04120156 CITY OF CUPERTINO '�"'` t '�� ' s%"'''�" a • - -- - ' -BUILDING DIVISION PERMIT 44NTItACTURII! pXtM'IV CQ
BUILDING ADDRESS: RUDOLPH & SLETTEN INC ""N004120156
19091 PRUNER
OWNER'S NAME: PERMIT ISSUE DATE
dL HEWLETT PACKARD 989 E HILLSDALE PT-11 12 /9.1 /2004
E; SANITARY NO. CONTROL NO.
(415) 572-1919
ARCHITECIENGINEER: BUILDING PERMRINFO -.
BLDG ELECT PLUMB MECH
�o o LICENSED CONTRACTORS DECLARATION - - Jo Description - -
I�z ueenceaseas ARcx Lk.DECLARATION
TI--46U RES b -
1 kmby afflrm that 1 sen li¢need under provWom of Charm 9(Mmou ncint
with Section]�ttttde effect.
Division3of the Buunusand Profession Code,and myIicenm la
:^ in fall rarer and ertmt. RESTROOM ADA
Dau Contractor '
*� 1 un erahnd my Plans shall he mad as public records
8ti gleaned ProfesMonal
OWNER-BUILDER DECLARATION
I
berchy s01rm Net 1 am exempt from the Contcamor's License Law for the ✓ •�t; r �y
a a following mason.(Section 7031.5,Business and Profusion Code:Any city or county
$ which mquima•Permit N moLruct.slur,improv,demolish.or repair any stmt--M - -
F�y prior to its issuance.Alm requires the applicant for such Permit to file a signed wument .
c that he is licensed pursuant
ktto the provision,of f Communes License Law(Chapter 9 Sq.Ft. Floor Area -_,��� z�fl„ -Valuation.,-- .
(commeneing with Section 7000)of Division 3 nftho Business and Profemlons Code)or - �''
$ thants exempt therefrom and the bub for the alleged exemption.Any vioWlon of )} I/ n
- Section 7031.5 by arty applicant for a permit subjects the applicant In A civil penalty of e10 0 ��'f 1 l 1 ,. Occupancy Type - ..
not mom than 0w hundred dollen(5500). r
Lasownmorum ° �'G
❑ Propmry,orm..ti.WyeuwiNngeaude(S=.7 ,Bremen,
will Pr t e worts Codd:he com ise ses Li enext Law
doers,an,a(Sec.W an Bnineu u and ProfeAalan Com:ITC Conumtors Limtue taw does tot appy h an owner of Required Inspections
property who WilN mMprowtMemen.and whodousuchworkhimvlf oruuou{h his
own employ es,provided 0.1 such improvements tie unintendW cauRertd forsake If,
however.the building or improvemem is mid within one year of eomplmion.he owner-
Wildm will kw the Wdan of proving that k did not Wild or improv for pro=of
sale.).
u owner of No property,am uelusiuely contracting with licensed contractor;h -
CnnyWm Ne pro)M(BCC.]esti.Business and PrnfeaLOn Cam:)Tk CmuCmra L(-
cenm law doer not apply to an owner of property who W Iles or Improves Nemon,and
who'
ho can w ymp wiNeconuacmr(g Llan:d punuanttolk Contrmtofa
❑Iamue tuneder .B&PCfor thbmuon - -
0 Dau
1 K COMPENSATION DEC - -
eM m unmr perWty of perjuryoro of the following dwimdome
I haw and will maintain a Certificate ofCommnt to selRinum for wmysYs Compen.
"tone.u provided for by seedon 3700 of the Labor Com.for the performance of the -- -
work for which this permit is issued.
❑1 have and will maintain Wormes Compensation Inanranco,as,mquimd by Section
37Mofthe taWrCode.for the performance ofthe work for which this permit is fussed.
My Workees Compensation lnmnrica carries and Policy number are: -
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thls section need not k completed if tic pemtil is rosette hundred mutant(5100)
or less.)
1 cordfy that in the purformanro of the work for which thio Permit is issued.I shall not
employ any person in my manner m as to become subject o tic Workers'Compenadon _.
Laws of Califorob.Dau
Applicant
NOTICE TO APPLICANT`If.after making Nb Centra:of Exemption,you should
become subject to the Worker's Compensation provisions of me Ls m Code.You most
0 font comply with men provision or this permit Mall k dimmed mwked.
r~N., CONSTRUCTION LENDING AGENCY
(•` lkreby afRrm Nat dem ba construction lending agency for the performatxe of
(Yt> tau work for which this permit is issued(Sec.3097,Cih,C.)
QLendefe Name
Mz Lender's Address
U 0 1 cen ly that I have mad this application and shut that the show Information I-
U,H correct.I agree to comply with all city and county ordinances,and sum laws relating In
0 U Wilding construction.and kmby wthor(x repoessnudws of this city or enter open Ne
W Chmc(We).ed to sa for Impecindemnify
purposes.
(We)agree to caw,indemnify and keep harmlm Ne City of Cupertino nd&AmR
Chy t f
rjj IICbllidca,cad menu. mus,whichmaymanywayecmnaPinal Cly
U IOPPLI qne UNDSN'tol aS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S
E Iy i
i2"21 ,0 Re-roofs
S'
t" '(Land onus or Dau
x OUSMATERIALSDISCLOSU Type of Roof
Will ppllcml or future building=open[Rom or hand- Ifhm W."ma:nal
u m y tic Cupcohm Municipal Com.Chapter 9.13.and tau Health and Safety
Cmle.Seeoon 25532(q? All roofs shall be inspected prior to any roofing material being installed.❑yes AN.
Will the applicant or totem Wilding occupant am equipment at demcaa which If a roof is installed without first obtaining an inspection,I agree to remove
It haarmm air contaminants u de0ned by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yu u
ev the leu dab requirements under Chapter 695 or ft Calilm,
nu S yCode. coon •255 Am12M31:1undcuanAthit Wilding
d ndy kw ajenan u my mmun ibility u nodfy We ox"pmt of Ne
u men ich mustl7em 'or:issuance on CcniRca:of Occupancy. Signature Of Applicant Date av
Owner ar umorizc gent Z All roof coverings to be Class"B"Or better