05080255 CITY OF CUPERTINO 'a' - `>
BUILDING DIVISION PERMIT �CONTRACTUR INFbRMATION
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BuiWINGADDRESS: SOUTH BAY CONSTRUCTION CO 3`#l'I.T NO.05080255
0400 MARTANT WE
NER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER PHASE B 511 DIVISIO 2005
NE: SANITARY NO. CONTROL NO.
(408) 379-0400
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�oo LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm tham at I licensed under provisions of Chapter 9(wmo
menein{
with Section 7M)of Division 3 of Ne Business and Profeuiaos Cpode.and my license is
_Zur Lmu Cis ercect. jJ�7(ca-I TI--EXTER. HANDICAP. RAMP/BATHRM UPGRADE
. Sz ucenxecl sec.{ ELECT. /MECH. /PLUMBING
all Dart Laill ar
A HIIELTS DECLARATION
1 unsermnJ my p6tu slWl he users.public records ®\�
DtO V
i0 Licensed Profound ml
no
qMOWNER-BUILDER DECLARATION
3<N I hereM1y.(Sinn that 11. exempt from the Casae,Co License hew for the
3:D O following mason.(Sadao]LOIS,Buutteas in on.d now Code:My city at county s.
which requires•permit re cures the alter,improve,rsnanolii,i or repair any tatucmm b
prior lo is iasuuu0.nm sit to ft dte applicant Tomei actor, file.signed Bauman
FFF< shit he is licensed purw.t to the provisions of the Conuacurs Ihcnse U.(CMpter 9 Sq. Ft. Floor Area UiBi2 8 8 8
Sg (commencing with Sultan 7000)of Division Sof the Business end profession,Crain)or
3 thus M H exempt therefrom and Ne basis for the alleged contraption.My vialNan of
Se ti o 7Nm nee n nmepBdmlenr a per It subjects we applicant w a civil penalty of APN Number ancy Type
31622018 . 00
❑1,as owner of Ne property,many emplayeu with"Sea as their sale compenntlon,
willdo the work.and theswcture is notinu bed oraRered foraalc(Sec.7W.Business Required Inspections
and Proussn relo ns
loru Case:The Common License Law dot apply an owner of q P
propenywW bulldsm lmprowa discount,and-who doessuch work himntter through his
awn employees,provided that well improwmenu art oo Intended mortared for sal..If,
however,the Wilding or improvement u aid within oro year of completion,the mvnen
Wilder will have the burden of proving that he did not Wild or Improve for purpose of
sal..).
❑h u owner of the Property,aan wclusively contracting with licensed emtracton to
convect dm project(Sec.70".Business and Prefectures Cade:)The CmtrxtoYs U.
cease Law docs not apply lo.owner of pmpany who bull&or Improves thereon,Md.
who contact for such projects with acontracser(i)licensed pursuant m the Controunra
Lkcase low.
I]I.me.eanptunser Sea ,BhPCfmthtsmason
n Dau
WORKER'S COMPENSATION DECLARATION
1 hemby Brim unser peas ty of perjuryone of the following seclamdons,
I hawand will mainWn a Cautious archaism inMi amnfmWarke'sCompen-
sstim,a provided fm by Sun.3700 of the labor Code,for the performame of the
work for which this Permit is Issued.
❑1 have and will maintain Workers Compemadon Inwv.w,as impaired by Semon
37M arthe Labor Cock,for the performance of the work for which this peanut is blued.
My Warke�r.�CComptte�nnsa''tion'' r
an=ciar and Policy number are:
Carrier./ Poliry No.: 0--yyl'Z -tl
CE IFlTEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE ,
(This seedne need mrhe computers If the permit tsfmamc hundred dollar({TOR
or less.)
I unity that in dhc performanee of the..,it!or which this permit Is bound,I shall not
employ anyperwn in my manner a as an hecomesubject in the Workers'CompensNon
Laws of CaRfoMa.Dau
Applicants
NOTICE TO APPLICANT:If.afar making this Certificate of Exemption,you should
became subject m the Want Compmuaden provisions of dee Later Cade,you mus
O O faMwith comply with such proviuom or this permit shall W domed reveled.
Z"5 CONSTRUCTION LENDING AGENCY
[-t�y+ Ihemby aRrm that there is a convection lending agency for tan performance,of
athe work(a,which this permit is bound(Sm.3097.Civ,C.)
A Lenders Names
0.0.z Lenders Add. .
U Q I many thn 1 Nor mad this application and suss that the aWve intuitionism is
U.F coram.1 agree to comply with nl city.d county ordinances and esu laws relating in
C)U building coonmctlon.cad herby autharim representatives of this city in cater upon the
W .bow-mentiowd property for inspectian purpowws
C (We)agree to an,Indemnify ad keep harmless the City of Cupertino shatter
T/1 Ilablliahs,judgment, cad expenses which may in my my accrue agaimt=it City
U r7< APPLroCANT UNDEuence of the RSTANggo$$f ANDWIWI L COMPLY WITH ALL NON-POINT Issued by: Date
S E REGULA710kfSJ P
x r °/ Rion Re-roofs
Signature of Appli HAZARDOUS
Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the oCalamnefMun Wilding mcupantcoreman the
h Health aanaurin
as defined by Ne Cupertino Municipal Code.Chapter 9.11.and tie Health a Safety
Some.25531(4)7 All roofs shall be inspected nor to an roofing material beim installed.
- i ❑y. P P Y g g
Will the. lir.,or mmro Wudln coca ant um equipment If a roof is installed without first obtaining an inspection,I agree to remove
PP d P q proem m devices which
MhayaMnus sit e.uminanu as sefined by the Bay Arta Air Quality Mmegemem all new materials for inspection.
Disrini
❑Yes j.7?la
I have mW the Wsardommaudals anqulrtmnms under Chapter 6.95 of the Califor-
nuHealthhSafety Code,Scrims25505,25533 and 25534.1 understood that ifthe Wilding
"U.— oily hew a unan6 that 1 u my rapoasihility an notily the mC.P.t of the
rrqul n hv:hmuubemm muancca certiReauafOcw SignatureofApplicant Date
au ` 'e Y4o'°S All roof coverin s to be Class"B"or better
Ow uthne e�—mLers art as¢ g
C