05010015- CITY OF CUPERTINO
BUILmNC DIVISION -PERMIT CONTRACTORAINFORMATION
BUILDING ADDRESS: NOVO CONSTRUCTION PERMIT N005010015
10431 N DE ANZA BLVD
OWNER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 1042 HAMILTON _
E:
SANITARY NO. CONTROL NO.
(650) 701-1500
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG0 ELECT PLUMB MECH
u 00 LICENSED CONTRACTOR'S DECLARATION -
iw F affirm Nat l am IieuCO under provsvons fcwpler Y(commencing - Job Description
-n with Sectam 1 IDivi ion Softhe Bminevaand Profc ns Code,add my license is
inmum defreec <71OZ2 30 DAYS TEMP PERMIT . (EXPIR. - 02/03/05) - -
4 p Liccnm lata Lic.p
Pio Dam comlracwr ORIG. #04120046 - --
" ARCHITECTS DECLARAT19N, -
'� '. I onp fund my plans Shall he used as While mcmds
'6U
3 ; Licensed Professimul -
OWNER-BUILDER DECLARATION _
I hereby affirm Nal 1 am exempt from be Contractors License Law for the -
00
following reason.(Section 7 31.5,Business and Pmfessiom Code:Any city or county
Permit
x m which.rxeires•peit to cnmuuct,after,improve.demoods.m repair any structure -
' y"n prior to its issuane.aIt.requires the applicant for such Permit to 01c a signed statement
that heis licensed pursuant to the Previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation$45
pmyts-•$ (commencing with Section 7100)of Division 3 of the Broadcast and Professions Cnde)or -
ENE_ that he is exempt Warrant and the basis fm the alleged cremption.Any violation of
Section 7031.5 by any apFlicant fan permit subjects the applicant to a civil penalty of - - APN Number Occupancy Type --
not more minfivehundred delta.("(0). - 32633114 . 00 -
❑1,re owner of Ibe property,as in,employees with wages u their sole compensation,
will der the work and ra mraure is not intended or infrared to,We(Sme.7041 Bmirmw Required Inspections .
and Professors Cade:The Contractor's License Law docs not apply w e an owner of - - - q p - --^-- - - -
-
proleertyfvhobuildsorimpravesthereon,and who doessuch work himulfor through his _ -
employeas,provided that such improwmencs arenotieadeal m ilifeed fm sate.If.
however.We Wilding or improvement is sold within one ymir of completion,me owner- -
builder will have dm thrden of prying that he did not build or improve for Furnace or ..
sale.).
ci I,m owner of dm property,am exclusively,contracting with liecmcd contractors to
,ximi he pmjee(Sec.7W4,Business and Professions Cade:)The Contractor's Li-
w
me law does not apply to an owner of property who builds or improves thereon,and
e contracts for such projects with a controads)licensed pursuant m the Contractors .. _..
fai
as
under Sec. ,B A,P C for this lesson
Owner Data
WORKER'SCOMPENSATIONDECLARATION
1 hereby alarm under penalty of perjury one of Ne following declarations: \\s VV
I have and will maintain a CeniGnm of Consent m self-inure fm Waseca Camped- ._. _ -- -
sation,as provided for by Section 3700 of the Ichor Cade,fm the performance of be
work for which this permit is issued. -
❑1 have and will maintain Worker's Compensation Imuran¢,as required by Section -
37Wofthe Labor Code.for Ne performanec of the work for which this Permit is issued. .. -
y Worke egsalom Tnaarane carrier and Poli be are: .,
Carrier III ( -Polio
ERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hceomplcmd if the Merril is for one hundred dollars(SIM) -
orcsst
1 unify that in the performance of the work for which this Permit is issued.1 shall not -
employ any Person mnany mannersomtobecome subject loin,Workers'Compensation
Laws of Cafluraia.Date --
Applicant
NOTICE TO APPLICANT:IL after making Nis Cedifcate of Exemption,you should -' -
become suhject to the Worker's Compensation provisions M the Labor Code you must
.JO forthwith comply with such provisions or this Permit shall be deemed revoked.
Z N CONSTRUCTION LENDING AGENCY -
[-. I herchy affirm that there is a constrains lending agency Its the perfurroarm of
(Ymthe work For which this permit is issued(Sce.3097.Civ.C.) ,
W Q Lenders Namea.
M
Z Lender's Address
U O I cmify mal I base read this application Sad stem that the above inform tiud is
Li, f^ corett 1 agree to comply with all city and county odlinan es and state laws relating to
p U Wilding constrnion,and hereby ambome representatives of this city to enter upon the
W ahovorentioned property for impaction purposes.
f+G (We)agree to save,indemnify and keep humless the City of Cupertino regainer /
N Iian,biliuridgeram,costa and expcmcma
s which y in any way mere aPudol said City J
U in consequence afore granting of this Permit. /
761"ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
... SOU E A(SbbSV I IN I�I
'� D Re-roofs
HAZARDOUS
D
Signature of Applicaam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thin a Cupar or furore building occupant stare are handle Health a material
u defined by the Cupertino Municipal Code.Chapter 9.12.and me Health and Safety
Code.Section 25533(x)? ErN. All roofs shall be inspected prior to any roofing material being installed.
❑TCS
Will the,applicant to building occupant us,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Pp s pan aAirmcn
. it hmardnos air contaminants u defined by me Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes �No
T have raJ the hvardnux mamrialsrcquimmcnu under Cbapmrd.YS of the Califory
nia Health s Safety Code,SCcuom 25X15.35533 and 35534.1 undersmnd that ifthe building
J 0y haves tenant mm it u my mspomibilitym nouly the mcup-
mgai "I 1,i m elpr; rmiaaaa�cananirxaleoracypancy. I Signature of Applicant Date
owme�m nrindagent 1 Data All roof coverings to be Class "B" or better