00070088 CITY OF CUPERTINO
BUILDING DNISION PERMIT CONTRACTOR INFORMATION:
BUITA)ING ADDRINS. PLRMIT NO.
19111 PRUNERIDGE AV/46T WATERPROOFING ASSOCIATES 00070088
' OWNIIR3 NAME: APPLICATION SUB HATE
J HEWLETT PACKARD 975 TERRA BELLA 07/14/2000
N ZONE: SANITARY NO. CEIM RUL NO.
(650)937-1299
O ARCIUI'I!CTIENGINLEII: IiD11.DINfi 19iItM11l'i'INFO
LC
BIDC ELECT' PLUMB MliCfl
I—) I- . 1 IJ L-7
SN= LICENSEDCONTRACIOR'S DCCLARAnoN Job Description
I hereby affirm that I am licensed under pmni,ion. dChapter 9(commemdng
•yFw wfit,See o''o"700X))ofldv iI 3oin,Ba,ioe..anJPmre,0m,Cole,all lian.e OVERLAY B. U. R. W/C
in lull Foci, oil sa -
ocf�, � e-rG4
S 3 HARCIII'I'LC'I"S UI'.CIARATION
1 underlaid my plans.hall Mused az public rccomis
m
app Llcc'laed lIn l'e"ion:d
•°• z OWNER-BUILDER DECLARATION
¢1 c n I trivial affiom thus 1 am exempt from,he Can mamr's License Law for the
F 6 I'ollo my ll I.[geld.."7031 5.lba,ire,,and Pude, nt.Cale:Any city nrtoody
FD which y p lu I I I imp d h., rcp any tore
a, primlo il,.e,mmct..Ia rectums the.pplicom marachfw 't to diva xfied_Itmem
'hal he is licensed fl to the provisomwone c I t %Licl La (Chapter 9 - Sq. Ft. Floor Area Valuation
(comm s fill r'o, man iD ki ri f'1 B 'ns,aid l , :: Caw) $51484
or that he is exempt Ihcmfmm and the basis for the alleged e.empuon.Any taolmom
of Section 7011.5 by any."h,am fora permit subjee,the applicant to a civil penalty
ormv'nnre than five hundred Aoua"(S501p. APN Number Occupancy Type
01.as owner of the pmpmor my employees at fill wages as their side compensation, 31607046. 00
will it,,,he work,and the strainer is nil Intended or offered for%ale(Sec.767.
Imine"and 11 1 ...on,a,da:'I he Co'tmmor,U—nm Law doe.ma.,TI,',I no Required Inspections
x r of pmpdy Who build,oo imrrommol mol and who docs such work himself 305 — FRAME
or through his own e'nMoyces,provided that such impmvememe am not intended or
ofmm'd lir ode.If.hovel in,building or impmvemeat is sold within o'ta y.,,,( 307 — INSULATION
icompletion.the owner.buEder will have the buNcn of lowing that he did not hold or
mprm.efarparpo^corxvlc.). 601 — ROOF TEAR OFF
❑1.as.ownebothe p,o, nellia,"elycommceagwitnhan.eda,mr:mlorto 602 — ROOF PLYWOOD NAIL
omuuct the project(Sec.7041.instant,aPm
iand feWonx Ga1ca The Colorado,',
License law dos not apply to lin owner of pmpny who builds or impmvcs thereon. 603 — ROOF BATTENS
and who miotic"to w'dt pmjcds will, a emumairtvl Ilccnsed pursumn 'o the
comoolo",Lleet¢c Law. 604 — ROOF IN—PROGRESS
❑1 vat aempd under Sec. .B&P C for this reason
0%net Ilam
WORKER'S COMPENSATION DECLARATION
I herehy ai'Inn,under penuhy n1'prinry an of'he oil lowing lMandamr,'.
7 I have and will maintain it Cenificam of Consent to self-inxvre for Nbrker's
mmensnfon, u. provided Ino by Sce,ion 17X1 of the Labor Cade, for the
prformvnce of ohe work fi,r which Ibis pini,is issarad,
ha and ,If maintain Worke—Con'pnsmia r hismance,a,raryired by Section
371X1 of the lalwr Code,fir flue pO1,11ol o 1,of Tho work or which Thi,l crall i.
i,,md.My Worker',Compensation Insurance cal
and policy
'rou'n er arc:,
Gaoler:✓_ -policy Na '( 9
CHRTIFICA [ON of;E%LA1YDON IBOM WORKERS'
COMto
PENSATION INSURANCE v
('Im,s,,daa nett,no be complem l if,hc p......is fir one handed dollms
151(X)1 or less.) V
1 molly 0'a,In etc pert an,c it the wad:for which'his pem,il Is Issued,I
shall nm employ any person in any manner so as to br l subject m the worker'
Compnsaion Laws of Copland..Dom _
Appli, f
NOTICE TO APPLICANT:IL after nmklng this Ccnifcate of Faanp,illn,you should _
became subject to the Nbrker s Compnsmii n provisions of the 1rMn Code.you most
Q 0 mnhw''Ist comply with such previsions or this crour shall be deemed revoked.
zVi CONSTRUCT ION LENDING AGENCY
1 1laffmt that there i,a construction lending agency for the performance '
of em work for which'his per:nn is rsual(scc.91107.Civ.C.)
G Q Leudcr'n Name
Q 7 Lender's Address
C.) Q 1 coil,Flat lhme,call IIs applica...land n,o,,111.1 he uMve in'orma,ion is
La. E" comma.I agree to comply with all city and county mbroncerand acme law.refacing
IJ m building ronevadion,and hereby amthotic representatives of this city m enter upon
ohe"""s-romio:led P'„pcity Iia in.pation porpmms.
F A. (We)agmvut nave.immartify and evia hltrmlcss the City or Cupnino again,,
N liabilities,judgment,casts and expmc,which ray in any say al against said
(J rZ•' Cily in co'»ecicmae of life planting of his lxrmit.
APPLICANTUNDERgrANDS N ILLCOMPL WITHALL N-2 14 Issue
by: Di11C
SOURCE REGULATIONS. 7 Jte Q.�
slgoamrc or Appbcatmcmnme,or D:Im Re-roofs
IcA t or future
MAT ro AUScepa tDISCLOSURE
Will,hcrCmamoo fmuunTal Code. hnipl,I)12,handle kvaNnun Safety Type of Roof
os de.Sec by the Cupertino Municipal CaJw Chupwr 9.12,and the llenhh and Sufcly
C1XIc.Section 255920x1:'
0Ye, - All roofs shall be inspected prior to any roofing material being installed.
Will dtenppfd'morn...mbuimin,1.11'p:mt me alalrvnemor de,ne,w mvh If a roof is installed without first obtaining an inspection, I agree to remove
coil haeallon,air com....mant as delord by the Bay Arca Air Quality hfaangemant
Di^,rim7 all new materials for inspection. Applicant understands and will comply with
❑Yes all nun-point source regulations.
I have d the hatradous materials requirements under Chapter t 95 or the
CaIdoimaIIt,a1lh&Sadvt,C It Statilm,255105 25531 and 25514.1 andc,ard that I'
it the building t ' 'lyl comm.0a„'. illy resp 11'ty' ml'yem 7 ' ”(
occupant of the re of emends which must M t t prour In'ssuune f C ndcme of I
O,Om e,, 7 Signature of Appliq.mt Date
ownn .,r seat — �W All roof coverings to be Class "B" or better