01070064 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19111 PRUNERIDGE AVE. ADACON CORP 01070064
OWNER'S NAME: APPLICATIONS BDATE
HEWLETT PACKARD 2048 A CORPORATE CT 07/16/2001
PHONE: (408) 321-8700 SANITARY NO, CONTROL NO.
O re i ARCHU ECrIENGINEER: BUILDING PERMIT INFO
00
y- BLDG ELECT PLUMB MECH
a i
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z LICENSED CONTRACTOR'S DECLARATION Job DO$CClptlOn
Z Z_O 1 hereby affirm that 1 em licensed under provisions of Chapter 9(commencing INSTALL 5 AC UNITS & Z PDD' S .
F Iota, with Section 70001of but
3°fthe Business and Professions Code,and my license
is in lull force anJ cIF S� 2-V 9
s Liccnu Class Ci Lic.a
O Dam Contractor
da 3 u.{n ARCHITECT'S DECLARATIONa
t=O a _ta,a?�1,r,gl m Ions sn II tl as M1lic records
f o,J AK.o./
zeas,
p L¢ sed rex impid
d><oLL OWNER-BUILDER DECLARATION
at C an, I hereby affirm that 1 am exempt from the Contractor's License Low fur the
tie
ti, (Section71a : a � t tLtl :Ayey ou...1 $300000
�Sp u,.min
poo to it,issuance,also rcquircs be opphc.arm Wr i uch penis to file a signed smramesm. -
a3
that he is lic=nsed puinsuam is the Pnovidus,ofda,Committees License Law(Chapter9 Valuation
(< mom<ndSectionng with Section 70001 of Division 3 of the Business and Pepfessiona code) yl .. ttllY/tt`S s _:"1 !t-,,•
or 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
lof not more than five hundred dollar.(5500). 3 01APN 4 WJGH PLUMB IN i'" " Occupancy Type
❑Loa uwnerrrme PrrP<ray.nr my emplryees wnn wages as tnebarle drmpenaatron. 3 ROUGH
-will do the wpW.and the structure isnot intended or offered for sale(see.lou: 3 04 - ROUGH EI1�fjLT�d Ldk�JTactlOtlS ''f
'Business mid Professions Code:The Contractor's License Law docs not apply to an "
owner of ptopcny Who builds or improves thereon,and who does such work himself 501 _— FINAL ELECTRI CA_ L ENERGY_
Of through his own employees.provided that such improvemrnm ore not intended or _
':ulTered for sale.If,however.Ih<builJing or impiovemeni i;snlJ-wiNin one yeai of '
completion,the owner Wreburden ilder will have the bofptoving that he did not build or 502 - FINAL PLUMB •t :< "
improve for purpn.eoale.l. 503 - FINAL MECHANICAL ENERGY
❑Luaowner of the property,adciu:iv<iv=ontractingwitn'a .ea<°m;a<n;R to _ .... _.__.505 - FINAL- ELECTRICAL_
construct the project(see.nus,Business and Professions CWc:)The Contractor a 507 — FINAL PLUMBING '. . .
Licenselaw docs not apply to an owner of property who builds or improves thereon,
and.who contracts for such projectswith a comamorlel.Iieenud pursuant to the .- -._. _ 508 — FINAL MECHANICAL--- - - - — -- - --
- Contractor's Liccnu Law.
❑1 am exempt under sec. .B&P C forthis reason
Owne Date
WORKER'S COMPENSATION DECI,RATIDN
I hereby affirm under pe ialty.ol pe Jury one of the following declarations:
O 1 have and will air aia u'Ceniticnm'of Cdan.sea in set hinsure for Worker's I�
Cm.,amoump, an provided for by Seaton 3700 of 0e labor Coda'for the F'N ® L E
lammmaonce of the work for which this Permit is i...W. �--a
❑1 have and will maintain Worker s Compensation Insurance,as required by Section r O
370171 of the Labor Code,for the peffix—nrm
ce of the work far which this Peit Is t 7 2001
.
issued.My Worker's Compema'i„n Lwumnce dirtier and Policy number arc:•
her 4 - CERTIFICATION I aPolieY No: i i , j p +
RTIFICATION OF EKEMP'T[ON FROM WORKERS” _ apUILDING _._.' COMPENSATION INSURANCE"' '''
'rfhia scctiodnced not to eoamle,ed If Ibe Permit is for one hundred dollars
(SIM)or Icss.l '
not
certify Ih:n in IM performanceinany
ann the work for which this petit a issued;1
copondt.iminemploy any Person in any manner u as to Become subject to the Workers' '
Compuonuuon Laws of California.nate
NOTICE TO APPLICANT:IC after making this Cenificate of Exemption.
A' licant- -
Excmptirn.you should
Z becdme subject Workers Compensation,Provisionsthe Labor Carle.you must
Q Q forthwith coomplyywith such Provisions or this petit shall
be deemed evoked.
CONSTRUCTION LENDING AGENCY
hereby tiffirm that there sp con4tanciton lending agency For the perfor fiance s'
of
, Lt
e
aework for wb ch hsPetra s'sweJ fSec JPAT Civ.C1
[� Isndcr's Name .._.... . ... -ai ..t ._ r.. .- ..... - .. . . _ .. .... _-._ ..
:D Lender's AJdess t;
1 C'amfY Lha'I have read thi,application and stat that the aMve infnrmminn is
fY [...
correct.,1 agree to comply vidi all.cty and tydi d., t laws m1aii.,
Q U tobuilding construction.and hereby'authorize Mprcwmdjfth.city to upon
LG Neboe mentioned p pen 1 .pct p ton y
F, y f% 1 gree to. rode fy dk Ph Ie.th ChymfCmpprmdm.gmrwt f
%
liabilities,judgments. t d extamozi ahich may'n any y accrue against turd
m
U.Z City coneyue.u
eme tit he eng of th s..r, t.
APPI,tC-.TUNDERSTANDS'AND WILL COMPLY WITH ALL NON POINT Issued by: Dale
sous Ec Lake Ns ,
sign.tare of pplicantlContmctor Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the nl,orlon'or.mture building°ecupsat smrc°r handle hazardous prourntd Type of Roof ._ . . .-... - . .-... .
as deftncd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code%Section 25532fal".r :
,
•17 Y<a' , ONo All roofs.shall-be.inspected prior-to any.roofing material being.installed.. .
WiEthe appliicantorfuture building occupant u.seequipment ordeviceswhich If a roof is installed without first obtaining an inspection}I iigree to remove
emit hazardous air contaminants an defined by the Bay Area Air Quality Management
District, all new materials for inspection. Applicant understands and will comply with-
0 ye,
ith_❑Yea 0 N all non-point source regulations. ,
1 have Mad the hazardous mspenals requirement,unJar Chapter 6.95 of the
Cellforida Hearth&Safety Code.Sections 25505;25533 and.25534,1 mderamd'hut
if die building docs not currently have a mriml,hat it is my rema iibilityta notify the
°cfupant of the requirements which must he met prior to Issuance of,a Cenifiame of
°c "'"`y' < - Signature of Applicant- __ _- _ Date
3waernr an hn is,agent Dam All roof coverings to be Class,"B" or better
_ ... .; ...✓ ._ , - ,. _. . - OFFICE-