08010126 CITY OF CUPERTINO P�.. r ?
BUILDING DIVISION PERIVHT
BUILDINGS:ESS: PERMIT NO. _
1933 VALLCO PKWY #03-1111 WOLF SOLUTIONS 08010126
OWNER'S NAME: PERMIT ISSUE DAIS
HEWLETT PACKARD 812 ALDO AVE 01/31/2008
PHONE (408) 727-7772 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMrr INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
O=0 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Professions Code,and my license is C OMM'L T. I . ,ADD A/C TO CMPTR RM, ADD NEW 2 0 0 A
;>y in full force and effeeL - 7 v 7 D j 4 8 0V
gj z License CI Le.0
3 p Date /—S)— � Contractor 1V OLIE El eCrfrlf
ARCHITECTS DECLARATION PNL,ADD NEW CONCRT EQUIP PAD FOR A/C
f1 understand my plans shall be used as public records
5yU
e Licensed Professional -
`� n OWNER-BUILDER DECLARATION
I Hereby affirm that 1 am exempt from the Contractors License Law for the
p gO following reason.(Section 7031.5,Business and Professions Code:Any city or county
Pi which requires a permit to construct,alter.improve,demolish,or repair any structure
z Hr prior to its issuance,also requires the applicant for such permit to file a signed statement
ss that be is licensed pursuant to the provislons or the Contractors License Law(Chapter 9 Sq.Ft.Floor Area 7 Valuation
M- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2 21217
that 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 to a civil penalty of ,A� I I�r�ber Occupancy Type
not moue than five hundred dollars(S5110). 316 2 0 0 7 5
❑L as owner of the property,or my employees with wages as their sole compensation.
will do the work and the swctme is not intended or offered for sale(Sec 7044,Business - -
and Processions Code:The Cmnractoes License Law do not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such wort himself or through his
own employees-provided that such improvements am not intended or offered for sale.If, -
however.the building or Improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or impmw for purpose of
sale.).
❑L as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec 7044,Business and Processions Codm:)The Contncmes Li-
cease Law does not apply to an owner of property who builds or improves thereon,and. .
who contracts for such pmjeets with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I tin Qanpt tmder See ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of pajury one of the following declarations
❑I have and will maintain a Certificate of Consent to self-insum for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is Issued - -
❑1 have and will maintain Worker's Compensauon Imwrance,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued
My Worker's Compensation Insurance aria and Policy number are:sassier: T(Ly"- t-s- ZjtC.-Policy No.: 60 2�Ds�
)67
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars($100)
or less)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person m any manner so as to become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
O O forthwith comply with such provisions or this permit shall be deemed revoked Z-c V) CONSTRUCTION LENDING AGENCY -
F-c I hereby affirm that there is■construction lending agency for the performance of
ad the work for which this permit Is issued(Sec.3097.Civ.C.)
W 0 Lenders Name
�t z Leaders Address
.0 O I certify that I have read ibis application and state that the above information is
correct-1 agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
GL (We)agree to save,indemnify and keep harmless the City of Cupertino against
V) liabilities,Judgmcots.coats and expenses which may in any way accrue against said City
U 7 in consequence of the granting of this permiL
ram- APPLIC NDERSTANDS AND W] COMPLY WITH ALL NON-POINT Issued by: Date
SOUR LATIO
/—_�/—06 Re-roofs
Signature or Applitant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hr®rdous material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safely
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ [7N Yes o
Will the applicant or future building occupant use equipment or d evdcca which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminranu as ed by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes o
1 have read the hanrdous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building _
does not currently have a tenant,that It is my responsibility to notify the occupant of the
regm+re niehmt,s—�isstr�ce0racatirteate��ptrncyo� Signature of Applicant Date
1 All roof coverings to be Class"Bt'or better
Owner or wthorvcd agent Date -