06040063 CITY OF CUPERTINO
BUILDING DIVISION PERMITN...I: �
BUILDING ADDRESS: RUDOLI:H & S LETTEN INC PERMIT NO.06040063
11000 WOLFE
OWNER'S NAME: PERMIT ISSUE DATE
HEWLETT PACKARD 1600 -cEAPORT LVD. STE 350 04112/2006
E: SANITARY NO. CONTROL NO.
(650) 216-3643
ABUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
i p O LICENSED CONTRACTOR'S DECLARATION Job Description
V p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z� with Section 7000)of Division 3 of the Business and Professions Code,and my license is
1=y in full force ande I DEMOLITION OF B42 COMMERCIAL SPACE
RQ 16�1
License las Lic.8
Date Contractor t
ARCHITECTS DECLARATION '
CI understand my plans shall be used as public records
�0,
t u F Licensed Professional
V2
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
a O following reason.(Section 7031.5,Business and Professions Code:Any city or county
$ which requires a permit to construct.alter,improve,demolish,or repair any structure AL $224320
Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.
uh (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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of UU Occupancy Type
not more than five hundred dollars(5500).
❑I,as owner of the property.or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered for ask(Sec.7044,Business Re<tjiref9U;;peCtiOriS
and Professions Code:The Contractors License Law dots not apply to 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 pmjett(Sec.7044.Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Dare
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
LJ 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 Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workees Compensation Insurance carrierrpnd Policy number am:
Cartier Gil bu ran}�isshi�n PolicyNo.:
ev..l p�yl
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE i
(This section need not be completed if the permit is for one hundred dollars($I00)
or less.)
I certify that in the performance of the work for which this permit is issued.I 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z— CONSTRUCTION LENDING AGENCY
H►��+ 1 hereby affirm that there is a consuuctinn lending agency for the performance of
pC the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
r7 z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
V." correct I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
�F to liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z inconsequence of the granuof this permit f_?"_'
►-+ APPLI ANDS ND Date WILL COMPLY WITH ALL NON-POINT Issued b): %_
CE ONS.
Z/- Z_0(0 Re-roofs
Si nature ntractor Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will 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
Cole,Section 25532(a)? J All roofs shall be inspected prior to any roofing material being installed.
Q Yes X211o
Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove
,mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new n laterials for inspection.
District?
❑Yes �J No
I have read the haz�{dtrus materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Codc 3505.25533 and 25534.1 understand that if the building
does not a an that it is my responsibility to notify the occupant of the
m ' menu w, must met prior a lasts of a Certificate of Occupancy. Date
Signature of Applicant
1 Z-�' All roof coverings to be Class"B"or better
Owner or authorizc3agent Dare