BLD-2019-1582BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 1 APPLE PARK WAY Cupertino
APN: 316 07 049
PERMIT NO: BLD-2019-1582
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 12/17/2019 10:15:47 AM
ISSUED BY: KDUNBAR
VALUATION: $50000
JOB DESCRIPTION
FOH - B-2019-0627 AND PLATFORM COVER - B-2018-2007 AND SPEAKER TOWERS - B-2019-0128.
OUTER LAWN TEMPORARY STRUCTURES:
OWNER -BUILDER DECLARATION
one of the following two
my employees with wages
exclusively contracting with
one of the following two
of consent to self -insure
Compensation Insurance,
of the work for which this
after making this certificate
permit shall be deemed revoked.
declarations:
as their role compensation, will do the work, and the structure
licensed contractors to construct the project (Sec. 7044,
is not intended or offered for sale (Sec. 7044. Business
I hereby
affirm under penatly of perjury
I, as owner of the property, or
Code).
& Professions
Business & Professions Code).
I, as owner of the property, am
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California. If,
with such provisions or this
V
I hereby
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
9.12 and the Health
Chapter 6.95 of the California Health & Safety Code, Sections 25505. 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
for this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and
representatives
liabilities,
comply
.