06070186 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORIlVF�ORMATION _
BUILDING ADDRESS: RUDOLPH & SLETTEN INC PERMrr N0.06070186
19091 PRUNERTI)GE, AVE
NER'S NAME: PERMIT ISSUE DATE
HEWLETT PACKARD 1600 SEAPORT
MZINE: SANITARY NO. CONTROL NO.
(650) 216-3643
ARCHTTECTIENGINEER: BUILDING PERMIT INFO
BLDG El.EC7 PLUMB MECH
0 t 0 0
co Zp LICENSED CONTRACTOR'S DECLARATION
,UE E I Wrtby affirm that 1 am IicenseL under previsions of Chapter 9(commencing
-Job Description
U with Section70M)a(Divican J ofd¢Business and Profeuiom Cade,and my licensee
I�h infull fo=and ef "4khG�f REVISION-ELECTRICAL .TO (E) OFFICE SPACE
,,vj? Licenu Cl sLk.g
rw Date Comw LDAI 617 ORIG PERMIT #05110136 NO NEW PERMIT
•�� ARCHITECTS DECLARATION 0_rhvs '
s< 1 undctaund my plans shall he used u Imblic records
iyU
C Cleaned Professional
OWNER-BUILDER DECLARATION
1 WrthY art,.cull I".exempt from Ne Cantraa.fr :Any C Law for the
p o which no mean. arch t 7031.5.stnBusiness and Pmfeasinm Code:Any city ar county
s: which mqui,ex a permit to construct,aWr.Wpc.vs,demm it t or repair any nructum
.Ie
prior toiuiensed p,auun:to the tWapionsof fm xchpctor's MeasLnedruvmcm
o that heiscingwitpursuant to Nc of Disioos of thehe Business
licenselaw(Chapter 9 Sq. Ft. Floor Area Val�ia't�®Q00
(commencing with Section7000)of Division)Of ad Businessand Professions Code)or
Natio u exempt M apple and Ne basis for bj alleged acmant n.W Any it penalty
of
Section 703 1.5 by airy applicant fm a pumit subject,the applicant to a civil pmalry of APN Number Occupancy Type
am roam than five hundred dollars($soap. 31606033 . 00 P Y YP
❑1,uowneroftWpmpcm,armyrmploy withwagsuNeesokcomp=Uon,
will do the &and Neauucrure u rotinteMed«.reared fertile(See.]aN.Business Required Inspe ions
and Prefessimu Cade:The Canuactoff License Law dors e.1 apply to an owner of q P
property who Wildsorimpmsss Nereon,and who doessuchwork himself or through his
owncmployces,provided than such improvement,am not inxnded moRertd for sale,If.
howevv.Ne building or improvement u sold widen oro year of completion.Ne owner-
builder will have the burden of proving that he did not build or improve for purpose of b
❑1,as Owner of the propeny,am exclusively contracting with licensed matrices;to V t^r
Construct the project(Sec.TUM,Business and Professions Code:)The Contractors U.
come Law does not apply to an Owner of property who Wilds or improves Merton,and
who contracts for such pmjcct,with a commacer(s)licensed pursuant to one Contractor'
Lee.Law.
Q 1 am exempt undo Sec. .B St P C for thisOr moon
Data
WORKER'S COMPENSATION DECLARATION
I hereby aDirm under penalty of perjury one of the fallowing dedanuans:
1 ham and will maintain a Cerdfiae of Contacts to self-insum for Workers Compem
ration.u Provided for by Section 37M of the Labor Cade,for the perfomor ce of the
work for which this permit is issued.
❑I have and will maintain Wortrrs Compenuu m Insvrence,u tmlutred by Section
3900 of Nc Label Code.for Ne pofalsom.ofd,wore(.,which this permit is issued '
My Worker's compensation Whostace Carrier and Policy number art: -
Gnrier. tLA& (.4 Pali,N., W C 349 r30�-a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section coed not W completed if de permit u foronc hundred dollars(SIM)
Or less)
I coJfy,that in the performance of the work for which this permit is iuood.I shall nut
employ any person in any mumrx u to become subject to One,Workers Celnpcuxtian
Laws of Cali(omia.Date
Applicant
NOTICE TO APPLICANT.If,after making this Ccnificale of Exemption,you should
become subject to Nc Wahm's Compensation provisions of the Lahur Code,you most
.JO forthwith comply with such provisions or this Perron shall W decued revoked.
Z N CONSTRUCTION LENDING AGENCY
[� 1Wmby affirm Wt urcrt is a construction lending agency l'nr the,performance of
QE > the work for whim this permit is Wood(Sec.]U9],Civ.C.)
6. Q Landers Name .
.7 Z Landers Aridness
U Q 1 certify that 1 have lead this application and rose that de aWva inf..do.is
L, F^ mmecL I agree to comply with all city and county ominames and sure laws relating to
0U building construction.and hemby aurhoris mpresentsums of this city to enter upon the
0. ahovc-mcmmncJ property for inspection purposes.
(We)agree to save,indemnify and kDDP harmless the City of Cupertino against
F" CO tocciues,judgmcnt,. sand expevss which may in any way aecrue agaioss lid City
U z in eonxq eco c ung of this permit.
APPIyyy�1111�VDDA U STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �- ��•-off
SOlE R G NS.
Re-roofs
Sign Il Appls UCantracior Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will trc ipplicun w future Wilding attvpantss.or handle hua,dous material
as defined by de Cupenina Municipal Code.Chapter 9.12,and cup Heald and Barely
e.
Section 25532(a)?
❑Tm 06 Na All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or Puts a Wilding occupant tax .Ail Qua or devices which P g
Dust hvamnua air conosminant,u defined by Nc Bay Aura Air Quality Managcmcm all new materials for inspection.
District?
Cl Y. on
Ihave rtaJ ehaarduus materials¢yuimmcnt,under Chapter 6.95ofNeGlifar-
niaHalthd:S cry ode,Seeuau 25505.25577 and 2553e.I undcrstantl Nati(Nc Wiltling
does not t ave a event that it u my respomihility d notify do occupant of the
mgoim mumhe met pdon 'su c,ot�D fiateofaeapaneY. Signature of Applicant Date
3k
Owner or an age, I Dae All roof coverings to be Class"B"or better