08040121CITY OF CUPERTINO
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BUILDING DIVISION PERMT
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IL IN A FSS:
�09� TANTAU AVE'BLDG 45
DPR CONSTRUCTION INC
PERMITNO.
08040121
NEWS NAME:
iiONE:
PERMIT ISSUE DAISHEWLETT
PACKARD (TRAINING RM)
1450 VETERANS BLVD
04/16/2008
SANITARY NO. CONTROL NO.
(650)474-1450
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDGD Ply
LICENSED CONTRACTOR'S DECLARATION
JOT) Description
hcteby affirm Nal I am Iimmd under preivisiam of Chapter 9 (commencing
with Sachin 7")ofDivision 3 of On Business and Professions Code, and my license is
EXPND EXSTNG CONF RM NTO ADJCNT AREA APX 180SQ
in full (arca and effect. JJ. s.'�G�g(„
License Cities Lic.B
.
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Contras,. _ _ _ / It.—L.
ARCHITECT'S DECLARATION
-
1 taxima and my plans shall he used as public records
Licensed Pmf xasm.&l
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from No Consomme, License Law for the
following reason. (Secuun 7031.5, Business Fred Profession, Code: Any city or county
which requires a permit to enrmmeL alma Improve, demnikh, OF repair any smactum
prior no its issuance, eke mr des the applicant for such permit, fie&signed statement
me Contractors Liccve Law 9
Sq. Ft. Floor Area
,
Valuation
Nu hekrsu (Chapter
mmlicensnd puant, be pmvieiooe of
(eoem ing with Section 70DO) of Division 3 or the Business u, Prolamines Cade) or
$114 5 9 8
Oat he is exempt daoefmm Fast the bask fo the Winged exuarreption. Any violation of
3 16 0 7 0 4 4:5'7' Number
Occupancy Type
Sccon 7001.5 by any applicant for a permit subjects the applicant to M civil Penalty of
wt mom dun five hundred dollars (5500).
❑ l.uawurof Napmpmty,amyemploymwlmwagesuthehsekcwpensadon,
Required Inspections
will dote work, and daeshucture is not„nded or offered fansie (Sec. 7114,1, Business
and Professions Cade: The Coneu,rs License Law dm not apply , an owner of
pmpeny who Wildsorimpm dth n, and whadoessuchwhichimulfieduough his
ownemploym, provided Nat such improvements art notin,nded mallard for ask If.
however, the building or Wprevemanl is said within one year of comPleon, the mvner-
builder will have dm burden of proving that he did mal build or improve for porpou of
❑ I, an owner of this, property, am exclusively contracting with licensed canuac,n to.
cmutmct the project (Sec. 70/4, Business and Pmfcssiam Code:) The, Conhacw's Li-
muse law docs not apply , an owner Of pluyeny who Wilds or improves ft.. sed,
who contracts for such pmjecu with a Ca arses r(s) licensed puranam he use Contrac,r'a
License law.
❑ I am exempt under See . B & P C for Wa mason
me Data
,
WORKER'S COMPENSATION DECLARATION
10
I Wrehy M. under pemlty of prudery ane of Ik following declaratiau:
❑ I tum atld will mainuin a Certificate o(Conunuo self-imam for Wahers Compere
nation. an pn idW far by Section 3700 Of the Labor Code, for the performance of the
Make for which this permit is imard.
❑ 1 have and will maintain Workers Compemteio t ImMMm, as required by Section
37M of the Tatar Code, far the peR^rma^u of the wok for which this Permit is loud.
My Workers Compenaetion Insurance carrier and Policy number see:
Carrier:I.IGFTItNJiiL Lia-7101.IPoI1ry No.:�J�i�I'i'$Bzi
k� CERTIFlCA7E OF MEMMON FROM WORKERS'
1 1 j*J>. COMPENSATION INSURANCE
oldsu mseedmotoeompkmdifthepermitisfoanehundred Hm(5100)
nr teas)
I comfy dot In the part... of the work far which this permit k issued, I shall not
employ any icon^ in Fay manner, u, became subject, the Workeu'C^mperamo^
Laws of California. Dam
Applicant
NOTICE TO APPLICANT. If. after making this CeeiRCate of Exemption, you should
become subject , the Workers COmRrismon previsions of the Labor Cade• you mute
' forthwith comply with such provisions in this Permit shall be deemed avarice.
CONSfRUCcIONLENDING AGENCY
1 herebyifnm dust them is leading agency for date performanca of
' Newark far which this permit is issued (Sec. Jo97, Clv. C.)
issued
Llndera Name
Lenders Address
1 minify that I have read this spplicadon tied sum date Ne Move infmmadan Is
' correct. I agree , comply with all city and county oMnatwes and sum law miming to
building convection, and Inmby aodaoiu representatives of this city to mutrupnn dac
Move-mentioned property for indication putpuus.
(We) agree to nave, indemnify and keep harmless date City of Cupertino against
j a. judgments. eau Fred expenses which may in any way accrete against said City
in consegmue of the germing of this Permit.
a APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOU CE
Re-roofs
Type of Roof
Lu 1"0
Signature of Applia^dC^mrxmr Do,
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Or future building occupants,, or handle haardaus material
de0ned by date Cupertino Municipal Code. Chapter 9.1; and the Health and Safety
Section 25532(a)7 ��.f�
All roofs shall be inspected prior to any roofing material being installed.
0y.f
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building accapatd use equipment ser devim which
emit harardnus air conWnim^u u defined by the Bay Area Air DOWRY Management
all new materials for inspection. ,
DiaWeO
0Yes $,Nu
materials
1 have mad the huant us requirements under Chepmrd.95oftheCalifor-
me Hilda &SWC ycodc, Scctians 25505.25533 am125534.1 undcmand"it date Wilding
Ot cumendy oma W'sent. dW it k my rCapomiNlily , notify dm =CupWt of the
quim new uame...isCemficateOf anon”'
Signature of Applicant Date
(t (foD9
All roof coverings to be Class'R" or better
D„
ower authaant