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CITY OF CUPERTINO
. � E ''-
MATIO,N"
BUILDINGDIVISION PERMIT
BUILDING ADDRESS:
ADACON CORP
PERMIT NO,0 6 0 7 015 9
11000 WOLFE RD
OWNER'S NAME:
PERMrI ISSUE DATE
HEWLETT PACKARD
2048 A CORPORATE C
2006
E:
SANITARY NO, CONTROL NO.
(408)321-8700
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACIDR'S DECLARATION
Job Description
I Terrey affirm that 1 am limited under provisions of Chapter, 9 (commencing
with Suedon 701111) of Division 3 arse Business and Profcssimm Code. and my linen¢ is
in full farce and eltecLG.7SJ 7ZO
REVISION TO ORIGINAL PERMIT 05060228
omr. Class comremr Alamo �' /
REVISING EXTERIOR LIGHTING FOR PARKING LOT
ARCHITECTS DECLARATION
I understand my parts shall ha used as public mcards
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby aRno Nat I am excmpl from the Cantramah License Law far the
fallowing season. (Section 70 1.5, Business and Professions Code: Any city or county
which requires a pumit m caraaac4 after improve, demolish, or repair any structure
! prior as its issuance, also minuses Ne applicant far such permit to file a signed statement
the Contractor's L"iecom Law(Chap=9
Sq. Ft. Floor Area
Vagla't[a000
that he ulimmCd Pursuant m use pmvivaru of
(commencing with Section 7000) of Division 3 of the Business and Prafessiom Code) or
that he is exempt Rmmfmm and the basis for out alleged exemption. Any violation of
N Number
Occupancy T
p y yl�
section 7031.5 by any, applicant for a Permit subjects the appliunl to a civil Penalty of
am
amart Nan r. hundred dollars (M).
3M07044.00
Q 1, as ownm of die pmpcny, a my employee with wages u their sac ammpemadon,
Required Inspections
will do the war,. and the swcmre u ru timended oraQerad feraak (Sec. 7066, Bmhsss
and Pmfcarmus' Cock, -The Carvaemes Liceme law dues ore apply in an awnec of
property who builds or improv thereon, and who dos such work himself or through his
own emplaycu, provided that such improvements are nm lateral oroffmad for We. If.
however. the wilding or improvement amid wastes arc year or completion, the owau,
builder wiR have the border of proving that M did rm build as improve far purpose of
ak
/
1. contracting :lttmed mnussmrs
❑ 1. as ower of the property, am exclusively
Cod U.
commit the aCode:) Cmuero, Lid
not (Sec. toad, Bidets
ro a fry who prohus
cense law does not apply je an ownm of progeny wce builds or improv Norton, and
es
$
whocontractsfor such projects wiNaeontranor(s)licenseti punwntm use Canuemh
\
law.
L)
I mi
❑lam ucmpt undo Sera .BA PCfe Nu ressan
Owner D
Js
U/
WORKERS COMPENSATION DECLARATIOIO N.
hereby affirm under perW y of perjury one of se following decimations:
b1
IIEK and will maintain a L'eNrl9re of Consent b self-Inmups for War,eri Camper.
on, as Provided far by Section 37M of the labor Code, for the performance of se
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation hu mon, as required by Section
3700 of the labor Code, far thc pcdo.. of the work far which Nu permit is issued
'
m
My Warkees Cmmperomimr Insurance d liry number art:
Cartier. %ygrv/ liey /O 7cY1
-
CERfIFl MOM
O EXEMPTION FR WORICER5
COMPENSATION .N
COMPENSATION INSURANCE
'
(This ecaion head not M completed if the permit is formic hundred dollars (SIM)
Or less.)
1 certify that in the Performance of the wart for which this Permit is issed, l shad! not
employ any person in my manner an u N become subject in the Workeri Compensation
Laws of Califomia. Date
Applice,
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
became subject On lie Worker's Compeoration provisions of the Labor Code, you must
foMwith comply with such provi3 mea Or this Permit shall be dumed revoked.
j CONST,
I hereby in ac0NLENDINGngagenY
that Nert uaco lending agency for Ne parfwmance of
whalum
(Sec. 3n
' theLa work for which this; permit is issued (Sec. 7097. Civ. C.)
lattices Name
Lattices Address
'
i I terrify Nal I have read this application and state Nu 0x above information b
' Carrick I agree in comply with all city and county woes and tam laws relating m
building construction, and hemby audtome mp a vas of this city to enter upon the
1 abovementioned pmany for inspcetion pu
(We)d nify and,¢ less the City of Caparison against
j anuswh' yioanywarscmmagaimustr idOl,
of Nis a NDSAN ILL COMPLY WITH ALL NON
Issued
-POINT
by: Date
Re -roofs
Type of Roof
V
Sign arc Iicam/C or Data
OUS MATERIALS DISCLOSURE
Will ser app 11 or future ding oseupanlsmre or luMle hvardous materiat
ss dcrncd by the Cuanino Muni aI Coder. CTapter 9.12, roti the Health and Safety
Code, Simian 25532(m)7
❑Yes Nu
All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or future building uccupanl use equipment or dcvieu which
If a roof is installed without first obtaining an inspection, l agree to remove
L, haaamam] air contaminants ss.derincd by the Bay Area Air Quality Management
all new materials for inspection.
ctr
C3 Y.Na
I have sal the hvardous materials repp menu under Qu,ter6.95.f Ne Califon
riaHWNkS Cotle,Sryyom25505,d uW25534.ItutNrstand thztifthe building
Jmes oat cu IY n1. dot i y rupamibility a notify the occupant of Nc
myulrtm ni m bemelp milmmmcOf. CartinmkofOccupancy.
Signature of Applicant Date
La/vtxr�yf
a/-
All roof coverings to be Class "B" or better
0w er mr auNorisd a Data .