05060093 CITY OF CUPERTINO •. - �- '9ily ai.a� ' � � ""'' -- -
''BwIbiN06rVIS1oN` ` PERMIT • CONTRA TORINFORMAr.CION, s
BUILDING ADDRESS:�,; ,. .;-p SOUTH BAY CONSTRUCTION CO t" 05060093
n NER'S NAME: "' PERNUT ISSUE DATE '
APPLE COMPUTER
NE:
SANITARY NO. CONTROL NO.
(408) 379-040Q
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION Job Description i
4F❑ •. 1 hereby affirm that l am littnsed under provisions of Chapter 9(commencing
iW with Sermon7oTlgof Division 3.rNC Best.and Professions Code.and my license is '
full force arta effecr -�. '" I
n=» i" . Tf REPLACE (E) GE A K
:n: um voclasi see.. 5�jp•�'.7��� t
-hip Dale--C Contractor_ a' 1 tE p
'y ,r• ARCHITECTS Dachar a L� rL�3a
j w� .-.I undersond my plans e1W I W oscd a public records
ss.
py Liccu.d Psofcuianal• "" /a� 1005 :
3 OW NER-BU ILDER DECLARATION t
0 Y ,,. . 1 h6rchj'affmm Not I am ex.mpt from the Camono 'License Law far the
O O rallnwing Bunn.(Sdedun](13 1.5,Business and Pmfeuiom Code:Any city or
county
which inquires a permit m cnnsvwl,alcor.impmvc,dcmnlish,pr¢pair any stiunum r
prior m its iuuancc,alw requirns IM applicam hug"h Parmiuo plea Ie a signed summcm
E=n that be is licensed pursuonuoth.pmvipinns of the Comon"cri License law lChapmr9 Sq. F[. FIOO r ValUanClOn '
y1Z-� (commencing with Scnion]OBO)nf Division3of the Business and Prof cog Cnde)ur
y $ Nat he u exempt th.mfom and the
buia for Ne alleged exemption.Any violation of
such..9031.5 by any aDPlicant tori pewit subjects the applkantwacivil,entity of 3AIN Nuf@l6er 00 Occupancy Type
nmmarc Nanfiw WaOxddollars(5500). - 1
❑1,u owner of the propmy,ar my emPloyces wish wages u their sole cpmpeuaOon,
willdo thewodt and the awnurt isnot intended or oRered fonalc(Sec.7044,Business
and Professions Cade-:The Comrecmr's License,Law doss net apply to an owner of Required Inspections
,.Pi who builds"r impowex thneem,i nd who does awh wmk Induction,through his
own employees,provided Nat such impmvemcnu are not intended or offered for sale.If,
however,the building or vnprovement is sold within one year of completion,the ownes-
Wildcr will have the burden of roving Net he did wt Wild or improve for purpose of
❑has owner of the propcny,am exclusively convecting with licensed contractors to
construct the project(Sec.7014,Business and Protrusions Code:)The Contractor's U
cense law does not appy in an owner of property who Wilds or barroom dreoon,and
who contracts for such projects with a eonvacmr(q littnsed pursuant m the Conmaco's
License La-
0 I am eacmpt under Sec. ,B&PC for this rasion
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury rax of the following declarations: '
❑I have and will maintain aCCNfieam of Coruem to self-insure for Worker'sCompen-
cation,as provided for by Section 3700 of Ne Lahr Code,for the performance of the '
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as inquired by Section t
3700 of the labor Code.for be performance of the work for which this pewit is issued.
My Workers Cnin1151ion lnsunntt carrier and Policy number ao::
Camid� C Q'V� Poli,No.: 03I Z S
CERTIFICATE OFEXEMPfION FROM WORKERS'^--
COMPENSATIONINSURANCE
(Thisseaion need not W compl.ted if IW Pcwit is for one hundred dollars(SIM)
or Ice.)
I ccnify Nal in 06 perfamtance of the work for which this permit u issued,l shill not
cnploy an)'pardon in any manner are as to become subject m die Workers Comparison..
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Candidate of Exemption,you should .
Wmme subject to the Worker 3 Comperismion previsions of the tabor Code,you moss
.J Z forthwith Comply with such Provisions or this permit shall W claimed rewired. ,
Z O CONSMCfION LENDING AGENCY
[-. I hereby af0w that himis a construction lending agency for the performance of
C' the week for which this permit B issued(Sec.309],Civ.C.)
QLamict's Name
z lender.Address
U Q 1 certify Nat I have mad this application and so¢Nat the above info m awn is
1t. F^ correct.I agree to comply with all city and county ordinances and said laws relating to
C) Wilding consudction,and hereby authorise repreaentariws or this city to enter upon the
r OW. above-mentioned property for iupccdon purposes
(We-)agree to save,indemnify and keep harmless tho City of Cupertino against
H h
liabilities judgments.casts and expenses which may in any way accord against said City
U z f th mNorispowit.
'AuTUNDRmTADS thAND
WI COMPLY WITH ALL NON-POINT Issued by:9 Date
S UR REGULATION ^ /)gyp '7/ !Of
t. I .4 _ 72 Za Re-roofs
( SIgi riu-re of App unducon or �� Data
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the applicamsir fuoo building oecupant it..or handl.th ardous ntamrial
as dcfoted by Or Cupertino Municipal Code.Chapter 9.12.and the Health and Safe,,
c,Section
2551](a)? / All roofs shall be inspected prior to any roofing material being installed.
(�
�'- If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant o fuwo building occupant use equipment or Wvicee which
emit harardoda air cpouminana as defined by the Bay Area Air Quality Management all new materials for inspection.
District? ,,((
❑Yes 6N. _
I haw read the hvaNmrs materials requirements under Chapter 6.95 of the Calir"r-
niaHealth&Safely Cada,Securers 25505.25533 and 25534.1 understood Nu if the Wilding
d o candy have a mnant that rtspouihility m nn.1'y the a apart of the
quiomcn which mugWme,pri f�(-^�ttance aIdoradu dy. Signature of Applicant Date
r L� All roof coverings to be Class"B"or better
Owner.....th"meJ agent Dam