05050015 CITY OF CUPERTINO77. 2atism°#MS«t a tryt¢�s .1
BUILDING DIVISION PERMIT gT'q.AACTUR INFORMAT19
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BUILDING ADDRESS: RUDOLPH & SLETTEN INC PERMITNcb5050015
9055 PRUNDERIDGE AVE
ERS NAME: PERMIT ISSUE DATE
HEWLETT PACKARD 989 E HILLSDALE 05
PHONE: SANITARY NO. CONTROL NO.
(415) 572-1919
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDOO Eta PLUMB
MECH
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�oo LICENSED CONfRACiOR'S DECLARATION lb Description
I homey affrm Ram at 1 licensed under previsions of Co
Chapter 9(commencing
with Section 70W)o1Divls1o,3of the Business and Professions Cade,and my licensee n /� n Cr—I-
n� in full farce and affect. HVAC UPGRADE (BOILER,[.2�AQ' LTN PTS
PN? License Class Lk.P a Ik];' h�i-_ il_a,� IL
CC'h9, Dam Canlrmmr
ARCHITECrS DECI.a ATION
II O I undetsund my plans aNll W used as Public records /_ 20 5
sed Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby 4MM that I atm emmpt from the Contractors License Lew for the f� (I my ff11 i
D O following moon.(Section 7031.5,Business and Profasians Cale:Any city or county
$ which acquires a permit to ennsmmL after.Improve.demolish.or repair my structure \\ ((=l
6 6 0 0 0 0
E>r' prior to its issuance.also requires the applicant forsuch permit to file a signed sutement — — ..
<
that he is licensed pursuant to the provision of the Contomm's License Law(Chapter 9 Sq. Ft. Floor Area "Valuation
(commencing with section 7")of Division 7 of the Besircss and Pmfeselans Code)at
Nat he is exempt muefrom and the basis rot Use alleged emmpumn,Any violann of
Section 7051.5 by any applicant far a permit subjects the applicant to a civil penalty of Occupancy Type
not mem than live hundred dollar(5500).
0 1,as owmr of Ute property,a my employe.with wagesu their role compensation,
will do the work,a ad W amucae is not intended or oReied for sale(Sec.7W.Business Required Inspections
and PrefaRons Code:The Contractors Liaam Law don cowant
q t apply to a
r of -
property who bei Ids or imprevea Neuron,and who does such work himself orLough his
own employe.,provided that such Impahmmenuam notim ended moRertd for.le.IL
however.the Wilding or improvement is mid within oro you of completion.the owm e.
Wilder will have W burden of Proving that he did at Wild or Improve far purpose of
.Ice.),
0 1,.owner of the property-am exclusively contracting with licensed contractors to
contract the projen(Sec.7044,Business and Professions Cade:)The Contractors Lt.
come Law does not apply to an owner of property who Wilds or improve,ounces.and.
who contracts for such pmjeaa with a matrimonial licensed punant toth Contractors
License Law.
❑1 am exempt made,Sec. .B k P C for this reason
Per Dam
WORKERS COMPENSATION DECLARATION
11 1 hereby same under penalty of perjury ane of the following decluadoes: '
0 1 haveand will mainmin a Cort ficste of Cnnaent to self-imum rat WorkersCompm-
sadan,as provided far by Section 7700 of the Labor Code,for the perfmmame of the
work for which this Permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,se acquired by Section
37fM1 of the Labor Code,fm me performance of the work for which this permit is Wood.
My Workers Compensation Insurance carrier and Polity number am:
Center, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
flTis.,I.need mlbecamPleteJ lath Pamtl ufmone I undmddollua(1100)
m tea&)
1 certify that in the performance of the work for which this permit is issued.l shall not
employ any person In my matter se as to became subject to the Woken'CompenssUon
Laws of California.Dam -
Applicant
NOTICE TO APPLICANT:If.after making this CeAfam of Eamption,you should
become Subject to me Worker's Compensation provisions a the labor Code,you most
.JO forthwith comply with such previsions re this permit shall W deemed mvoked.
'y y CONSfRUCf10N LENDING AGENCY
EIhereby affirm met there is a construction lending agency for the Krfmmeme of
(Yr> the work far which this permit u Weed(Ser.7097.Civ.C.)
W Q Lenders Name
z Lmdera Address
U Q 1 certify mu I love mad this application and sate the the above infoan,lun is
U.!� come"I agree 0 comply with ill city and county ordinances and sou eves rel,ing to
rV^ building conmucdon.and hereby mutual MPmsenutivcs of this city to enter upon the
W above-atemioned prop ary for impaction purposes.
gL (We)agree m save.iMannity and keep heroic,the City or Cupertino ague,
V7
liabilities,judgmcnls.costs and expaamati which may in my way section against aid City
(,)7 in consequence of On Stenting of this permit.
tom— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO RCE R UL?sT10N rj
Re-roofs
Sigatiture,of Applican otuamer m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m farm Wilding acoupmt stem rehandle lambda.mammal
Wined by the Cupertino Municipal Code.Chapter 9.17,and the Health and Safety
eus77c.)7
0 Yes
\ No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hxsardous air conuminanu as dcOned by the Bay Area Air Quality Management all new aterial for inspection.
District?
Oyes `�N4 i r
( —
Ihavcreadmeh.a .mateaa,25533 de 534.Jc,ChaPted6ulf Wildi.1
nisH.Im&SatetyCode,sections 23303,75577 anJ 75371.1 undemm�d mull Ne Willing ^Ar
does notwmally ham tenant mat It u my rospomi illty m mtil'y the oceupmt of -
mgmre nu wh(ch Wyypi mi,ama raccniraamaf Gem Sig tore of Applicant Dae
ear amhadDole/agent ICO e/ All roof coverings to be Class"B"or better
A ��