03030008 E— ER'S
Mrr TY OF CUPERTINOBUILDING DIVISION PERMIT UN`TRAC�Tox TNF'�DING ADDRESS: MECHANCIAL INC PERMrr NO.
10500 N DE ANZA BLVD 03030008
NAME: 1990 OLD MIDDLEFIELD WAY FERISSUE DATE
APPLE COMPUTER 03/04/2003
NE: (550) 934-9485 SANITARY NO. CONTROL NO.
ARCHITECT'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSEDCONTRACTOR'S DECLARATION JobDescri tion
e s.70 affirm Nu 1 3 0ecmed under and
pmroc of Chapter 9(commencing p
wnN Salton 1IX10)of DlHaan 3 o(the Buaneas end ProfeaaMm Code,and my Iiceme Is
a infull mrceendefren. 4q 20 TI--REPLACE CW LINPHMARm E93
Et 614
Lh.
Dem Conue
ARCHr1EC1'3 "RATIONA�_ J.
2003 nderstanJ my ptsmahabe l used tl public rccordt c
LL Licemed Pmfcuion,l
80 OWNER-BUILDER DECLARATION
Cmu ION ����®'��
a S I herebyn efrom on I L ucmpl s an the ConuactoYs License law for county
i p o following moron.(Saban]831.3.Bassinets end ove, oli demolish.or AnY city err County
which myulmaae.mithim reuire11ho pWLImprov,h peltorrepaira sig anyatmcwre
H �^ pdortoits isueap,au,mquiro lbeepions o for suchpormi0ufimaeLaw statement
ggg
(Commenthat he cing with
pmction700)ofsuant to the Division fthe eBuinessand ense Profession
(ChapterCode)or Sq. F[.Floor Area On
$ (commcncing with Scc0on 7000)of Dlvislon3 of the Business and Profcuiom Cnde)ur
.. mat he ts exempt tbere(ram and the basis for the alleged exemption,Any vlolNon of
Section 7831.5 by any applicant for s permit subjects ties applicant m a civil penalty of - Al"lqtabe
not more then 0w hundred dollars($300). T Occupancy Type
❑I.asm000rorme Property,ormyemployces with wgca u their sole compensation.
willdo the work,and the ewclure is notion rtded continued forsale(See.7044,Dothan,
sad Preparations Code:Tim Contractor',License Law does 801 apply to an owner of 102 - P I ERS Required Inspections
repent won Wilda ommprovestbemon,and whodouauch work himulfor through his 103 - UFER _ "- -`---
ownereployees,provided that such Improvements are not Intended molfered ferule.If,
however,the building or improvement luold within one year orcompldon,me owner. lO4 — REBAR
builder will haw;me burden of proving that he did not build or Improve for purpose of
ash3. 105 - ANCHOR BOLTS
❑1.as owner of that property,am exclusively commuting with licensed eontramors m 106 - SEWER & WATER
construct the project(Sec.7044,Business and Profession Code:)The Commmorn Lb
now Law does not apply to an owner or property who Wilds or lmpmvu thereon,and, 202 — UNDERFLOOR PLUMBING
who mmu,mac for such pmjecu with,commuto(s)licensed pursuant to the Contrantnfs
License law. 203 - UNDERFLOOR MECHANICAL
❑I un exempt under See ,B&PC for this meson 204 - UNDERFLOOR FRAME
r Dam 205 - UNDERFLOOR INSULATION
WORKERS COMPENSATION DECLARATION 301 ROUGH PLUMBING
I hereby,f0mm undcrpenity of perJury one of the following deelarsdom: 302 — TUB & OR SHOWER
I hew and will mlmal. CeniOnm.r ComenttoulGinsuet far Worker's Compen- 303 — ROUGH MECHANICAL
sulm as provided for by Section 3700 of the labor Code.for the performance of the
work for which this permit is issued. 304 - ROUGH ELECTRICAL.
D I hue and will maintain Worker's Compensation Insurance,as required by Secoun 305 — FRAME
370Dof the labor Code,for the Performance of the wnh for which this Permit Is Issued. -
My Workr ,Gator ep a{lon Inaun ce certicr Poncy numberare; 306 — HOLDOWNS
c e 7 G do yi yN �'Y/'1,2.QOS' 307 - INSULATION
r.yµ. Fl COMPEN3A OmN ItN+SURANCEORKER4 308 - SHEETROCK
(Thu section nndnorbeeompleted lithe permll hforane hundred 011.($100) 309 - EXTERIOR LATH
mless.) 310 - INTERIOR LATH
1 certify that In the perfnrmuce of the.,it fa which this permit is Iasa41 shall not 311 - SCRATCH COAT
employ any gotten In my marwran as to become subject to thewuracrs'Compensation Data Laws of C,Ilfo313 — ROOF NAIL
mle. u
Applicant
NOTICE TO APPLICAN7%If.after making this CcnlRnm of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
become subject he the Worker's Campcmation provisions of the labor Code,you most 502 - FINAL PLUMBING ENERGY
Z forthwith cemply with such provisions or this Permit 0,11 be dimmed invoked.
z0
CONSrRUCT10N LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihemby,Birm ren inert las construction lendingagenry far the perfwmmceof 504 - FINAL BUILDING ENERGY
o:>
the work for which mhpermit isissued(See30W,Che.C.) 505 - FINAL ELECTRICAL
W Q Lender's Name
7z LendcesAddreu 506 - GAS TEST
U0 1 cmdfy that 1 have read this application and auto that the show Information Is 507 - FINAL PLUMBING '
ly E cormcL 1 agree m comply with all city and county ordination and also,law rotating to
C)l[J' building construction.and hereby authodm repmaensilm of this city m color upon the 54,8 — FINAL MECHANICAL
W ahovc(We)a re property any for impaction purposes, 5 0 - FIWQD(We)agree Io saw.Indemnify and keep humleu me Cily of Cupertino against4z) Ilabilitim,judgments.core and expenses which may in arty way accrue against asd City 0 IAPPLICANT UNm R ANDSof this permit. `2�
AyVALL COMPLY WITH ALL NON-POINr Issued by: 5ORKSDate -
S GUL ON
0 3 Re-roofs
S9""mm"I'Applm/Condracuff Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occomml sort or handle huudau material
I
ned by ate Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Section 25332(e)7 �y All roofs shall be inspected prior to any roofing material being installed.
❑Yu, NuWill the applicant or future Wilding occuysm use equipment or dcviaa which If a roof is installed without first obtaining an inspection,I agree to remove
atanbus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
et7
❑Yeao1 how mad me hanrdwsmaterias requirements under Chapter 695 or the Canror.
lth&SLf Co@j,'%"25503,255 25531.1 understand that ifine Wilding
mortly haw 0aa naltolllyto f the acupant of the
me 'ch mus m bran �' U ��
e CNd0m0 a Signature of Applicant Date
Owner or anmarivea ase I ,te All roof coverings to be Class"B" or better