01120038 CITY.OF CUPERTINO
-BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:. PERMIT NO.
CONSTRUCTION2 8
OWNER'S NAME: APPLICATION SUB DATE
HEWLETT-PACKARD COMPANY 1705 RUSSELL AVENUE 12/07/2001
`•PHONE: SANITARY NO. CONTROL NO.
V (408) 492-1007
G'aa ARCHITECTIENGINEER: BUILDING PERMIT INFO
- BLDG ELECT PLUMB MECH
lhad
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.R r ,..°i LICENSED CONTRACTOR'S DECLARATION Job Descri tion
SRI- r ^• hereby affirm that I am licensed under provisions of Chapter 9(commencing p
y,t s�i with Sd4fgpt7000)of Dirision3of the eusines end Pnrlcssions Cale.and my liven¢ ARCHITECTURAL DESIGN REPLACEMENT OF COOLI
¢—y li iolfuil c1(�t.q
:0,6.E ii'i•,aos' ��-`LUu G.i.a '-�'
.d 3 v-N d¢ Q'{ Comma
ARCHITECT'S DECL .TIO. u-+./f•
a O g _ I undemnnd my phin"l ill be used as public records
�Y
u Li<en.,ed Professona
il
o.a'e, - OWNER BUILDER DECLARATION
='to Literary affirm that 1 am exempt from the Contractors Licame Law for the
.'Irwing reason.(Section 7031.5,Business and Professions Code:Any city or county
F f which requires o permit to construct.alar,improve,demolish,or repair any swclnre $50000
i3m „Primhoi ,alt q ' th ,plicum ter such permmo file a signed statement- - - — - --- - -- —� - - _ _--_ _-
tMth¢41 medpursu tt the pm .r¢msonn<comm<mr,uanselawlenapt<r9 „r _ r, St Ftt Floor Area;, k r�;,-, , Valuation
(commencing th Sectio7") f Division 3 of the Business and Professions Code) 4 .• ', )-:.3.1'6 0 6'0'4 2,•0 0' I-
or Nor he pf therefrom and the bass for the alleged enemamm Any violas un
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty '
;of hot room than five hundred dollars($50(t. APN Number : Occupancy Type
❑1,os owner oftheprole Y normY emloecs with woes as their sole compensation. 204 - UNDERFLOOR F E
p Y 6 penia
will do the work:and the'strucwrc"Is nor intended or'oRerN'for sale(Set,7(94,- - - ---
wlibure,off and PWImnbuild,o The rove,Conth¢req and who oe such work Kn�.eif 3 03 - ROUGH M fictions
ownero aproperty Proves
or through his own employees.provided that such improvements are not intended or3 0 4 --- ..ROUGH--ELECTRICAL-
offered for sale.IL however.the building or improvkmem is sold within one year of _. ._ . ..._.-... ._ ... _. _ _ .......
completion,the ownenbuilder will have the burden of proving that he did not build or 505 - FINAL ELECTRICAL „
` - improve for Pu"im.fmieJ.
sm ,.per t. pert. with _ ... .. . _ _ 507 - FINAL PLUMBING ,...... . . . . . .._..
❑Lumewnm¢r Orapxnyam Businessrsela,melyand ntmcting ssioWemsMeontrvcactr consa 508 - FINAL MECHANICAL - .. .
License Law
prooes oil(Sec. to or owner of
and Professionsilds no The Contractor -
i u«nseLawdoesnmapply man¢wnermrpropertywho baildsnrimproves'n<re¢m, 514 - FINAL PUBLIC WORKS, .
mul who co musta,for.such projects with a commissions)licensed pursuant.w.the ..
Commerce,Licehx Law.
❑1 ora exempt antler Sec. ,B'&P C for this reason
Dnie.• . ppy pp
- r—I Nt6 LED
:u.L, nOwner.`n'y;w4e'!C:^t° .. .. . ..,
:;,WORKIi COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the fallowing declarations: p 000'1
0.1 have and will maintain a Cenilicarf of Consent to self-insure for Worker's MAR 2 O L L
Compensation. as provided for by section 37W or the Labor Code, for the
performance of the work for which this permit is issued. BUILDING 9
ry
❑1 have and will msintaln Workers Compensation Insurance,as bar imd by S«son
3700 of the Labor Code.for the performance of the work for which this permit is
'
tssu u"' Worker's Compensation Insurance cam and Policy no Z,me:
vymmcr� ',J .. d 1.-.vP IrcYN WW /O DUS�`7. .. —pert. _ ._ ... . . . ... .. ... . .. ... _ .. _, ..
u
TION OF
•_,C-.RR-T."I.I.;I".C_.A..... .... ...EXEMPTIONFROM WORKERS
COMPENSATION INSURANCE
._. .. _. _.pert..._.._ ._.
.... .... .,- - . ._.pert -.....pert.. ..... ..._.........pert-.—. .,.. •_ - ___ _ _
(This iectmn need not be completed if the Permit is for one hundred dollars it -
ISIW)orlexi.)
�1 cenffy'that in the performance of the work for which this permit is issued:I -
shdi not employ any Mrsbn in any manner so as in become subject to the Workers'
.Applicant
Comion Laws or CmiOrmia.time
cant' t. .... . .... ._- .. _ pert ... _
.�.: ...pert_ ._ .... .—.. _. .. ..
after
n.
ld
NOTICE TOAYn the Watk If.Cum,,,asatiom provisions
of of Labor Code,you must `
bernme subject y the Workers Compensation provisions cf the Labor Cede,you must
� O
forthwith comply lith such provisions or this Permit shall be deemed invoked. '
... . . .... ... ..
,^r ` " '' CONSTRUCTION LENDING AGENCY
a ' 1 hereby affirm that Here is a construction lending agency for the perfomunce
of the k for which this Permit is isseed(s c 3097,Civ.C.) - ,. - - _ _ •- _,- _-,
[5 lands' Name" .. ... ... ... .. ... .. .._ _.
Vz Lende;Address
.
teem
fres I have read Chia application and state Just the above information is
LFtF.m c, met f agrcn to comply with.all city and coholye,ordinances and mete laws mlming
I.I. siruaion.and hereby amborix'mprsenmtives of this anion enter upon
Me above-mentioned propenY for inspection purposes.
Ftl (We)itsme iu saee:indemnify and keep harmless the City of Cupeninoagainst
"W) liabilities,judgments,costs and expenses which may in any way accrue against said '
V.Z City in c"n.equrnce of the gmining of this Fermi[ -
ID
AFTLIC 'NDERSQNANDS .COMPLYWITHALLNON-POINT'' Issued by: ! Dale
0
SigniumbiApprc Contractor " . . .. .. am Re-roofs
AZARDOUS MATERIALS DISCLOSURE' .
_ willth" plimm"i„future building..Paulsnorm°r handle mirardoos matnial .. Type of Roof .a:,- •. ..,
- : ri d f pe
d by the Cun no Min pal Code Chaps 9.12,and the Health Safety Safc , - - -
CodeS<aroh255321x1 I!; •n. .'i 'j t: e7 )' (p't . t
t . ,.
sus - :- °,' _ +,'- " ' •• All roofs shall.be fns eeted prior to any roof ng material being installed.- _ -.-
Wll the applicant or future M,ilding occupain use equipment or devices whim If a roof is installed without first obtaining an inspection, I agree to remove
em t Inisardins air nxitamm nts as defined by the Bay Arca Air Quality Management
District'. ;'- all new materials for inspection. Applicant understands and will comply with
oyesall non-point source regulations.
1 nave read the harm oils :miuls requirements order Chapter 6.95 of the
California Health&Safety Code Seinions 25505.25533 and 25534.1 understand that
iftncbuilding does not cundy have a tenant.that it is my responsibility to notify the
occupant of his requirements w met prior m issuance of a Cendicate of
°`°pa"`y Signature of Applicant Date
a¢thorne semi .- - Date All roof coverings to be Class"B"or better
rjPxrmT tor - .r - .__ OFFICE . .
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