04120084BUILDINGDIVIs10N -_ PL`RA41T
1
TRUCTION
PER"up"`04120084
m
IOWNER'S NAME: PmtlNn' ISSUB uAfe
AM1k APPLE COMPUTER 7.042 HAMTT.TC)N COURT '12/'14/9 n n4
-- 1 (650)701-1500
yOp LICENSED CONIRACIOR'S DECLARATION
u I hereby affirm that 1 am Iiceneed under provisions of Chapter 9 (commencing
mm win Section 7") of Division 3 of Ne Business and Professions Code, and my license is
^<d in full forte and cff
j a Z Lieenx Cl+y i Lie. g 8 79I DZZ
Z F O Darc /l_ / / a /n V Conlnnor DUD r1N S{ti.�F�
N ARCHmICT'S DECLARATION
U 1 understood my plans shall be used es public mentos
SK
;p� Liccnmd Pmfcssional
q 5- OWNER -BUILDER DECLARATION
+�y I hereby aRrm
that 1 .m emmpl from the Contractors License law for the
i
00 following mason. (Section 7031.5, Business and Pr Atevsium Codc: Any city or county
K s � which requires a Permit to construct, eller. improve, demolish, or repair any swcture
prior In its issuance, also requires the applicant for such Permit o file a signed statement
< that he is liccmed pursuantto the provisions of the Commctios Licxnse Law (Chaper9
FFG (Cammereing win Sccuon 7BOB) of Division 3 of the Business and Profusions Curio) or
y $ that he is exempt therefrom and the Isssu for the alleged exemption. Any violation of
Section 7031.5 by art, applicant four a permit subKCta the applicant to a civil penalty of
not more than fisc hundred delta. ($500).
❑ 1,mownerk they tome, mmyemployees winwages r ncirroleeompenmtion,
will done work. end the swcture u not intended or offend faual apply
7066, Buimm
and Pm who bis Cattle: The Convamors License taw does out apply lf rt owner of
is
ownproicro who builds sirimprovesthereon.and who am not
himulredthrough his
tun employees, provided nal such improvements art not intended m oflbmd for We. if,
however. the building Wi improvement is sold within one yam of completion. the ow
Wild., will have the Wrdcn of proving reel W did not build or impmw for
of of
role.).
❑ 1, as owner of the property, am exclusively convecting with licensed contmcmm to
construct the project (Sec. 7064. Business and Professions Code:) The Convector's Li.
cerve taw does not apply to an owner of property who Wilds or improve dmmon, and
who contracts for such pmjecu with a contracmr(s) licerued pursmm to the Commerce,
LKersz taw.
❑ I am exempt
rryuunddLe�rl Sac --- B A P C far Nis,/ n
Owner �wv C -177t TJ - Dale ze L>
WORKER'S COMPENSATION DECLARATION— _-
1 hereby aRm under perWty of perjury ane of the fallowing dalentians:
Thaw and will maintain aCcnifinm of Consenuo self-imum for Warkers Compete
ration, a provided for by Section 3700 of the labor Cut. for the perfmmntce of the
work for which this permit is issued. ..-.- c
❑ 1 have and will maintain Worker' Compensation Insurance, as requited by Section
37W of the tabor Cade, for the performance of the work for which this permit is issued.
My Waimea Compnwtion lrwmme caner and Polity number art: -,
COMPENSATION INSURANCE
(This sermon Treed not W completed if the pmmil is furore hundred dollars ($301)
or Icss)
1 cmifv that in the performance of the work for which this permit is issued. I shall not
employ any person in any man �sgazt come subjcn to lM Workeri Compensation
Laws of Califor�i a Data
% Y V
Applicant , n GeG+vil�
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become subject in the Worker's Compensation previsions of the labor Code, you mut
.JZ ronhwirh comply with such pmvisionsorris permit shall by deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-+M I hereby affirm that them is a mnstsuction lending agency for the perrurmmce of
?'. the work for which this Permit is issued (Sce. W. Civ. C.)
[[) Q Lender's Namc
= z landcr's Address
V O 1 certify that I have mad this application and sum Net the aWw infOrmok n is
^F coma I agree as comply with all City and county ordinances and sum laws mlaong to
U Wilding construction, and hereby authadM rcpma4ntotiwa of this city m enter upon the
U ahove-meminncd property for impaction purposes.
(We) acme to aave, indemnify and keep harminss the City of Cupertino against
raj?
liabilities. judgments. Cosa and expenses which may in any way we= against mid City
U in cortmquence ofthe granting of this Permit.
— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
HAZARDOUS MATERIALS DISCLOSURE
Will for applicant or forum Wilding occupant store or handle h mous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Seen.. 25532(.)7
❑Ycs JIN.
kWill the applicant or future building occupant use equipment or devices which
i hal rdous air Contaminants as armed by the Bay Arca Air Quality Management
District?
❑Ycs 01N.
1 have maJ the hmaNnus mamrialsmyvimmenu under Chapmr6.95 of the Califon
nu Hwlth&Safety Cade.Sectiau 25505.23577 arW ZSSl4.l undertmd thvifnc Wilding
does oat eurend, haw a tenane oar h ei my mrponatiliry m ootify the mcuPmt of the
mvuimmchis .but p ust be mer prier or issuance of a Certificate of Occuwncv.
NO. - - CONTROL NO.' ' -'-
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
DEMO --CARPET/ MISC. WALLS
16000
Sq. Ft. Flo6rri,Area f ' Valuation
Issued by:
Re -roofs
Type of Roof
Required Inspections
Date/� a�
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection. .
ggnature of Applicant Date
All roof coverings to be Class "B" or better