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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 .,. ... .. ... ._. . . __. . ......-__ . . ... ... .. .. ... ...