06080178 CITY OF CUPERTINO ■}
BUILDING DIVISION PERMIT
BUILDING ADDRESS: SW RTON BUILDERS PERMIT NO.06080178
)483 PRUNERIDGE AVE
PERMIT ISSUE DATE
,vNER'S NAME:
HEWLETT PACKARD 1995 LAURELWOOD RD 10/09/2006
SANITARY NO. CONTROL NO.
PHONE:
(408) 450-7018
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z 8 with Section 7000)of Division 3 of the Business and Prof inns Code,and mytic-rase is T I INTERIOR ONLY-E LE CTR I CAL,ME CHAN I CAL
;.<Q.w in full force and effe t
, ? Licensc,Clas Li-.a
� ;WOUGHOUT. PLUMB INSTALL SINK ONLY. NONSTRUCT
f Date Contractor 1
ARCH rLECrS13
a< I understand my plans shall be used as public records
)yU
Cy Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
00 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
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement V ddi0ig 0 0 0
_� that he is licensed pursuant to the provisions of the Contracuor's License Law(Chapter 9 Sq.Ft.Floor Area
at- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or bb L1
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 3 �j 8 4 4 r 0 0 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 sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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 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
`-ease Law.
am exempt under Sec. B&P C for this reason
,vner 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 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 Worker's Compeneatian 1 surance carrier and Policy number are: L
Cartier. -aL Policy No.: C
i ki
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
(�.r►�.. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q L-endcr's Name
az Lender's Address
U C) I certify that I have read this application and state that the above information is
Lr. correct.I agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
L7~ (We)agree to save,indemnify and keep harmless the City of Cupertino against
t) liabilities,judgments,costs and expenses which may in any way accrue against said City
U z to co quence of the grantin of this permitMPLY
Date c'5,,.5_,V z
►-r APP ICA UNDER RWDS AND WITH AL N -POINT Issued by:
SOU CE EGULA NS. 10
Q
Re-roofs ---z____
signatu or pplicandContractor J Dare Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
tcrrned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
.le,Section 25532(a)7 �N. All roofs shall be inspected prior to any roofing material being installed.
❑YC3 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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes �No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hca &Safcty Cod-,Sections 25505.25 33 and 25534.1 understand that if the building
does of urrentI ha mnant that it is y responsibility to notify the occutU6
t of the
requ rats whtc usi be met rior u u of a Certificate of Occ pane Signature of Applicant Date
10 � All roof coverings to be Class"B"or better
Owner Nr authortrcd agent Datc