06100070 CITY OF CUPERTINO ('t ARMT
BUILDING DIVISION 0PERMIT
BUILDING ADDRESS:
PERMIT NO.
10951 TANTAU AVE SWINER'I
OWNER'S NAME:
PERMIT ISSUE DATE
HEWLETT PACKARD CO 1995 LFURELWOOD RD 01/04/2007
.NE: SANITARY NO. CONTROL NO.
(408) 4E:)-7013
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0
O p LICENSED CONTRACTOR'S DECLARATION Job Description
e V r_ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Sze withScction7o00)ofDivision3ofthe Business and Professions Code,and mylicense is TI COMP.ERCIAL OFFICE SPACE— MIDLEVEL 2ND FL.
=,O,, in full force and effec
z License C7 Lie,x 2 EMP IMIROVMENTS. RECONFIGURING EXISTING OFFICE
iz Contractor W%
rr Datc ARCHITECTS DECLA TIONSPC
m U I understand my plans shall be used as public records ��
A.
ZG y Licensed Professional
n W', OWNER-BUILDER DECLARATION
x I hereby affirm that 1 am exempt from the Contractor's License Law for the
r C Oe� following reason.(Section 703 1.5,Business and Professions Code:Any city or county
e fi which requires a permit to construct,alter,improve,demolish,or repair any structure
y Z r prior to its issuance,also requires the applicant for such permit to file a signed statement
F=c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area O Valuation
t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4
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 or 316 0 7 0 9 3 .�$N Number Occupancy Type
not more than Five hundred dollars($500).
❑1,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 sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law dors 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 project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs 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 Sea B&P C for this mason
OwnerDate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Conscnt 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 Workces Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workeescompensatilon Insurance carrier and Policy number are: p
Cartier �� Policy No.:wL A ` & 1 ` d
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Chis section need not be completed if the permit is forone 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 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
,J,Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
tx> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
az Lender's Address
U Q I certify that I have read this application and state that the above information is
w►-� cored.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.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
LL
tHt liabilities,judgments,costs and expenses which may in any way accrue against said City q
V rZ-t s permit.
APP CA STANDS ANDanting of WILL COMPLY WITH ALL NON-POINT Issued,by: Date
SOU U ONS.
Re-roof: ..
Si u Applicant/Conlractor 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
Code.Section 25532(a)?
[I Yes KN. All roof;shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is 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.naterials for inspection.
District?
❑Yes Wo
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
rewhit be
quiremcns mel prior to issuance of a Certificate of Oce onc. Signatur,of Applicant Date
Owner o' agent �� ,m v All roof coverings to be Class"B"or better