04110151 F
PERTINO .. - - ••x�''r,,y; ^-e^*?F' .__ - "h 7- +r-�... _ _
PERMIT (SN
BUILDINGIVISION
$.
: RUDOLPH & SLETTEN INC PEaMITNcb4110151
"NER'S NAME: P®tMR 66UBDATB
HEWLETT PACKARD 989 E HILLSDALE
PHONE: SANITARY NO n CONTROL NO.
415) 572-1919
ARCHI7ECTIENGINEER: _ BUILDING PERMff INFO
BLDG ELECT PLUMB MITCH
yap LICENSED CONTRACTOR'S DECLARATION " Job DCSCrIPUOD
I hcmyyyqy��YYf a01nn Nu 1 am Iicenac0 under es of ChaPmr Y(commencing V tj f •i - •I'.
with " )af DlWsion 3af the Businw eultns Code,mdm Iicenxeis / / , a •- -
'a mfnn_,h o.deff � � q8 ��q y TI--UPGRADE CEILING CU14.?� '
aha VIZ Lici)amnxe Clue - C mumor D -
- _ ARCH17ECT'S LARATI
? ndcoand my plans shall W used u p
-; Licensed Professional +.- ._ /��n yr j �• ?n/y� -
5^ OWNER-BUILOHR DECLARATION'
4 1 hemhy affirm Nn I am eaempt from the Contrtnofs License law for the
O O
i following mason.(Section 7081.5,Business and Profeaaluns Coda:My city or county - v(Ll,f a'at
s�$ which requires a permit m common,ager,improve,demulble.or mpalan
r y structure .1
t- �^ prior to its issuance,alsu acquires the applicant forsuch permit in rile a signed summnt. -�
F�<
that he is licensed pursuant the provisions of the contractors License law(Chapter 9 Sq.Ft. Floor Area L/ �,Valu�&�ion
" Cg (canmencing with SeNon7000)of Division 3 of the Business and Professions Code)m
3 that he is attempt therefrom and the buss for Ne alleged exemption.My vlola0on of
Section 7071.5 by any applicant fm a permit subjects the applicant to a civil penalty of el0 0 Occupancy Type,
rant roto Nan 0w hundred dollars 0700). ... ... -
❑I,u owner of Ne pmputy,ur my emPtoyea with veld as Neb wa compewtion,
wi it do Newark.end the swcture is not intended or oRerud f e vele(See.7044,But.
and PmfeWons Code:The Conbactofs Limine law dao and apply to an owner of Required Inspections _.. ,
propanywho buil swimPrawa Nemon,andwMdwauchworkhim f«through his .. ..
ownemployeu,pmvidedthai Suchimpmwmanuatonoiimmnde4woffemdforsale.lf. - - .
however,the building or improvement is mid within ans year ofcmnpletion.the owner.
builder will Mw the burden of proving that he did rant build or improve for purpose of _ -
um.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to -
.. construct the lattices(Sec.70".Business and Pmfeudom Code:)The Contractor's Li-
ttre law does not apply ve an owner of property who builds or improve thereon.and
who contracts for such projects with a contractons)licensed pursuant m the Contractor's ,
License law. 1 -
0I.CaemptunderSec. .Bh PCfothsmanne -_
Dam
WORKERS COMPSNSA77ON DECLARATION -^- -
I hereby ofrirm under penalty of perjury one of the following dxlarWons:
01have and will maintain ACWOcamoMmsem to WIN" re for Worice.Compen.
inion.as provided far by Section 77M of the labor Code,far die performance of the -
work for which this permit is issued.
❑1 Mw and will animism Warkees Compensation Insurance,as acquired by Section
3703 or the Labor Code,her the performance of the work forwhich this permit is Issued. -- -
My I�nsallun lmm�nce curies and Po/llry number am:
er:��l AMS7J77
11 a.: WC
CE If�FICATEOFE)(EMpI]�(f�GAOMWORKERS'
COMPENSATION INSURANCE
(This active need not becompmmd Tithe permit Isfmona hunNed dollars(SIM)
maF)
1 cemfy that in Ne performance of the work for which this Permit is Issued,I shall net
employ any person In any manner an as to become subject in the Workers'Compensation _
U.of C.1if pals.Data '
Applicant -
NOTICE TO APPLICANT:If.after making this Cenificsm of Exemption,you should - _ .-
became Subject w Ne Wohers Compc wnwo provisions of the Labor Code you muse
.,O forthwith comply with such provisions m this permit shall he darned nhwked.
zl� CONSTRUCTION LENDING AGENCY
E••I I Manby affirm Nat Nem las,...auction lending agency for the perfurmence of
7i > Ne wark for which this permit is issued(Sec.3097.Civ.Q
a Q Lender's Name
7 Z LeMetsMdmu -
U Q I cenify Nat 1 Mw read this application am tum that dim above informal"IN
ly correct.I agree to comply with all city and county ordinances and sum laws totaling to
Q Wilding construction,and hereby whorito mpresenutisea of this city m enter upon the
W above-menduncd property for inspection purposes
Ly,a (We)agree to saw,indemnify and kap harmkas the City of Cupertino against Aplw
ilabllilles,judgment,toss and cap Inch may in any way....against said City
V',[ In Consegancc of Ne grantln of i Tanis.
•" APPLICANT UNDER WILL COMPLY WITH ALL NON-POINT Issued by: Date
5 URGE REGULATION . 12h0 6
Re-roofs
Spline
anti ApplicanUConu t
HAZARDOUS MATERIALS DISCLOSURE , Type Of ROOF
Will the applicant or future Wilding oceupam atom or handle haumous material
as defined by the Cupertino Municipal Coale.Chapter 9.13,and the Health and Safety
Section2553z(a)7 All roofs shall be inspected prior to any roofing material being installed.
1-]Y. V.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha'ramnus air canmminanu as defined by the Bay Area Air Quality Management all•new materials for inspection.
District]
❑Yes V.
I haw mad th Is usmamrialamquimmens undaChapux 6.95 of the Califn.
nit Hctlth&StittyjG 'ore25JU5,25333 uu1255N.l undersand lhuifNe Wilding
does not euamn Y/tl nant.Nn is u my responsibility m notify Ne occupant of Ne
toy reactor is a eMCIPriormiuuanceof4ccrdfacateofoccup cy Signature of Applicant Date
t jI
0rwNori7ed eC WWI All roof coverings to be Class "B"or better