05090209CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
RUDOLPH & SLETTEN INC
FERMI TNo. 05090209
10955 TANTAU AVE RLn 4c;
R'S
PERMIT ISSUE DATE
11NAME:
HEWLETT-PACKARD
969 E H
P ONE:
SANITARY NO. CONTROL NO.
(415)572-1919
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
o
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7") or Division 3 of the Buslrcssand Profeaions Code, and mylicommit
in frill roree and effect.
TI --ADD WALLS TO CREAT ELECT. LAB AREA,
Lkenm Cl Lk.Nfi
Dam Contractor
TEST/ADD CARD KEY ACCttt9
RCHf1ELT5 DECLARATIONNA
I on lend my plana shall he used as public record
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DEC 1,3 1005 Luo
Licensed Pmfossional
OWNER -BUILDER DECLARATION
I botchy affirm that I am eaempt from the Contraclers License law for the
following mason. (Section 7431.5, Business and Pmfeetions Code: Any city or aunty
which require., a permit to construct. alter, borrows, demolish. or repair my structure
prior to its issuance, also requires the applicant ranuch permit to rile a signed statement
that he is licensed porment to the pro,unmesof the Comracmr's License La. (Chap= 9
Sq. Ft. Floor Area I 1 4546
(commencing wish Section 7000) nr Division 3 of the Buanestand Profusions Code) or
that he Is exempt Ncmfrom and the basis for the alleged eamption. Any violation of
er enc
APN NumbOccas T
Occupancy Type
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of
dollars
Out..than five hundred dolw
31607033er
❑ I, as owner ofthe pmperty, ler my employee with wages as their tele compensation,
Required Inspections
ewner
will do the work and the structure is not intended orortered for salc(Sec. 7044, Business
and Prolealoa Code: The Comtaemn License Law does at appy m an oof
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property who builds or im prove aheran, and when does such work him sel f or through his
own employees. provided that such Improvements are notimended orortered for sale. If.
however, the Wilding or improvement is sold within as year of eompletia, the answer.
builder will have the burden of proving that he did not Wild or improve for purpose of
talc.).
❑ 1, as awoer of One property am eamlwimly contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Canuactor's U.
comes law does not apply to an owner or properly who Wilds or improves thereon, and,
who contracts for such projects with a conusamr(s) licensed Furman, to the Contractors
Lice. Law.
❑ l emeaemptunder Sea ,BkPCforthlsroason
r Dam
,
WORKERS COMPENSATION DECLARATION
1 hereby afamt under Penally of perjury one of she following decimations:
,
❑ I ham and will maintain a Cenilam of Consent to self-Wum for WorkeraComport.
sation, as provided for by Section 3700 of the labor Code, for the performeao of the
work for which this permit is Wood.
❑ 1 ban and will maintain Workers Compensation Insurance, a required by Section
3700 of the Labor Code, for the performance of due wade for which this pont, is issued
My Warkera Competuadm lnwraPnce a an ,Pp lgyf mWs
1l'1h-.I-YvGtPtroan �PoI'i`cy�r/VaL: mNsta,�+1�
Center. t�V" l.a��
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlon need not he completed Base permit is rmonchundred dollars ($101)
or leas)
I unify, that in the performance of the week for which this permit is Issued, 10411 not
employ any person in my manor an as to become subject to she Woreeri Compenadon
,
Law. of California. Date
Applicant
NOTICE TO APPLICANT: IF, after making this Cc tilate of Exemption, you should
become subject w she Wohet', Compensation provisions of the labor Coda you most
fonhwith comply with such provisions or this Permit fall W domed revolted.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Them lea c.omuctinn lending agency I'., she performumm of
the were for which this permit is Wood (Sec 3097, Civ. C.)
'
LerMcrs Name
Lender's Add.,
1 cen fy that I have read this application and slate Use tine aWw information i.
'
emmmL 1 agree to comply with all city and county ordinances and stale lawn relating to
building construction. and hereby authorise representatives of this city to ether dram the
awm-mentioned pmpeny for inspection purposes.
(We) agree to ave, indemnify and kap harshest the City of Cupertino against
Ilatildes, judgments, cats and cap... which may in anyway accrue against aid City
in conIC ace of the granting of this permit.
APPLIC NT UNDERSTANDS AND WI L COMPLY W ALL NO POINT
Issued by: Date
0
T70Re-roofs
Type of Roof
it. or DaleHAZARDOUS MATERIALS DISCLOSURE
plicant or future Wilding Occupant sore or handle hevardous material
r-
Cupertino Municipal Code, Chapter 9.11. and the Health and Safety
s3z(a)7All
f]�el
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
theapplicant or fuuture Wilding Occupant use equipment or devices which
emit harardnus air contaminants as dcMcd by the Bay Ara Air Quality Management
all new materials for inspection.
DiWict7
XNu
❑Yes
I ham mW the hvxdous materials requirements under Chapter 6.93 claw Cable,
nia Health 6 SafelyCodc, Sttdau 25505.25533 ami 25334. I understand that it de Wilding
'
does not cumendy hamsters Netit elmy mgoonsibiirym rushytheoccupantnr Ne
requlreme welch oat prior a ancwlq aputey
Signature of Applicant Date
All roof coverings to be Class "B" or better
ized bite I
wnee rad o .gcm
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