07100199CITY OF CUPERTINO
BUILDING DIVISION PERNUT
BUILDI G D ESS:
1N1N WOLFE RD BLDG 42 #1,2
DPR CONSTRUCTION INC
PERMIT NO.
07100199
OWNER'S NAME:
PERMIT ISSUE DATE
HEWLETT PACKARD
1450 VETERANS BLVD
04/03/2008
PHONE
SANITARY NO. CONTROL NO.
(650)474-1450
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter (commencing
with Section 70DO) of Division 3 of the Business and Professions Cc&, and my license is
COMML TI , , CARPET, CEILING TILE TBAR, ACCESSABILITY
. 111 force and err �Td Y6
License Class�ARCHrrE�E
UPGRADES TO BATHRMS
Datenttamor
DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to tbna11711M alter. improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$ 2 5 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
316 0 7 0 4 4 Number
Occupancy
P Y Type
Section 70315 by any applicant for a permit subjects the applicant to a Civil penalty of
not more than five hundred dollars (ss003.
❑ L as owner of the property, or my employees with wages as thew sole compensation,
Re sired Ins
Ll
will do the work and the stmctumisnot intended oroffered for sale (Sec.7044,Business
and Professions Code. Ilse Contractor's Lice= Law does not apply to an owner of
P ections
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.).
❑ L as owner of the property. am exclusively contracting with licensed contractors to
constmct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li -
cerise 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.
❑ I am exempt under Set: , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I 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 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 in anInsurance carrier and Policy number are:
t.an rds aL. Y 1-51
Carrier. �� .a � i Policy No.: W L S� S
CERTIFICATE OF EXEMPI7ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed lithe permit is for one hundred dollars (S 100)
or less.)
I certify that in the performance of the work for which this permit is issued 1 shall not
employ any person in any maaner so is to become subject to the Workers' Compensation
Laws of California. Dale
Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agerwy for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lenders Name
Lenders Address
I certify that I have read this application and state that the above information is
'
correct. 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorve representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless tine City of Cupertino against
liabilitles,judgmens,costs and expenses which may in anyway accrue against said City
in wnssequence oC c granting of this permit.
APPLICANT U ERST AND WILL COMPLY WiTH ALL NON -POINT
Issued by: Date
SOU
! 3
Re -roofs
Type of Roof
liantlConuaclor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
.
as tried by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, Section25532(a)?
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
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 hazardous air contaminants as do reed by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes o
1 have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health &Safety ode Seetiom 25505.25533 and 25534.1 understand that if the building
don not cur. aw a t, that It is my responsibility to notify the occupant of the
rt:qu eL prier to issuance of Certificate of Occupan .
Signature of Applicant Date
��
All roof coverings to be Class 'J�'` or better
Dater '
Own r authomed agent