04120046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT .CONTRACTOR INFORMATIO.,N
BUILDING ADDRESS: NOVO CONSTRUCTION PERMIT Ncb 4120046
OWNER'S NAME: PERMIT ISSUE DATE
AM APPLE COMPUTER
NE: SANITARY NO. CONTROL NO.
650 701-1500
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ti O O R'S DECLARATION
cmby,affirm Net 1 am lice ed n rovisiuns of Chopmr Y(commencing Job Description
WIS Socuiliali Sof MmB nests Prufcuiom Cade,andmyliccnu is
in 5qi emx
TI-MODIFICATION /MECH/ELECT/LIT. /DOORS/
�t: xagr FRAMS/HDWR/WALLS/CEILIGS
AR CTS DEC`. v�
yyY nmmiandm SM.11buuscdaspublichi TEMP. PERMIT #05010015 (EXPIR. 02/03/05)
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Licensed feasional
OWNER-BUILDER DECLARATION
Y mby Affirm that I am exempt(rum the Contractor's License Law for the
❑O following mason.(Section 7131.5,Business and Professions Code:Any city or county
which requires a permit to ConswcL alter,improve,demolish.or repair Any deuton
poor In its issuance.also requires the applicant for such permit to file reigned statement
<
dust hculicensed pursuant oftprovision or McCamracmriLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
Is--$ (commencing with Section 7HB)of Division 3 of the Business and Profusions Chile)or
— Met he is exempt therefrom and the basis for the Voicd exemption.Any violation of 1617 2 3 2
Section 103 L5 by any applicant for a permit subjects Me applianuo a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). P Y YP
❑I.asowner of Mx proprny,or my employers with wguas recti sole eompewdon,
will do Me wok and Me awnum is not intended.raRered for sale sec.7044,Businessand Profusions Code:The Comment's Limuue Law does not appy to in owner of Required Inspections
pmpeny who builds or improves mercer,and who doe such.,it himselfrorthrough his
own employees.provided Mat such impmvemencs An,not Intended proffered for sale.If.
h.Im,.Me building or improvement is to within one year of wmplation,the ower
builder will have Me buNen of proving that las did not build or impmvc for prurience of
Ask L
D I.as owner of the property,am exclusively contracting with licensed contractors to
comuuct me pmjecs(Sea 161,,Business and Professions Cade:)M Coommun's Li. '
terve law dors not entity 0 an owner of property who builds or improv Merton.and
who contracts for such projects with aeumrumgs)licensed pursuant in the Consumes ��
License Law.
I am exempt under Sec. .B h P C for this mason a�
AIA
Owner Date
WORKER'S COMPENSATION DECLARATION - ®
I hereby Nem under penalty of perjury one or me following declarations: A�dA�
iAAI have and w" ems crus .ns enuusell-insumfor Woftes Compere 'I)H
ion, video(orrtAy�' Bo Mc bon Cade.for the performance of Me Data (�lr
r which this is'.
1 he and w' odejon Worker's Com ton okfor hi as required by Section �Fl sq
l of V rCode,for Meperf.nne c Me wary for which this permit is issued. CCC 4�p ?yy al\pVep�
My .eke mpensation lns,mn cr and Policy number are: YH®
Polity No.:
CE TE OF EXEMPTION FROM WORKERS'
CO INSURANCE
s soman need not he completed if[be permit Is foronc hundred dollars($100)
o est)
I ecru in to performance of thc work for which this permit is issued,l shall not
employ any pcisen In any mannerso as or become subject to me Workers Compensallon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making mu Certificate of Exemption,you Mould
become subject in Mc Worker's Compensation provisions or the labor Cock.you most
.,O foMM complype
wiwilb such Nuivisimu or Mia rmitsMll W deemed revoked.
z"' CONSTRUCTION LENDINOAGENCY
Ds Ihcmb affirm that Marc is a construction kinin to Mc forreance of
Y y.) per
C' Le work fur which this permit is issued(Sec.3091,Civ.C.)
!1)0 tender's Name
D. lender's Adores
az
V 0 1 certify that 1 hawply read this application and stain Mat and
about information is
F Wildin 1 once m comply with all city and county anlinaoof and stare laws r upon
e
V builtling conswnio rtprtsentauv.f this city an color upon me
above-mc property for inspection p s
PaSAPPCA
gree m save,indcmnIf +rad cp b of Cupertino against
IF—t Vygmenta,csts end experscswh ayu.nywyac cagainstuid Ciy
me seq
U eUNDERSTANDS ArND LL COMPLY W ALL NON-POINT Issued by: Date
GULATIONS.
Re-roofs
Si
Pines
MATERIALS OSURE Dak Type of Roof
Will applicant or future building uccupanusorc die hirardous material
"a definW by Cupertino Municipal Code.Chapter 9.12,and Health and Safety
code.Section 55321a)? All roofs s ed prior to an roofing material beim
❑Yea ❑N. p Y g g installed.
roof is installed with n inspection,I agree to remove
W" me applicant at forum building oceupam tau equipment or devices whit P g
mous air conteminants As dcfincd by me But Area Air Quality Manage no I new materials Inspe c ion.
Distrin?
❑Yes
I aJ Mchm rmsm rialsocrommcnuundcrC ¢16.95.(Mc Calif
iia Hes afcyc Sectiones 503.25533.d25534.1 matifthe ing ,(�
J.on, my have mmnc.Mat it u my reI,. y m,oily the oceup t or the
64
myuirem i mch mus ct ormissu a cenifluN or Occur., nt Date
Owner or Ault -- Dare All roof coverings to be Class "B" orb tier