00060145L.
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CITY OF CUPERTINO
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VONTIRAC7 OR INFORM=ATI,OM ^i
PERMIT No. ,
BUILDING DIVISIONPERMIT
NA a. � B 1,
BUILDINGADDRESS:
SANITARY NO.
SUBMITTAL DATE
06 Ul 4s
UWNCRSNA
NIC
❑
. CONTROLk
06/21/2000
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HONE: APPLE- COMPUTER
ItCI 111'ECGCNCINEER _
,., .+B BIJ4DIN0(PERAnT+INI O:+g, W'10SM
LICENSED CONTRACTOR'S DECLARATION
'Ithereby that Issofthedundo provisions of Chaplw9(wmnieno.i.
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Job Description .
with Sadw ]0110)ofDivision l''^^of the Huaivna W('Ro(eviou C/a��e ad mY littnac is
))of
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n_CR
in fullse V `IOFB
Cla .D .g
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.
'WIRELESS ANTENNA INSTALLATION
me conl•ww,
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ON
I undenurd my plane shall d used u Public
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_
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Licensed Professional
OWNER BUILDER DECLARATION
1 hereby affirm Nat I am exempt from Or Contractor's Ucenw,L•w for Ne
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following mesas. (Sawioo 7031.5, Business sd Professions Cade: My city or county
Sq.�Ft.FloorArea
Valuation.
which" onto.p`.i.lawmnct,adier'imrove'denlnlisincoupsireny`m'm"'e
priorm ins iuuence, also'requires the applicant for such partial in Elea signed statement
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Net he in lianrd punuwt m Ne provisions of Ne Conrtactots Littnac Law (Chapter 9
'
adore (Any viCode)m
Wt he is . Any violation of
Oat he is emergeNtrzfrom W tk bPor for alleged axe
m rgi the eircon and! de, We. far O illegal
APN Number,
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OCCUpanC� � 00
iT
31.5 b
5utlon ]0)1.5 by anydred oll fora permit mbjecu the applionuo a civil peulry, of
bj Bart t
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nm more Nw five hundred dollen ($500).
urn
_'316QILry 1'{}CILYUI�teO)InSpeCIl005 ' •' '
❑I, ae owbei of the propenY•ot mY emPloyeei wird waguudRir eolccompemuion,
1 wBl do the work, std Ne ewctu"is trot innddmoRemd fm Nc(Sw.]041, Busiuu
.it ProfessionsCode: The Commissars License taw docs rot apply in an a.ner d
Property who builds or improves thereon, and who does such wok himself a duough
his own employees, provided Net such improvements proveents are nal inmded or aRered for
101 -
FOUNDATION
sale. If. however, the building or improvement I, sold within one masrcuf cowlefon, site
,
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owner -Wilder will haie the burden of proving Nat he did nor Wild car improve for For-
102
PIERS
OatoWe:),
pmum-am,
0 1, u owner of Ne property, un exclusively mum-. ng with licemod connacrots m
_
103
.
UFER
construct Ne prejecl (Sce. 7W, Business and Pore"nine code:) Me Contractors Li-
i. 04� —
•REAR R
cense law does nut apply t. w owner of Property who builds or immavea Nerton, rod
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whocanwctifor such pwjwu.iNacwtrsctm(q licensed antn
tl polh<Ccmrs
whocac
105 —
ANCHOR BOLTS -
few.
❑ lamemmqudersec. ,BkPCfwddaroson
2
I/ 106 --
SEWER & WATER,
Owner Date
/ 202' -
203 —
UNDERFLOOR PLUMBING '
UNDERFLOOR MECHANICAL
WORKER'S COMPENSAnON DECLARATION•
I tummy aRrn under Fealty of pmjury ooc of the following deelvatiwu:
I have and will marotainaumRc."nfconwnllo"If-inwreforww escompen-
20�h —
UNDERFLOOR FRRME
anon, ea provided fm.by Section )]00 of On Labor Code, for the performance of the
work for which this permit is issued.
l
." 4 205 —
UNDERFLOOR INSULATION
0 1 have and will mnmuin Wnrl"r• Compensation Imuratice, u re moo l b «dvon
3700.1'Ou abwCodejeadre,ofta n ddiewoA hic ertn('jgysyy�Zj L
Wokcr' (/ —
'7a 301 —
i
ROUGH PLUMBING '
My y�o sus artia eM PoIiS�V
302 —
'TUA & SHOWER
comer: PolicyN
303 -
.OR' ,.
ROUGH MECHANICAL'
CERTIFICATE OF MEMPIION FROM WORKERS'
COMPENSATION INSURANCE-
(This swdnnreaul. eenmplatmirNapemdlisfin.hadledmt.(Slao)
304 -
ROUGH ELECTRICAL_
or leas,
I. the par(ormumcof Nework Nis Wi•icauof, I shallComer.
Ioy,spy
.. 305 —
FRAME .
notch per comesuwhich je the
spy Califon in my mwnar w u m become mbjaci m dm Workenl Compen-
306 —
HOEDOWNS
mtionLawsofCalifornia, Data
Law
Applicant
.307 —
INSULATION -
NOTICE TO APPLICANT: If, after making this CeniBcate of Exemption, you should
s
hwnmesubject 10the wnkerscnmPnnntmnpwvisinnsofineLnmrChile, you must
308 —
SHEETROCH
forthwith comply with such provisions in this permit shall M deemed resulted.
_ '
309 -
.'
EXTERIOR LATH
CONSTRUCTION LENDING AGENCY
hereby dor Ne"i.aand(S.,307.Clending agency for the perro,n,mme of
310. —
INTERIOR LATH
which
Ne dworkee. Na witsah Nmpcmtii is i,xad (sw.laz cm. C.)'
' lander. Name
dee.
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- 311 —
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SCRATCH•'COAT' .
ROOF NAIL
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1 unify that l have read Nis appliwion andmare Nal ft above information is
wtrtw: f agree to comply wilhall city rod wunry much nancis andeuu law, relating m
501 —
FINAL ELECTRICAL' ENERGY
building aonstmction, and he"by aulhorim reprtawutires of this airy m enter upon the
abowa-menriond piapertr far mapeation parpn"•
- 502 —
FINAL_ 'PLUMBING ENERGY
(We)agreem;va, indemnify and kaepharmlenthe City ofCupertino against
juOilitiu, judgmwu. con and upeues'which may in my way acerae against mid City
•503 —
FINAL MECHANICAL ENERGY
in wnmgnm"e of she gusting of this Found.
504.—
FINAL .BUILDING ENERGY -
APPLICANTUNDERSTANDS AND WILL COMPLY WI111 ALL Nd•11NT
EREGDLATI Ns.
•
505 -
FINAL ELECTRICAL'
t7
506 -
511-7—
GAS TEST
E NAI DI IIMBING
Signature ofApplican /Concractw Dale
HAZARDOUS MATERIALS DISCLOSURE
Re -roofs 506 —
FINAL• MECHANICAL
Will the applicant or future Wilding occupant stn" or handle haier&s maul'
as defind by the Cupcnino Municipal Code, chapter 9J; and the Realty ad Safe,,
Cdc, Suctm, 853200? t
Type of Roof
S@g —
FINRL GRADE
❑Yes I ON.
Will theapPlicant or furore building occupant use equipment or devices which
All roofs shall be irlsioeeteff tt�htl FNd4 material being
installed. If A lthft
emit havrdois air conruninuu u defm%] by the Bay Arca Air Quality Mmagement
a rooN. nstall"
WoNll�Rtllig an inspection
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❑Y Na .1
I agree to.remove all new
materials for inspection. Applicant '
r
1 have mad the haurdous malenal• rcqui"menu antler outfitter 95 of the Cats -
understands and will comply
with'' all non point source regulations.
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forma Health As Safety Code, Section 8505, 25533 cod 853x.1 undersmd dor if Ne
doeanmcurrem havicemnanL Nuit is my ruponsibiliry ton ifyN maput
it
of ui..".hic un be nim priwm issuance of a Cenili f ancy.
Signature of Applicant
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Date
ner arauNd
onc• ur "
All roof coverings to be Class "B" or better ,.
OFFICE
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