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04060172 CITY OF CUPERTINO nmLmNc OrvisioN PERMIT ��COA1TYtACT INywo. ATI�N J - i,p ;fir , •�kdx u ButLO1NG ADDRESS: GOLDEN GATE SIGN CO PERMIT"°04060172 11000 WOLFE RD OWNER'S NAME: PERMIT TSSUBDATE - HEWLETT PACKARD 711 INDEPENDENT RD 06/21 /2004 qE; SANITARY NO. CONTROL NO. (510) 366-3838 ARCHITECT/ENGINEER: BUILDING PERMIT INFO M BLDO� EIFCr„ PLUMB MECH p H © v= Lp p LICENSED CONTRACIDR'S DECLARATION Job Desc'p4 I e•' il I hereby aRrm dostdost1 un licensed under provisions of Chapter 9(commencing <_5 with Secd �)of Dhoaftt3 Bsiessr um had He imm�foR' efLa. onmla SIGN--HEWLETT PACKRD tLicenseCi AZ 3/ 2'U1 99 DauComncur 3 J l ARCHITECTS DEC ATI N en 'y9 lundundmyp4na mall be utedupuM1 CRcnrds i LLud"" Licensed Pmfcesiond OWNER-BUIIDER DECLARATION f 1 hereby affirm that I am exempt from the Comnctofs Licenw law for the 0 o following Raton.(Section 7131.5,Budneu and Professions Code:Any city or county $ixi which requires a Permit to construct slue hopmve.demolish.m repair soy structure 820500 i„ZL^ prior to to issuance,a4u mqW.the applicant f(fsuch permit to file a signed untruml —Q that he is licensed pursuant m On Provisions of the Conuatur's Liccmc Law(Chapter 9 Sq.Ft.Floor Area Valuation 0P5( e3 Icommencin{with Section 7000)of Division 3 of the Business and Pmfesiom Code)m R .. that ha 4 asempt therefrom and the lassie for the alleged exempdon.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of arn Occupancy Type sol more than five hundred dollars(5500). ❑Luownerofde propertyar is otimeyceswithcagesr00(m.comperwness will deduwork Code: The 1 License Law ed does apply W an romerof Required Inspections and enywh obu Cade:The ConumrorY red who law rine Inst apply b rt rouse is q P propertywho builds viire that whodatastint work himselfarllwuah his awn employees,,thiprovided that such improwmantsarc n tended nraRerM fm sale r. bode''the building or Mprovemant is mid within ore oar of epteve fee thepa ower• bulkier will have W burden of proving that he did not build or(reprove for puryase of ❑1,m awoer of the property am ascludvely contracting with licensed mnoacbn In cumlmet the project(Sec.7044,Business and Profusions Code)The Conuamots U• come Law does out apply in an owner of property who builds or improves thereon,and, who cornets for such projects with•conuacter(1)licensed pursuant w the Comrmufa LkenR law. ' ❑1 mn exempt undo Sec. .B&P C(m this Ramo Owner Dau WORKERS COMPENSATION DECLARATION 1 hereby eRirm under penalty of peQury am of the following declarations: ' haw and will maintain aCertifiuu of Consent oself-insum fm WoM1t(s Compen. salon,as provided for by section 3700 of the labor Code,for de Performance of the work for which this permit is issued. ❑1 haw and will maintain Worke(s Compensation luminance.ex required by Schon 3700oftho IaIxerCode,for the performa e.ofthe wort for which this permit is issued. My WarkeYa Co otos In u e ca and Polley nu Cera . Cs PaBeYNi 77-9Ge000 , CERTIFlCATE OF E%EMPfION fBOnI WORKERS'0(e COMPENSATIONINSUKANCE (Thissecden need not hecomplesed if the Permit Isforme hundred dollen(5101) or leu.) I certify that In the performance of On work for which this permit 4 mesiad,l mail not employ any perms in any mann,r so as in become subject in On Worker'Compensation Laws of California.Dau Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you shouW become subject u de Worker's Compensation provlaors of the labor Code,you mus .7. Z foMwith comply with such provisions or this permit Oill be deemed revoked. zO CONSTRUCTION LENDING AGENCY [—i (hereby M.than then is a consmction lending agency for the performance of Ori> one work fur which this permit 4lssued(See.3097,Civ.C.) Q Lender's Nurse . z Lenders Address, O Q I certify Nn I have read this application and Ne that the above information is U, correct-I qRa in empty with all city and county uNi sseces and auto lawn nesting an Q building construction,and beroby authorize representatives of this city to enter upon do W above.mcnO now pmpeny for inspection Purposes. (We)agrt to caw,indemnify and keep harmless the City of CupCniw egdml (,j liabilities,judgments,costs and expenses which may In my way actor,against said City in U�+ APPL CANMCUN ERSTANDS ANof ft grand.j of this D WILL bMPLY WI L NON-POINT Issued by: e . SOU CE ULATI NS. % rr F� a,/� �/ +� Y Re-roofs Ignuurc of ApplicanlDateHAZARAZAR HAZARDOUS S MATERIALS DISCLOSURE Type of Roof WIII thea Cupertino or future building occupant more or handle huaNm omaterial u defined by 0u Cupertino Municipal Code,Chapter 9.11.and tits Hula and Safety Cade.Section 25531(&). r�� All roofs shall be inspected prior to any roofing material being In/edove❑Yu YNoWill the applicant or f//utwm building aceupem um equipment or devieet whichIf a roof is installed without first obtaining an inspection,Iagree t heverdous air contaminants u defined by to Bay Ana Air Quality Mamgcment all new materials for inspection. nuict7 ❑Yen No I have mad the he rdous m udalsmquimmenu under Chapmr6.95 of the Califon zeta Hcahh&SafetyCuJk%Sudom135115,25537 d25534.Iundcnurdthuifue huikling dots rust udy how a unset.that114 my mihilhy m notify oeeupem of the Rqun watch be met Prim 'w earajjeriii an Signature of Applicant Date owner sir amhorimd eget Gf" Y Dow All roof coverings to be Class"B"or better