05010104 CITY OF CUPERTINO
Bu1Lo1Nc DrvlsloNPERMIT COO NgTR.ACT-,OR-INFOVIAT Q
BUILDING ADDRESS: SYL-MAR CONSTRUCTION PERMrrN005010104
)111 PRUNERIDGE AVE f� 42
W NER'S NAME: PERMIT ISSUE DATE
HEWLETT PACKARD 1310 TUL 2005
NE: SANITARY NO. CONTROL NO.
(408) 293-7969
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB ME(2H
0 0 0 0
joo LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapmr 9(commencing Job Description
with Section 7M))of Div isJqn 3o(thc Eusinutand Prof nasions Cadc,andmyliccnscis
nt mu mmea deffe/cq a_/L 6 DEMO 4 CHILLERS/2 TOWERS
j M Lkensc C�Y07n/y/�� � 5 Lk.N
Dam C. luxcu r
f q
—ARCHITECTSDECLARATION
2 1 understand my plans shall the used as public meet&
6
So Licensed Pm(caeinnel
7y Oat I am exempt
from
DECLARATION
20 1 Maso .(Sere that 1 I.S.eusin from the Corston Coo License c taw for the
0 0 which
rtres.Permit ,, TOTBusiness and Pmfeainu Code:Any city or county
S§2
$tri which requires a permit re vires the
alcor,impmsu h Permit t Fie a repair say tatubwm
_Zj, poor that he its Issuance.
ensedprsumat in the tbovisiosofcant for Contractors iccm,a ned aw(ahapterl
< (comma cingwJpuntion70hepmvislonsnfthcComnnessan Procesaw(Chaptcr9 Sq.Fl. Floor Area Valuation
Eq,x❑� 'hat he is xempt Section]and of Dlvi+ion 3 of the al Busieged exempt on.Any
Calc)or
e 3.- that he is exempt Ncmfmm and the buil for Ina alleged exemption.Any violadan of
Scctlon 7031.3 by any applicant for a permit ubjects me applicant to a civil penalty of 311"—cr00 Occupancy Type
not more Nen five hundred dollars(SM.
❑L u owner of the property,m is employees with wags u Heir rok Business will do the work,end the sltueunt is tors Licensor Law
do sonata(Sec.1.Ire Bulnw
and property
Profession,Cade:The Convector, rad wha Lew dace net apply ir t owner of Required Inspections
own enywho bullas ornarrows that
Herron,ve who am notI Intended
oroff mal foough his
awn employees,p ing or I pr such Improvements in not ear ore maOerW foe sdeown If,
however,the building uimprovementh sold within one Wild
orcompletion.the owner T
builder will nam the burden of proving Nu he did not Wild or improve fm purpose of C
❑1,a twat of the property,am exclusively ei uacting wilt licensed contractors to
convect the project(See.7064,Business and Professions Code:)The Convector's Li. 3
cense Law does not apply to an owner of property who Wilds or improves Neuron,and
who contracts for such projects with a convacou(s)licensed pursuant o the Contractors O
Lkense Law.
❑tun eacmpt under sec. ,B&PCfor this moon
net Data
WORKER'S COMPENSATION DECLARATION
1 hereby afprm under penalty of perjury one of the following declarations:
1 have and will maintain+Ceniftcoto of Consent to self-lnsum fm Workers Coni
1371M
an.u provlMd for by Smion 3]00 of the Labor Code,far the perfartnentt of the
ar which this permit is issued.
1 have and will maintain Worker,Compensation Insurance,a required by Sudan
of the labor Code,for the performance of the work fm which this Permit is issued.
Work`er�'pCo,mpensation sen�n}annnio, ad Policy number,m �"7/7tE 'G`N'U Policy No.:
CERTIFICATE OF EXEMPTION FROM RK S'
COMPENSATION INSURANCE
( o,sdctimt reed amoc,oreplemd if1W permit 1,(Drone hundred dallan(Stolf
or less.)
1 certify that in the performance yf the prk fo hick this permit k issued.I shall on
employanyper�in mymaoa(,p rl ld me subjecumM Workers'Compensation
L ppliu Celifeo, pa _ Lam
"/• !�'
NGTICnt CANT:
NOTICETO—�PLICAort ':r' afterCom ing Nis Centras or the
Labor iocyou ahwW
Wears anomp y the Worker',Coons or this
provisions or thc IaWr Cage,you muse
=,7. forthwith comply with such provisions or this permit(hell he deemrA rooked.
CONSTRUCTION
x 7 CONSONLENDINGAGENCY
1hereby elltrm Nnmemisaconstructionlending agency
for me Performance of
the work fur which this permit Is issued(Sec. 07,
Civ.C.)
31 0 LeMcr' Nilotic
1 Landers Address
J 0 I certify that 1 have read this city
and coup and sum mu the above information, g is
YF building lagree to comply and with ycityand county ordinances and cute levelruttinge
7 building construction,andhereby aumorisoreprtsenutive,of Ni,city to color upon rbc
4k1 +hove( e) icd agree he ertysaw fordamnify an keep hs
r gy
(We)agree to um,indemnify and kith may
in M the City of Cupertino id City �W
• f`{A
liabilities.1sorju 111,.cmu. of In* which may in+ny way accruc+g+i^st aid City
APPLunceUNDERmnANon'DStAs WILL COMPLY WITH ALL NONPOINT Issued by: Date
50 NS. `�/may
/ (/ Re-roofs
\ Si tare of AppliaHAZ r Data
NA US MATERIALS DISCLOSURE Type of Roof
Willy ftC pen du rum building Chanumrt2,an the
nd Safety a defined by the Cupertino Municipal CDM,Chapter 9.11,and the Health and S,&ty
ode,Section 15533(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu ,No
Will the applicant or future building Occupant use equipment or dcvice,which If a roof is installed without first obtaining an inspection,I agree to remove
mit Wardau,air contaminants u defined by me Bay Area Air Quality Management all new materials for inspection.
❑Yu to ryu
Ih&Sg.t mquomments Calling ,,,/_ p ,/•1 / D�
nie Hcalm&SNcty CoM,Sccdou 355115,15577 and 355Jd.lunJcrsmnd thotl(thc building
Jou Rurtcnlly haw a))ehan4 met yyis my responsibility m nnJl'y me occupant of Nc
m , aTW ren artainuknccofa Ccri am of Oc�p yO ignature ofA (cant Date
ner tar authooretl xscin / Dow All roof coverings to be Class"B"or better