02010076 (4) CITYBUILDING DIIV��ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
ONE RESULTS WAY BLD 5 SOUTH BAY CONSTRUCTION CO NC 02010076
APPLICATION SUB DATE
VM�YIpM^1�ELLS/MEASUREX CORP 511 DIVISION STREET 01/17/2002
AHONE; SANITARY NO. CONTROL NO.
(408) 379-0400
B
O pOp ARCHITECT/ENGINEER: g UILDING PERMIT INFOBLDG ELECT PLUMB MECH
I I I_J
Z 5 m i5i LICENSED CONTRACTOR'S DECLARATION Job Description
of=o thereby nRrmthat lwas licensedunder provisions ofChapter 9(commencing TENANT IMPROVEMENT
with Section 7000)of Division 3 or the Business and Professional Cade,and my license
a m C is in full force and effect.
E9
� Ucenu Clus Li,.M
ng a.
Date Contractor
u. ARCHITECT'S DECLARATION
C!h y g 1 undersm ad my plops shall be need m public records
gii arc-.p Licensed Professional
OWNER-BUILDER DECLARATION
R y I hereby.(Sect that 1 1. exempt from the Gnsion Professions
s o Any c Law for the
Z< fallowing reason.(Section 7113I.A Business and improve,
darma Coale:Any city or county $10000
which requires a permit m ronmwa,ulmr,improve,demolish,or repair any stmcurt
u�3Q priormaliensed palsaremom provisions
fur Cartel
ow(Chapter
Chmmcm --- - - - - -- --'-----'on
that he 3lieen.eo pSectim io the of Division
of the Conwaoh License Low(naCod ) Valuation
ard, h ingwithSauon7W0)otebsiso the elicited
1355$ -IL`t:t`''•
m that io is 31.5 bt medfro"m and the basis for the etsthe eumant to Any violation -
-of sedionathaniv any undredicomrs($5 for a rmiuubjatsthe applicannoncivilpenalty; p yTyp
for not more than five hundred dollars(5500). 101A� ATION ppla r,-'" Occupancy e
❑I f the property r my employees with wages as tit ole cam pgahr+ .. - - -
-will de the work..nd the particulateisnot intend
t Bloomers nd P:ore.alon c Thp eq., ar's l,Fi �� `a r:P` o.n-' 3 UFER Required Inspections lr
owner fp perry who hila'improves s' nal d h` rk nal,If 4 REBAR _ _
or m gh h s own employatd((p''msprotded Nath mpm_]rmnts ars m d + ^" _
of...If b r le.If h er Wilding or t mem is msW - rap __ 1 -5 ..�—ANCHOR BOLTS'
Ecom leuun the ownervhildcr ' lee he bee � f «' did m IJ ar ,
tmpt"ov f rparpm.rdsive) � ° 6, SEWER & WATER _
Oip,nwne ne�Proaay, exewsb.l at licensed as ' to b' =-`UNDERFLOOR-'PLUMBING —
con.tm.ttop ,ect(Sec7 Prot. . acke)The Comrecmr's Y203 - UNDERFLOOR MECHANICALlri:y
License Law ones not apply to an owner of property who holds;or improver thereon.
_Co twit cammcts Law.I., pmec«.wan. mnuactagaLlicensed.pnrsaent.m.me__- ----.._-2 04 ---UNDERFLOOR— FRAME--..._......__...--_._--.-..._.__-------..__..--
C I cum ar's License Low.,. -
"I`` " '`' :" � 205 - UNDERFLOOR'`rINSUliATION
O 1 am exempt under Sec."' _ .. B&P C far this reason
owner Data " 301 - ROUGH PLUMBING
-WORKERSCOMPENSATIONDECLARATION
302 - TUB & OR SHOWER
Ihereby elf rtn tvmdqel.peotd!yIafpe,ary.d nee(allowing aenamdnnse 303 - ROUGH MECHANICAL
t - ❑ I have nd ill atmmranif
Cecme of Cnsent t If naure for worker's 3 04 - ROUGH ELECTRICAL
Gompeq yt naprovided-for by Section-3700 of the Labor Code, for the
p rro m n of therk to which this pc milia .sued. 3 05 - FRAME
❑I ha<and'will'trainimin WI Onsonaverammitan Inshmnce as required by 5 lion 3 06 - HOLDOWNS
3700 of the Lnwr Cala r thep<eorma.Ii of the work r:which This perm t is 307 - INSULATION �✓ l/i
issues My W rke/a C rape no Insmn.e came{end Po1¢y numbe v'e� ^ ,
t it r .+ . 't. ; e:'eatcy bI .: .: . __ 3 08 ' SHEETROCK.._ _
.k CERTIFICATION'OF EXEMPTION FROM WORKERSe t. '�4. 3 O 9 4 EXT•ERLOR'•-LATH-i-
..�.t (TTIa aenien neve nmhebmpl tee'nhe permNCE .INTERIOR--LATH� .'
COMPENSATION INSU
tee: 1^ nisforonehundrcod Ilan 311 - SCRATCH COAT
f510)o leas) r _ _
117 1 -313- —ROOF,-NAI-L
1'n1 I cent favor m rT rm psi f m work for which this permit iissued,1 +. .. "^" al i t
"lit 11 not employ any permit' y manner o as to became s F,ec('to the Waken- 501 - FINAL ELECTRI CAli`"ENERGY
'C 1.1- nLuwsofI, , mYa.'Dp1 - - - -.---._ . .. -502---.__FINAL._PLUMBING.._ENERGY-------`- ------
Appplmmtt - .__a ..
r NOTICE TO APPLICANT:If,after making this CeniQpate of Exemption.you should 503 - FINAL MECHANICAli'ENERGY r
OO 'became sub,ectt the Worke"Compensation pro islons of the Labor Cale.you must.
form ith 6omply with such provincesorthisPermitshallbedeemedrevoked SO4 -- FINAL_ BUILDING_ENERGY -_.
u ICONSTRUFnoNLENDING AGENcr 505 - FINAL ELECTRICAL t "f
1 hertny gfBtm that them
is oo t d n IctWing age rut the performance 506 - GAS TEST I 1 t
' 1 cued l5 J0]Civ C) , a_a.:l L _:
of the wok( hchm spermtiut --FINAL''
_ _
o Lender.Nam - 507 ' FINAli'PLUMBING;
:Le .cI Y Address '
1 cndy thm,l have rend Nis.pPl¢non and erat.thn the above informmm�is
50 FINAL MECHANICAL
kprust 1 ag to S mp4 with all city.nd cp my rdine c d.m,rows relmog 5 9 - INAL&GDO.0 - hurd n«rep pinsfN citytoemerupon 5 0 - INALNGIlh i ogcJp ponyfor,impe u n purpo(W I gkeiosa ndemmi(yandke phmmlesslh Cty fC peninb.Iain,, 51 - INALRKS
y 1 ebmu ,dgmcros.costa end expenses h«h m y in n y y ecc a again;t said
U Cayy In ansequence of the four
ng of Taxpermit
lAPPUCANT UNpEk$TANDSAN�WILL COMPLY WITH ALL`lON'PGENT, 1SSUedb Date
SOURCE REGULATIONS, t Y
Sidnamre,of APPlicdnUComruaor, "/":"". - ''" " Data;': 'i Re-roofs
HAZARDOUS MATERIALS DISCLOSURE - -
WIII'me oppbcant r future hila g becupont serve lir handle haaardwa rtmtenal .... Type Of.Roof - - .__ .,....,..
�a d<feed by the Cupenm.M Municipal Cod Chapter912 and the Health and Sefty. d; I,`. Fr ] a s S' -'� , m_- --
Code Section.25532(417 s .- t
Qy 'r 1sT ( Tri t .O No Ut �f�p� t R ..I '1..j.
All.roofs,shallbe Inspected.poor,[oany.roofing,materiaLbemginsCalled.__...,.__ _.
Wilt the applicant oefuture building occupant use equipment or devices whichIf a roof is installed'with'out first obtaining an inspection,T-agree to'reearlove
lmn hmnrdouenr conteimnsn«as defined by me Bay Area Air Quality Management
D tinct -all new materials for inspection. Applicant understands and wil comply with
y.t O Yn .. _,. . . - _. . .
r .°No )`^ all non-point source regulanons.
I have Teed.the'hazardous'�material.�rcquircmenIs an er Chapter 6.95 of the
California Health'&Safety Cade,Sections 25505,25533.4 23534,1 understand met _. . _.
'•
if the building docs nm mervi all have a tenant.W aNat it is my tnponsibilaY w notify the ,. : 1'
oc5viant of tbe,requiremcma phich'mun he met prior m iisum¢e of S Cenifcam of
Occupancy._^,. ...
__ _ _Signature of Applicant _. . _ Date
;T Owmru wmnneaegem, , nam All roof coverings to be Class "B"or,bitter
..:.:. I _..:..._.... :'. . - -OFFICE .,. ... .. ... ._. . . __. . ......-__ . . ... ... .. .. ... ...