04030212CITY OF CUPERTINO
CONTRACTOR INFORMATION.,
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO04030212 4030212
106
R'S NAME:
PERMIT ISSUE DATE
APPLE COMPUTER
ONE:
SANITARY NO. CONTROL NO.
ARCHMMENGINEER:
BUILDING PERMIT INFO
BLOC ELECT' PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nes 1 am licensed under preaiaians of Chapmr 9 (commencing
P
wiOSu' 7 )or Divy �'on 3ofthc Bu' and ofessionsceek.andmyliceveu
License CR c x
Dam cry r -41CONTRACTOR:
REPLACE 2 MECH UNIC A/C EXH. FANS/NEW SYSTEM
r' r
FLUID INDUSTRIAL SYSTEMS
AR TI:CTS D A ON ��ee -r-
1 understand my plans dull be used u public records `' SSlem S \ rj
Licensed Professional
OWNER -BUILDER DECLARATION
I hemhy affirm Nal 1 am exempt from an Contrsrors License Law for the
following maser. (Section 7031.5, Business and Pmfmaiom Cody: Any city or county
which require a Permit to cnnWugL sire. Improve, demolish. or repair any nmcsure
,
prior w its issuance, also require the applicant for such Permit to rile a signed statement
that he is Eocnsed pursuant to the provisions of the Contmnor's License Law (Chapter 9
Sq. Ft. Floor Area Valu$Lipp*000
(mounctse ng with Section 7") of Division J of the Business and Professions Code) or
than he is esmpt Om efrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects on, applicant m a civil penalty of
APN Number
Occupancy Type
Y YP
not mom Nan rm hundred dollars ISMP
32610047. 00
❑I,asowmer of Ne ptopusY. ar mY emPloyw with wegeiudeGmle compcnvtion.
will do Nework and Necuucwm u not imm.ded.,offered r.,W. (Sec.7044, Business
Required Inspections
and Pmfeasions Calc: The Commetura Licence taw doe not apply to an owner of
p ropeny who builds or ire prove thereon, and who dauuch work himsl f rr Nmugh hu
own employee. Provided that such improvements am not intended uoRemd fussle. If.
builder Neaveteorimprovementis coldwithinone yeti of completion, the rwv^
builder will have the burden of proving Nat he did not build or improve for purpose of
sale.).
1, as manor of the property, am exclusively contracting with licensed contractors to
construct use project (Sec. 7(64, Business and Professions Code:) The Contractu'a Li.
cove taw dux not apply to owner of property who or improves Nerern, and.
/
es sed p
for such pmjccu wiNaconvacwrt¢)liunsd pursvmw the ContracwYs
whocse
License law.
Law.
❑Tem exempt under See .B&PC far Nia recon
cr Dam
WORKER'S COMPENSATION DECLARATION
1 hertby afrum under penalty.! perjury.. of the following declarations:
1 have end will maintain a Cenifmme of Consent to elf -insure for Wvkers Compcm
seri.., ss provided for by Secuu. 77M of the labor Code, for Ne performance of the
vrork for which this permit u issued.
❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section
]700 of dm labm Code, for the performance of Ne work for which this permit u issued.
My Workei Cyr 11 tion lnsuranA -curio ka�nd PU Nliey numbergo art: � I I
CERTIFICATEp EXEMPTION FROIOAWORKER
COMP NSATION INSURAKE
from smash need Manecomplesed Vote permit is foronc hundred dollars ($100)
tar less.)
I unify Nal in the perfumavo of Ne work for which Nis permit is issued, l still nor
employ any person in any manner an a to become subject o the Workeri Compevau^n
U., of California. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Ccniricate of Exemption, you should
become subject w the Worker's Compensation previsions of she Iabnr Cade, you must
foMwirh comply with such pmvisums or this permit shall be deemed revsked.
CONSTRUCTION LENDING AGENCY
I bor by affirm Nn Nem ismsed(Sm.construction agency for tic perfurmenec of
'
wh,, 097. Cing
the work far which Nu permit u used (Sec. ]097. Civ. C.)
Name
Under's
Lender's Address
I certify that 1 have read this application and sum that tim above informed. is
cmrccL I agree w comply with all city and county ordinances and sum laws relating in
building construction. and hereby authome repmscroul ea of this city to enter upon the
lMve.menudgm pmpeny farinspection purposes
(We) agree m save. indemnify mW keep bummas the City of Cupertino against
grantandofthis cwhich may in any way accrue aguinn sd0 City
in f the
APPLICANT of the granting of this Per mit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATI NS.
Re -roofs
�/ D
(
JIM. Appli uContractor ate
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
ill Ne applicant or future Wilding occupantatom or handle aerdousmaumai
defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
. Sectlon255J2(n)?
❑y x PC.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant us
PP C P equipment which
If a roof is installed without first obtainingan inspection, I agree to remove
P
it h.CMm. it conumimnss as dcrined by the Bay Area Air Quality Management
all new materials for inspection.
P
oisuim7
Yes
1 have mad Ne hatemlous materials requirements under Chapter 6.95 of Oc Cabins,
nia Health & Safety Code, Secure 25505,25533 and 25534.1 understand Nu if the building
docs not currently have a mount, Nat it IS my responsibility w notify the vcupam of the
"4115FIN.whichmupbemctpdorwusuanccrf 'ficamofOCcup
Signature of Applicant Date
O"
All roof coverings to be Class "B" or better
o mror lhodecda .t