04040132 CCI'Y OF cull"2'fINO
BUILDING DIVISION PI'sRMIT 'CONTRACI,OR IN "6kMATI01ia4.'
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO ITN`04040132
10101 BUBB RD
R'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 511 DIVISION STREET 4 20 2004
PxJNIi: SANITARY NO, CONTROL NO.
(408) 379-0400
ARCHITECPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
0 0 0 0
uop
LICENSED CWT RAunder
ndOR S orpDECLARATION Job Description
e u F 1 ion 7 affirm that 1 am licensed under previsions or Chapter Y(commencing P
n<u with Section T(xMp of Division 3orthe Business and Professions Cndc,and mylicense ix
j = in but force and Kee -3 -7tf TI--DOOR OPENING
Liccnsc Claa Lic.x
n�� Dam T'S DEar COLT
ARCIIITECTS DECLARATIOF�
U Iunderstand myplans shall Mused aspublic records MAY 11 2004
a
eoN Llcemed Professional
I OWNER-BUILDER DECLARATION wp�
p
S 1 hereby aIfrm that 1 am exempt From the Contractors Liccnsc Law for(be BUILDING®���
o following reason.(Section 7031.5,Business and Professions Code:Any city siL
r county sW
m which requires a permit In construct,alter,improve,demolish,or repair any structure S9000
_Z}
Prior to its issuance,also requires the applicant for such Permit to file a signed statement
a mmheisficenscdpnnuanunthepmvLmnsORheCommnur'sLiccnsclaw(Chaptcr9 Sq. Ft. Floor Arca Valuation
,H (commencing with Scclion Wally of Division 3 of Business and Professions Code)it
i that he is exempt therefrom and the basis for Bic alleged exemption.Any violmion of
Section 7031.5 by any applicant for a permit objects the applicant to a civil penally of 3 5q�ero 0 Occupancy Type
notmomdeanlivehundreddollars(s5oo). P Y YP
❑ I,as owner of the property,or my employees with wages ns their.mle compensation,
will do Ne work,and the structure is not intended Or offered for sale(Sec.7044,Business
and Proressions Code:The CoomMlori License Law COCA not apply to an Owner of Required Inspections
property who builds or improves thereon.and who Cres 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 Wild or improve for purpose of
Aide.).
❑1,as owner of Ne property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Profcamor Case:)The Contractor's Li.
eerue law does not apply to an Owner of property who Wilds Or improves Orman.and.
who contracts for such projecm with a contraaor(s)licerosd pursuant to the Contractor's
Lice m Law.
❑ I am exempt under Sec. .B k P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
1 hereby off rat under penally of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insum for Worker's Compere
amion,a provided for by Scctinn 37M)of Ne Iabnr Cndc,far the perfnrmancc Of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for the performance of the work for which this prorml is issued.
My Worker's Com pensmion Insurance eamier and Policy num her am:
Carrier:yb . F;ttt2. Policy No.: 0 3%ZZ'--t�
CERTIFICATEOFEKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This see ion need not W complemd if the Permit ea fmoric hundred dollars(SHIP)
or Icsk)
1 ecni fy that is the performance of the work for which this permit is issued.1 shall net
employ any pcomm in any mannar an as to become subject o the Workeri Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Cent ficam of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you most
.J z forthwith comply with such Provisions Or This Permit shall W deemed rivaled.
Z' CONSTRUCTION LENDING AGENCY
F" I here by affirm thm there is a constioclion lending agency l or the perfurmanec or
Q' the work for which this permit is issued(Sec.3097,Civ.C.)
!l.1QUnder a Name
a
z Under's Addrus
a
U Q 1 Certify that 1 have read thirty and County
and stoic that led above information is
ty U bandit I agmc to comply wile all city and repmy Obuives or and slam laws r up in t e
pU abbuildingvcotioned construction,and hereby or inspection
tivesof Niscity toenter upnn the
above (We)are to ertysave Tor inspcctiun keep hi )
d
(We)agree m save,indemnify and keep hay in a the Cil,of .gamins adorns(
rn bail inco RismuencOfth.grantiO. ng of thisa,apsmitcM1 may in anyway accrue against said City
U in consrqucnce of the graining of this permit.
LICANT UNDERSTANDS^'D WILL COMPLY WITH ALL ON-POINT Issued by:9 Date
O RCE REGULATION . '/n b
/yaK Re-roofs
e of Andican Comreclor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant scare or handle hamrdima mamrlul
as defined by the Cupeninn Municipal Code.Chapmr 9.12,and the Health and Safety
.c.S.Yat 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
es Vzo 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 g
emit haraAOus air contaminants As defined by the Bay Arca Air Quality Management all new materials for inspection.
DisvicB /1
C3 Yes C�`ta �r
Ihavemad the hanWimsmamrialsmquim=nuun&rChapzr6,95ofthe Califor- L' ?�J 02
oral "safcty Calc,Seedruw 25505,25533 and 25534.1 eadcesund Nal if me be lding
Jt
currently Lave a Tena t Nal it isymy respvnsm,.lit,m nmily t acupent of Ne
re
1 owhich mull 1pflVr LLI SUyoce of a"Couff roof YPNC.
v(/fl�al/•!V•/— Sr t nature of Applicant Date
' owne'mamlimi..edageni Dam All roof coverings to be Class "B" or better