t
improve(«purpose of tile.).
n:w.hpr:or the - -- ---. .._._. _ .. --._106 --_.SEWER _&-.WATER
01, prope y,ten exclusively contracting with licensed comncutrs to
onswct the project(Sec.7044,Business and Professions Code:)The Contractor's 2 0 2 - UNDERFLOOR PLUMBING f 1...
ueemeLow mesnmapply manowner°rpropnvwho bmmanrimproveuneren"' 203 - UNDERFLOOR MECHANICAL
.end who,conrects for such projects with a co morons)licensed punuant.to.the ... _ __._ _ _ .._ ..... .. __ .._ _ __ .-_ _._.... ..
ComraetnraLi...Law. 204 - UNDERFLOOR FRAME
- - _ ❑l am exempt undo Sec. ,B h P C for His reason '3
205 - UNDERFLOOR INSULATION
Owed,' ' Data
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I Ihembyaffirmunder,pen'tryofperjuryoneofthefollowingdeclarations: 302 - TUB & OR SHOWER
.p 1 have ant will mai main a Ceriferne of Consent to self-imme for Workers 303 - ROUGH MECHANICAL
1 Compensation, as provided for by Section 37W °f He Labor Code, for He 304 - ROUGH ELECTRICAL
performance teubce of the work which this permit is issued.
" "' 305 - FRAME
❑I have and will maintain Worker's Compensation Insurance,es required by Section 3 0 6 - HOEDOWNS
3700 of the labor Code,for the performance of the work,f«which this permit is
�atad My ker's Compensas on lnsumnce earti and Pnhey namber.re - 30-7_- INSULATION.urn`r ]e GERbTTFlCATIONOFEXEMPTI NFR3aoa1y ,'S? 1,3;08f1
3_0,9 i1SHEETROCKI
_coMrENSATIo"msuaANCE - EXTERIOR_LATH_ _ _- _ -------
crbrssemiovned cot he crumpleied if perms is for on hundred dollars 31O '— INTERIOR LATH
51°°)011"" 311 - SCRATCH1. COAT
I cen fy Nat in the pert rmance of th k far which this permit is issued'I - —'_` -
thrill nrn employ any person n any manner ad as n become mbject to the Worsens' 313 — ROOF NA'IiL ! _ i(pf;:'+ .• .
Compeh+paonlawsofCaurnrnia,Date 501 - FINAL ELECTRICAL ENERGY
.'Applicant..'
NOTICE TO APPLICANT:If.after."in,this Certificate of Exempnion.youshould 502 FINAL PLUMBING -ENERGY-
. ..
Z become subject to the Worker's Compensation provisions of the labor Code,you must
Q O forth-th comply with much prommum,or this permit shell the
o' ! d
teed rooked.
;
- 5.03 FINAL MECHANICAL
ENERGY
cONSTRUCT1oN LENDING
AcegCv 504FINAL BUILDING"ENERGY '-
- "
1rcy uffmthat h a constructiong agency for the nce 505 FINAL ELECTRICAL
rkfb
LeadBrwhich ms .it is issued(Sec 3097,Civ.C)
or
- -506 -- -GAS
- -- '
- .506 -- -GAS TEST .. ._ _. . . .__ .-.
Faso <neIII . ma 507 - FINAL PLUMBING, -,
I certify that l have read this application and state that the above information is 508 - FINAL MECHANICAL
cmrectr I agree to comply with all city and county,ordinances and state laws relating
o U to building mnawniOr:and hereby malmnze representation ofthis city went,,upon 509 - FINAL GRADE
Ax the.tin(We)htmemProperty ve:indfor inspection keepharr em; 510 - FINAL PLANNING
Iii ve-m agree in Poop,indemnify and keep hannleu the City of Cupenico against
Vn liabilities,judgments,cost and expenses Which,may in any way aurae against said 514 - NA WORKS I)�t O
U City is Coosa Ice of the gianting of this permi.' �tl
LI uND11RIS.II SAND WILLCOMPLY WIT LL"Dd.PoiNT ` Issued b Date
—rte Jfi
Sigan
nse Applicam2mmm
nor • , � J;DaRe-TOOPS
-.
HAZARDOUS'MATERIAI3 DISCLOSURE te.
Will the
2applicant
ppperIIf;1 building« ant t orhaz-ardc oumate ad 'Ty'i p'w e i O4f- Roof.
as d fned nCuenno Muqrp CoChpt9,14,uralthe Health and of
Code is A
ir
0YsAll roofs shall be inspected.pnor
..
tgany,roofng material being installed.____ . .-_
Wall thp applies t f rare bu pant use equipment or devices which If a roof is installed without first obtaining an inspection;'I'agree to remove
m
m t h zartl us air comm nems as fed by the Bey Arte Air Quality Management ,
Listener?r7 all new materials for inspection. Applicant understands and will comply with
"° all non-point source regulations:'
I ha lc rta l Ne hazardous mammals oa mrements'under Chapmr 695 of the "
California Health
&Safety Cde:Sections n505.25333 and 25534.1 vadenund thm
irthe Wilding dna not currently have a tenons,that it is my mspinambility w notify the -
.Capans- a ust menta which must be at prior to issuance of a Certificate of
G Oclu c � . / -
W. . . ' 2-20- Signature of Applicant Date
w«,a,aahonudag , ' Da,p All roof coverings to be Class "B" or better
:5
,`,�•.., ....,,. _ . . _. OFFICE -
..