041101200C
Z C
CITY OF CUPERTINO-
BUILDinG DIVISION' PERMIT
''`CONTRAOTOR INFORMATION:—
BUILDINGADDRESS:
SOUTH BAY CONSTRUCTION CO
ITNG04110120
ONE INFINITE LOOP
OWNER'S NAME:
PERMIT ISSUE DATE
APPLE COMPUTER
511 DIVISION STREET
11,11R/2004
iE:
SANITARY NO. CONTROL NO.
(408)379-0400
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
.
BLDG ELECT PLUMB _.-..-MECH._
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nat I am licensed under provisions of Chapter 9 (Commencing
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with Section 700g0)of Division 3 mf the Business and professions Chin end to, license I.,
in full to= and effect
REVISION --IN HOUSE USE ONLY
Dan"clax' ve.a
Dale
NO NEW PERMIT ISSUED/ ORIG. #04100099 -
ARCHITECIie DECLARATION
T'SDECr
I uMcrLand my plans shall be usml as public Records
Licensed Professional
Oat MER -BUILDER DECLARATION
Y
I herebyLaw for tM-
a(SCe that1 exempt from dr Como. Co
e: Any
following meson. (Section 7031.5. Coda: Any city or county
and Pn,
dennnx
alcor, improve, demolish, nr su
which rtuussu a permit , Lifer.
which
whicheturshtimes
---
re be, a asig ed ment
thior m s l ceased pursuant to to po app rte, of for such permit m f le salla( alaumem
(comm iscingwiit umContractor'sBushora LianxLaw (Charter
Sq. Ft. Floor Area
Valuation $p -
Code)
(commencing with Section 7Ig10) of Division 3 of the Business and Professions vi Cm1e) Lir
tion 7Nc of Doon 3
INa k u eumpt therefrom and IM baso for the alleged eumption. Any violation of
Li
_
AIN Number
Occupancy Type
section 7031.5 by my applicant for a permit subjects the applicant in a civil penalty of
not more than five hundred dollars (1500).
31602107.00
I, u cess"^, of the Popmy, m mY mnployccf with wages ss Mev sole camp'"` -don,
Required Inspections
will do Ncwork and the suucwa is not intended oro@rod Timate (Som. Was, Business
and Pmma ions Code: The Contrumr's License Law itis not apply m an owner of
pmpeny who builds or improves therrnn, and who does such work himself or though his
own employ=. provided that such impovOrmnu are not intended wo@red forsale. If.
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however. the building or improvement is sold within one year ofcompledon. the owner.—
builder will have dm burden of proving that he did not build or improve for purpose of
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1, as owner of the progeny, am exclusively contracting with licensed contractors m
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0vtrmt Ne project (Sec. 7W. Business and Professions Code:) The Cont acmfs Li -
cove law docs not apply m an owner of propenY who builds or improves Merton. and
who contracu for such projects with a contmctor(s) licensed pursuant In One Comnemfs
-- - ---- "--� -'
Lk sm Law.
lam a tuntla See. .Bh PCf Nis n
Ow
ORI aP SATION DECLARAT0
1 hereby affirm under Mistily of perjury one of the following declarations:
1 have and will maintain a Certificate of Covens to sel6in me fm Wur Compcm
urian, ra provided for by Sc imm 37M of the Labor _Code. for IM perf im u ce of the
wod for which this permit is issued. -
0 1 have and will maintain Worker's Compensation Inaunna, as mquirod by Section
37M of he Labor Code, for thin performance of Ne work for which this permit is issued.
My WmOR'a Compensation Insuomme caner and Policy number art:
Cartier. Polley No.:
CERTIFICATE OF EXEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(Tltuuction Reed not hccomplcu d if the permit is forme hundmAdollars (SIM)
Lir leas.)
1 and, thin in the pc,futm ure. of the work for which Nis permi, is issued. I shall nm
employ any person in any manner an az to become subject to Ne Workcri Compemadon
Laws of California. Dae
Applicant
NOTICE TO APPLICANT: IL arm, making his Ccnificam of Excmpimm, you should
become subject m he Workcr's Cmmpcnsadoo provisions Lir thc ISM, Code, you muse
fonhwidi comply with such provisions or Nis Permit hall M deemed conked.
AGENCY
CONSTRUCTIONRe.
CLENDING Coding
1 Mr that Ncre is a Construction lending agcmy for the perfurmencc of
chrm
which (Sec.3
the work for whimh thea permit is issued (Sec. 3M. CO. C.)
Lenders Name
'
Lender's Atltlm.=
I 1 ceNfy that 1 have read this application and sum Nat she above information is
Correa I agree b comply with all city and county on inanaa and sate laws Relating to
building construction. and hereby authpdne represenlxtiwa of Nis city to cmer upon the
above-mentioned pigmy for inspection purposes
(We).,me to save, indemnify and temp harmless the City of Cupcnina against
j liabilitiv,judgmenta, costa and expenses which may in any way License against said City
in consequence of the graining of this permit
' AP PL A DERSTANDS AND WILL COMPLY WITH ALL NON- OINT
Issued by: Date /
SOU C G A ONS. /
Re -roofs
Type of Roof ,
A , 71.,
Sign rtof 1' p
HAZARDOUS MATERIALS DISCLOSUn
Will do, applicant or fmum Wilding wcupanumm or dk hvudousmauriel
pal Code. charm, 9.12. and the Health and Saki,
as defined by the Cupertinommfi
i
cndm, Section zss3z(a)7
IN.
All roofs shall be inspected prior to any roofing material being installed.
❑Yes N
I!Will
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant or rumrcbuilding occupam tax equipment ardevices which
, havardous air conuminanta as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes Hi
1 have mad the hinudous materials mquiremenu under Chapur(.95 of the Califon
nu Helm cIyCodc. Soctiau25505. 25533 and 25536.1 smancorW that if building
docs mol y have a Onset Nati u y reaponsih' ity m ondfy the ice pent mf
rt trim Re eh muuM in C" soon«ser mrmat r roup x
Signature of Applicant Dale
All roof coverings to be Class "B" or better
Owner Lir t nr;x<d agent e