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BUILDING DIVISION PERMITkTCT7��T
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PERMIT NO.
PRUNERIDGE AVE
TBD TO BE DETERMINED
08040049
OWNER'S NAME:
PERMIT ISSUE DATE
HEWLETT PACKARD CO
05/22/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGiNEER-
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Chapter
Job Description
I hereby affirm that I am licensed under provisions of 9 (commencing
with Section 7000) of Division 3 of the Business and Profession; Code, and my license is
T . I . - ADD UPS EQU I PMNT & PDU
in full force and effect
License Qua Lie. 9
.
Date ConlroctW
ARCHITECTS DECLARATION
i undems d my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following rnwrL (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve. demolish, or repair any struclum
prior to its issuance, also requires the applicant for such permit to file a signed siatemcnt
he is licensed to the of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant pn*sions
2 0 0 0 0 0
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Occupancy Type
P Y YP
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
31607043 A41 Number
not mare than five hundred dollars (shoo).
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Conuactoe3 License Law does not apply to an owner of
-
property who builds or improves thereon, and who does such work himself or through his
ma 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
sak.).
❑ L as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec- 7044. Business and Professions Code:) The Contractors LI-
erase law does not apply to an owner of property who builds or improves thereon, Ind,
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
-
Lice use Law.
❑ I am exempt under Sec , B & PC for this reason
Owner Date
/
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WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Wodcds Compeer-
,
1
station, as provided for by Section 3700 of the Labor Code, for the performance of the
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wort: for which this permit is issued.
❑ 1 have and will maintain Worker's Compensadon 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 are:
Carrier Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
elms section need not be completed if the permit is for one hundred dollars ($I00)
or less.)
1 certify that in the performance of the work for which this permit is issued, t 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 Ceniftatc of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you mum
forthwith comply with such provisions or this permit shall be deemed revoked.
CONYMUCnON LENDING AGENCY
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)
Lentices Name
Lender's Address
I certify that 1 have read this application and stale that the above information is
correct. I agree to comply with all city and county ordinances and state Imes relating to
building concoction, and hereby authorise representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expense which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WM ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of Appliant/Conuacwr Date
HAZARDOUS MATERIALS DISCLOSURE
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
ends, scales 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
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
emit hnrardous air contaminants as defined by the Bay Area Air Quality Managanent
all new materials for inspection.
District?
❑Yes ❑Nu
1 have read the hvardous materials requirements under Chapter 6.95 of the Cahfor-
nia Health & Safety Cade, Sections 25505, 25533 and 25534.1 understand that if the building
does not currency have a levant- that it is my responsibility to notify the occupant or the
requirements which must be met prior to issuance of aCertificate oroccupmcy.
Signature of Applicant Date
,...___ _. _ — ____. I_._
All roof coverings to be Class'A" or better