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05060228 CITY OF CUPERTINO x'J v'�'6'`*r+¢�>s"da�'"^ •Syr '�'�" " "�° �'"��xx'. BUILDING DIVISION T CONTRACTOR=INR' TIbN t. BUILDING ADDRESS: DPR CONSTRUCTION INC PERMIT NO.05060228 1000 WOLFE RD OWNER'S NAME: PERMIT ISSUE DATE HEWLETT PACKARD 1450 VETERANS B 01/05/2006 NE: SANITARY NO. CONTROL NO. (650) 474-1450 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTO PO MECH Y00 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm Nat i.n Ikemcd under previsions of Chapwr 9(commencing n� with Section 700U)of Division 3of coo Business red Pofeuinns Cade.and my laanwu nfaufmceandeffen ���� PARKING LOT RENOVATION Licence Class Li..I Dare 3� ems—Contra ARCHITECT'S DECLARATION I undtmand my plans dull he used as Public records k w0 Licenced Pnoessioul 5 OWNER-BUILDER DECLARATION IleI hereby from thin I am exempt from the Contractor's License Law for the a afollowing lesson.(Section 7031.5.Business and Professions Cade:Any city or county which acquires a Permit w CmammL alter,Improve,demolish.or repair any someone $300000 :41Epoor w its Issuance.at"requires am applicant for such parrot am Ble aligned tummentValuation F G that heis licensed Pumuntat the provisions ofthe Contr.wriUccnce6w(Chapter 9 Sq.Ft. Floor Area X 1l WC Setion7000)of DlvBion3of the Susincuand Profcuim CMc)ur .- Nat he h ssempt 0wwfmm and dor e.sa for the alleged evrp0m.Any violation of Section 7031.5 by any applicants for a permit objects the applicant w a Civil penalty of yU U Occupancy Type not owe than Ran horidmd doll..(5500). I,uoww of the pmpvty,ormy uoploycal with waguuthe'v lea onmpewtion, will do the work.endme auueu eitontthmnded or offered for.le(Sm.7OµBusiness Required Inspections and Profusions Cad.'The Conhwwls License Law deal rut apply m an owner of tl P property who builds or improv thereon.an d who dao a uch work himsel f or though his own employ=.provided th.such improvements us not intended cr Offemd for sale.If. however,the building or Improvement is sold within oro yew of completion,the owner. builder will have the burden Of proving Not he did not build Or Improve for purit of tile,). [:11.ss Owner of the praperty,am eaclusively contracting with licensed Contract.to construct are pmjce(Sec.7044,Business and Professions Cade:)The Conuacwh Lt. cause Isle deal not pply w an owner of property who talks or improv demon,and who conmcu for such projects with a canuactar(.)licensed pursuant w de COnuuwM1 License Law. ❑I am uempt under See .B&P C for this amsen Drew Dam WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of an,following dedwath ns: I have and will maintain•Certlficace of Cement w self-insure for Worker's Compel. u0on,u 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 Compensation insurance,as required by Section 3700 of the Labor Cada,far Ne performance of the work for which this permit is issued. My Worker's CompeuNon Insursnce carrier and Policy number are: eareted1lmolIAl union Pae INS.Policy No.:Ws,' 1210O6vrl _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Hills saYton owed ootbewmplecd If tie .it is foram hundred dollars(SImB or leu.) I certify that in the performance of the work for which this Permit is issued,I shall not cmplay any Peron in any parents,an all in became subject as the Workeri Compewtion . Law.of California.Dam Applicant NOTICE TO APPLICANT:If.after making oi.Cenineae of ameplion.you should become subject w Ne Worker's Compensation provisions of the labor Code,you must .J O forthwith comply with such provisions or Nis permit shall W deemed rooked. zy tiCONSTRUCDON LENDING AGENCY [.r I hemby affirm that theme a construction madat agency for the performanm of 0e walk for which N0 permit H issued(Sm,3097,Civ.C.) W Q landefa Name ' z Icndeft Addis U Q I certify dor I have«ad this application and sum that the above InfmmNun Is I7.!' coma l agree w Comply with all city and county ordinates and sum laws relating to ' O building consummation,and homily authoom repreanutim of this city in coal upon the W above-menitamd property for inspection purposes. 01. (We)slime to save,indemnify and keep harmless the City of Cupertino against rats,co) IlabilWu,Judgments,calm and expenses which may In any way scenic against said City U 4 in consequence of the granting of this permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. r-' I r 5/c6 Re-roofs Signature of Applialn mon Dare ATERIA HAZARD US MLSDISCLOSURE Type of Roof Will the applicant or future Wilding Occupant store or handle haardOus mammal as Conrad by the Cupe tion Municipal Cade,Charter 9.13.and the Health and Safety Cade,SONO.25532(e)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu allo Will the applicant or forum building mmvpanr use equipment err devices which If a roof is installed without firs[obtaining an inspection,I agree to remove It ho.altors oic commormina as defined by the Bay Am.Air Quality Management all new materials for inspection. District? l ❑Yes ❑Nu 1 have lead the ha>ndnus materials requirements under Chapter 6.95 of the Cali far. nia Health&Safety Code.Sections 25505.35533 and 21534.1 undctamnd that if the building does not Currently heve a a nam,that it is in,on,vall hillly in armory the ,.pant of the mquiamcnu which must be pact prior w Issuance of a CcrOficae of Occupancy. Signature Of Applicant Date /�79�,-. t,`'/'s All roof coverings to be Class"B" or better Owner or samhorivcd agent- Dow CITY OF CUPERTINO �� BUILDING DIVISION PERMIT PERMIT NO. ADACON CORP 05060228 BUILDING ADDRESS: ' 11000 WOLFE RD PERMIT ISSUE DATE OWNER'S NAME: 2 0 0 6 HEWLETT PACKARD 2 0 4 8 A c:ORPORATE CT SANITARY NO. CONTROL NO. rre'INE: (4 0 8) 3 2:L-8 7 0 0 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH c C LICENSED CONTRACTOR'S DECLARATION Job DesRNALF1.) r V 0 I hereby affirm NS I am licensed under provisions of Chapter 9(commencing =z with Section 7oew)otDivision 3 of the Business and Professions Code,and my license is PARKING LOT RENOVATION n=a. in full force and effect. £ Lie S D v�Z License Class _ Lic.#Contractor r e.pl' 3 r Date ARCHITECTS DECLARATION "� YZ -' 1 understand my plans shall be used as public records z ,aU t1.y Licensed Professional O` OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the BUILLJ IN(;000 p Oa following reason.(Section 7031.5,Business and Professions Code:Any city or county K m W which requires a permit to construct.alter,improve,demolish,tort repair any structure Valuation u"rn prior hi its issuance,also requires the applicant for such permit to file a signed(Chapstatemter 9 S Ft.Floor Area _Z a that he is licensed pursuant to the provisions of the Contracwr's Litxnsc law(Chapter 9 zF G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ❑1,as owner of the property,or my employees with wages as their sole eomper'satinn. Required Inspections will do the work.and the structure is not intended or offered for sale(Sec.7044,Business and professions Code:The Conuazmr's License Law docs Trot apply 10 an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are 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 improve for purpose of sale.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li. cense Law does not apply to an owner of property who builds or improves themon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason ❑1 am exempt under Sec ^•miner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure 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. ❑I have and will maintain Workees Compensation Insurance,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 carrier and Policy number 4 �" Cartier. Policy No.0 P 6'3,92137_ RTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 1udiur f (This section d not be completed if the permit is for one hundred dollars(E 100) or less.) 1 certify that in the performance of the work for which this permit is issued,l shall not employ any person in 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 Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of p; the work for which this permit is issued(Sec.3097,Civ.C.) W ALender's Name Q+ Lendees Address U 0 1 certify that I have read this application and state that the above information is VL correct I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. >.a (We)agree to save,indemnity and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which hich may in any way accrue against said City Date U Z in consequence of the granting of this permit. r-� APPLICANT UNDERSTANDS AND WILL C MPLY WITH ALL NON-POINT Issued by SOU EG CATIONS 1 G l(o ©bFRe-roofsSig umotApplicant/Contrsctor Da Roof HAZARDOUS MATERIALS DISCLOSUREWill the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ^nde,Section 25532(a)? Aroos shall be inspected prior to any roofing material being installed. ❑Yes "° If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which all new materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0,Ycs ) Nu I have read the hazardous materials requirements under Chapter 6.95 of die Califor- nia Hcalth&Safety Code.Sections 25505.25533 and 25534.1 undcrstartd that if the building docs not currently have a tenant.that it is my responsibility to notify the occupant of the f. Signatur of Applicant Date rcyuire which m be or a'ssuartce of a crificatc at Occup an lb ' All roof coverings to be Class"B" or better Owner or authorized agent Date