06110080 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORY�tF'ORMATION
13 H. ?m: hn. Fd..v >.fc S,•4.n T 14 N'; -d
BUILDING ADDRESS: PERMR NO.
OWNER'S NAME: ATE
IEWLETT PACKARD 1600 SEAPORT BLVD, STE 350 12/22/2006
91WE�
SANITARY NO. CONTROL NO.
(650) 216-3643
ARCHI'fER/ENGINEER:
BUILDING PERMIT INFO
. BLDG ELECT PLUMB MECH
0 0
loo LICENSED CONTRACTOR'S DECLARATION -
m Job Description
I hemby affirm that 1 am licensed under provisions of Chaplar 9(commencing
ie, with Section 10M1)ofDivivon3afdteBusivissInd ProfessionsCode.andmyhe..is TI COMMERCIAL- MINOR STRUCTURAL, INTERIOR
o• in full fora and cif L
jq? Lianaea tie.« INCLUDES
c Dam,A_L'OnlDECL
IES ARCHITECTS DECLARATION Inc ELECTRICAL LIGHTING, NO EXTERIOR, LOBBY AREA
r"
< I undcrsund any it..shall he used IS Public records
iyp
°try
Licensed Professional
5 OWNER-BUILDER DECLARATIONCortn
<I 1 Wrca
hy alum Not 1 am cmUtinpt from e Conveor's License Law for the
el o following reason.(Section HD I.S.Business and Professions Cade:Any city or county
ie which requires a Permit W canuruct.alert impmve.demolish,or repair any swctum
�Z> prior in its mufice,also requipas BC application far Such permit W file a Signed ata4'ment
< that he is licensed = W the provisions of the Contmctara License $5 Q 0 O Q
Law Sq.Ft.Floor Area Valuation
C (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
S
s Urn he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit Subjects the applicant W a civil Finally of yp��Number Occupancy not mom than five hundred dollars(M). 316 0 7 0 4 4 .V V' P y T'Pe
0 1,IS owner of the pmpany,or my employees with wages as their=to compensation,
will do the work,end Ne Swctute u not intended or alienist forsake(Sec.7004,Business
Said Professions Cade The CantracWra Lis.Law doca act appy W an awns of Required Inspections
property who Wilds or improves Ncrcon,and who does such work himsel f or through his
own emplayre;provided that Inch improvements and Mt intended oroRercG for sale If.
however,the building or improvement is sold within one year of completion,than owner.
builder will have the burden of proving that he did not build or improve for purpose of -
sait.).
El I,as Owner of Ute property,am exclusively contracting with licensed conVInWrs to
construct the project(Sec.7044.Business and Professions Code:)The Convaaor's u-
anse law docs not apply W an owner Of progeny who Wilds or improves themes.Ind
who contracts for such projects with a conuacWr(s)licensed pursuant W Ue Contractor's
Licenx Law.
❑1 am exempt under Sec. .B&P C for this maen
e Dae
WORKER'S COMPENSATION DECLARATION
1 hereby affirm blah,penalty of perjury one of the following declarations: `
1 ham and will maintain a Certificate of Consent W elf-moan for Workers Cont
.rich,an Provided for by Section 3700 of the Labor Code,for the pmformaha of the
wort for which this permit is issued.
❑1 have and will maintain Worker's Compensation Itsunna,.required by Section
3700 of the Labor Code,for We performance of the wont for which this permit is issued. '
My Workers RCompensationI_w�trIna amen Ind Policy number am:
Carrier: 71)X iC. k IU1 V k d'Vefolicy No.: lAtL?,A q 531;7 0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihusacmlmh need Mt becomplemd if the permit It Taste bund 4doBan(SIM)
or less.)
I ccnify that in the peif...of the work for which this Permit IS issued.I shall oat
employ anyperson in any manrcrm as to become subject to the Workers Compensation.
Laws of Califoria.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exomption,you Should
become subject be the Worker's Compensation provisions of the Later Code,you most
.J z foolwith comply with Inch pmvisians or this permit Shall be domed nevaked.
z� CONSTRUCTION LENDING AGENCY
[•+� Thereby affirm Wt them is a construction lending agency for Ue performance of
athe work for which this permit is issued(Sec.3097:Civ.C.) -
W 0 Lender's Name
IL
D z Lender's Address '
U Q 1 certify that I ham mad this application and Sue that tie aWm information is
ly COMCL 1 agree W comply with all city and county ordinances and cute laws rclming m
(�U building construction.and hereby authorise reprinentativa of this city m cmc,upon ft
4 liaovc-mentioned property Sur inspection purpuWa
(We)agree to save,indcmm fy and keep hamless the City car Cupcnino against
h incoitluunivic ,thents.corksandexpcneamitM may in any way acauc against seidCity
U'z A consequence of the UNDERSTANDS
of this permit.
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-Poll Issued by: Date
SOURCE�REiUi°NS. - S_
1K t�r ��!' /� Re-roofs
am
3lgnc of ApP�nanUContmcmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tW appfiant car future Wilding accupam nom or handle haardont material
as defied by tie Cupertino Municipal Cade.Chapter 9.u,Ind the Halth and Safety
ale.Section 25533(a)7,
C]Ya All roofs shall be inspected prior to any roofing material being installed.
�No
If a roof is installed without first obtaininginspection,I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which an P g
emit harardatas air conmrrimin s u defined by the Bay Area Air Quality Monitor., all new materials for inspection.
District?
❑Yes T7 Nu
I harm real Ute hvardnus mamrials requimments under Chapmr 6.95 of the Califor-
niaHwlth&Safety Cao,S=Umn505.25533and25534.1 undersand thni(the Wilding
does act Eu/
y han a he th t it u my maponsibility m notify Ne mcupant of the
rcyuim cnsw b IWm4 o tuissuan acchilkwaof Oce Date
fl u/ ��, I"�� Signature of Applicant six i� �� All roof coverings to be Class"B"or better
caner m amhomrA agent m