06020171 CITY OF CUPERTINO '-� -= � '
BUILDING DIVISION PERMIT < CONTRACTOR INFORMATION,=
.•fir:•a .
BUILDING ADDRESS: hil. Cc PERMIT N0.
19091 PRUNERIDGE AVE
41 TO
NAME: PERMII ISSUE DATE
HEWLETT PACKARD 1600 SEAPORT BLVD, STE 35 03/28/2006
PHONE: SANITARY NO. CONTROL NO.
(650) 216-3643
ARCHMC rENGINEER: BUILDING PERMIT INFO
BLDG - ELECT PWMBMECH
X0, LICENSED.licensed under p DECLARATION
of Chapter
w 1 hereby affirm Wt 1 am licensed under provisiom of CTapmr 9 recommencing Job Description
Z. with Section 70fIU)mfDivision 3ofdm Bulinus anJP •fcuinns Cole, tlmyliccns is TI-DEMO (E) CONFER. ROOM REPLACE W/SMALL
°<^• in full form and eB r
uanse lass Lt.p CONFERENCE ROOM
F p DdLL' CUnlydebr
A HITEGTS DECI.A ATION FINAL
�®
1 undersunJ my Plain shell IE uuJ u public ATION R■■■�
JaU
s o Licensed Pmfcssianel „
OWNER-BUILDER DECLARATION
<Z 1 hereby alnnn on I am exempt from the C:sdon, o :License Law for the 2006
OO following season. vomit h](131.5.Business and improve.
de oli Code:Any city or county ,LIQ lj
i m� which requires a permit m ronamcL slur,improve,demnlixh,m repair any xwaum '
priarmrucented pumarcquiroct visiamofeConpermr's U= aigncdaiptcrt
ma<
loathe itcing wit pumtion to cc of Division
of theeBusiness IJ YIQCIJW(C Code)or Sq.Ft.Floor Area V
x t-$ (commencing with Section]000)ofDivisionJ of the Business and Professions Code)urAl III
Nat he u exempt rwmfrortt and the hasis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3 a pN �g�� Illaw III
not mom NM O Oan five hundred dollars(SS(k)). Y T fflpltnd�TW
❑1,u owns of the pmpeny,or my employees with wagca u coir ole compenudon,
and PotW work andtW he Contractor's
roundedm Law
W in owner
and Prtywho u Code:The Convector's and
Law dors not apply to an owner of Required Inspections
property who builds or improves suchicon,and who doessuchwink himself m throughhis
own employ=,th building
Natsockimprovements artnot roundedmplcdred for owner,
bualder ,thebuildingarimprovement issold didnane year of completion,the owe of
builder will have the burden of proving Out W did not Wild or improve for purpose of
aa1eJ.
❑I,as owner of the pro tent,am exclusively contracting with licensed rontrumrs to
consvuct the project(Sec.7004,Business and Professions Code:)The Convector's Li-
came law does not apply ho an owner of property who Wilds or traphar,es Merton,and
who contracts for such projects with a contramor(q licensed pursuant to the Contrsenses
License Law.
❑I am exempt under Sec. ,B k P C for this reason
nu
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne fallowing declarations:
IMmend will mainuinaCWfi®u of Comenno self-insurt(mWorkehCompcn-
ration,as provided for by section 37M of the IaWr Code,for the perfotmence of the
work for which this permit is issued.
Q 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code.fm the,performance of Ne work for which this permit is issued.
My Wo cc's Co�nmpensation ln"'carr' Policy nu lac the
Carrie Y` /Aa�l c3'No.
CERTIFICATE OF EXEMPTION FROM WORK
COMPENSATION INSURANCE
(This section need not becomplcud if tW permit is foram,hundred dollars(SIM)
or le.)
I unify,Nat in the performance of use work for which cis permit or issued.I shall not
employ any person in any manner so a,in become subject to the Worketi Compensation
Laws or California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeniOcam of Exemption,you should
became subject ho the,Worker's Cmiss'naatian provadmis of dm law Code.you must
'.,O faMwith comply with such provisions m this permit shall he deemed revoked.
Z'� CONSTRUCTION LENDING AGENCY
(-+ I hereby alarm that them is a conmuntion lending agency for Nth performance of
a
the,work for which this permit is issued(Sce.309'],Civ.C.)
lender's Name
Z band,r's Address
U Q 1 unify that 1 have read this application and sou that Ne above information is
U.F correct.I agree to comply with all city and county ordinan es and state laws relating to
U building construction,and hereby amhorim representatives of this city to enter upon the �/�fy�t(/ /
above-mentioned property for inspection purposes. 1/"w�/VC/V
Fr„y (We)agree to uve,indemnify and keep harmless the City of Cupertino against \\
h liabilitin,judgmcnu,cosuindexpcnseswhich may roan way seems agaiw said City
U z in consequence of c ting of Nis Smit.
ti A ANT UN STAN S I CO P WITH ALL NON-POINT Issued by: Date 3 ,2�- d)
CE REG
o can on r r Aa Re-roofs
H ABOGUS MATERIALS DIS SURE Data Type of Roof
Will the applicant or future building occupant shoo orhsndlc hazardous mauriJ
as defined by the Cupenrno Municipal ,Chapter 9.12 end the Health and Safety
ode.5cction 35533(x)?Ye All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvicet which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants o dc0nc by the Bay Arca Air Ouality Management all new materials for inspection.
District?
ED Yes
I have mad Ne haammo rd,requirems aper G95 IWCzlifor.
nix Fkal cly Coo,Sccti 5. SJJ 334.1 dors fIW Wildin
docs c nt ly have mymibili to and(
requ m Lawhic mu Wm ' r ane is 'mato ancyy. Signature of Applicant Date
Owne i odzndagent Dem All roof coverings to be Class "B"or better