06080042 CITY OF CUPERTINO 3
PERMIT A' ION
BUILDING DIVISION
BUILDING ADDRESS: HEWLETT PACKARD CO PAf"NO'06080042
19410
NER'S NAME: PERMIT ISSUE DATE
HEWLETT PACKARD CO
NE: - SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERM"INFO
BLDGO ELECTO KUMECHMH
00 LICENSED CONTRACTOR'S DECLARATION Job Description
0 uF� I hereby 4M Nu I am licensed under provision of Chapter 9(mmmcncing P
j N ntfullfo,ea�rAncl. idon3afNeBumr¢nandRofwwuCode.aodmylicevcu RESTORATION OF EXISTING STEEL BRIDGE, CONST
mon Z Licen¢a. Lic.a
r Dam Ctufl r PACKAGE 2 ARCHITECTURAL AND ELECTRIC
:19ARCHITECTS DECLARATION NO SANITARY CONDITIONS .
i 1 underwnd my plans"I be used u public records
hyU
r a Licensed Professional
OWNER-BUILDERexemptDECe comr ON
H 1 herchy.(Emit Nal I I.S.exempt from the COntranofs Any c Lew for the
o op- which um moon.(Section IIdanBusiness and improve.
dcauna Cade:Any oily m county
$w which R9Usmes uae.permit,aCMSWc4pplicmfor such
pormittmliath. fie a sig ed NNCla2
+Zy PdormiuluuaopJtsa requires thovisios of for suchpermitmxmmLaw(Clumem
� That he is licensed purmantm the provisions of Nc Cantrocuri LIcense law OChaPur9 Sq.Ft. Floor Area Valuation
l� (commencing with Section 7000)of Division 3 of the Business and Prolamines Code)or $110000
$ that he is exmmpt therefrom and the basis fm fee alleged assumption.Any violahm of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penally of APN Number Occupancy Type
not mom than Ow hundred dollars(A500).
❑I,u owner of tm property.amycmployeeswith"gnu theh solecompewdon, 3-160
will do the wok and theslrx,om B not founded croRered lmule(Sec.7044.Budrcss Required Inspections
and Profauiom Code:The Conuacmfa Liames Law does rot apply man Owner of q P
property who buildsorireprows merete.and whodoessuch work himselfor through his
.employ=,provided thatuch improvements art ren intruded oroRemd for lain If.
howevm,the building or hnpnevemml ism to within arc year Of competitor.ft—
builder
mpettor.Aeowm-
builder M0 have to burden of Proving that M did ears build or improve for Purpose of
❑1.as Owner of Ne property.w exclusively contracting with Iiaused conaaemn of
common the project(Sec.7044.Business and Profadona CdeJ The Canmcmfs I!.
cew Tawdnaoohap mm owner ofp.pmy who builds mimpes.memos and.
whoconuaeu fora leen with a eonuumr(s)licensed Panama of the Conuaetoe's
Luew
❑tom mp�ih a. ,113P or Ni rt
Dam
O CERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of do forming declarations:
C I haw and will maintain a CestiOa d of Covent Of self-inau,far Wenrke/s Compen-
.free.as provided for by Section 3700 Of the labor Code.fm the peefarmaoe of the
work:for which this Permit is issued.
Q I have and will maintain Workees Compensation Imuran.u required by Seton .
3700 of the labor Code,for the perform a ce of the work far which thea Permit is issued.
My Worker's Computation Insurance artier and Policy number ace:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section food not be completed if the permit is forma hundred dollar(glol)
or lass)
1 certify Not in the performmce yyf the work Ire which this permit Is issued,I shall at
employ any perm.harry manib p{o become subject in the Workers'Compensation
Laws of califomlfL w 1
Applies,, 11,,
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
heceme mbj=of the Workm's Compensation provisions Of Nc Labor Code,you muse
.,O forthwith comply with such p..ism.or Nu pereall shall M domed mated.
Z CONSTRUCTION LENDING AGENCY
(—h rA Imuchy Nim that tore lace consuacti,n lending agency for the perfmmuceof
C> the wens fm which tam permit is issued(See.3097.Civ.C.)
ALenderes Namc
Z: z Lendefs Address
V O I certify that I have red this application and suis Nu the teen.information I,
W coned,l agree m comply with all city and county ordinsect,and suis laws mlaning to
V building ccoswction,and h„byamhon.rep,scnutiver of this city to enter upon Nc
W movomcutiuned property for inspection purposes.
0. (We)some to u..edcmnify and keep hannlw Ne City of CuPenino againal
fA liabilities,judgmem,costs and expenses which may In my way Ace=against said City
V z inconsequence of Ne Ong of his Permit. L
.. APPLI ttIIN ANDS ANO WILL COMPLY WITH AL NON-POINT Issued by: Date
sou E RL s. �,J d b Re-roofs
signu Appli ntraelar Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will applicants applicaor room,building oaupsut part or handle beardau material
as defined by the Cupertino Municipal Code.chapter 9.12,and the Health and Safety
Sato,25332(,)+ ,�y� All roofs shall be inspected prior to any roofing material being installed.
❑Yes ANo
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicmt or future building occupant esu e9u1pmat m devices which
COIL hmtNnm air canuminants u depend by the Bay Area Air Quality Management all new materials for inspection.
District?
El Y. Nu
I own mad the hazard u maurialssequirementsunderchapurd.95aftheCalifor-
niaHcal"s eayC e.Sec ?3915,25533ad235M.Iumknundtha,If&Wilding
Jona Ml cu nil,ha .a o r)r, at It u my responsibility to n ol'y the TO-1 or Ne
rogelrement which ted ei dormIssuance f.Ceni” '.olOccup �yy Signature of Applicant Date
A-P 3n E All roof coverings to be Class"B"or better
Owner or rot Oct cnt Dau"