05090163 CITY OF CUPERTINO ',,ON'
K°- 7'-�" a
BUILDING DIVISION PERMIT CONTRACTQR INFORM. 10W.
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO fNtTND.05090163
400 MAPTANT AVE
OWNER'S NAME: PERMIT L4UE DATE
APPLE COMPUTER (PHASE B) 511 DIVISION 2005
E: SANITARY NO. CONTROL NO.
(408) 379-0400
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION
til E I bemby affirm that I am licomed under provisions of Chapter 9(commencing Job Description
Z
W wiNSection]IXIU)afDivieimn Jof the BULast and Aofcssiom o dmy'<emeu
a« mmurnrecamderrec. Q REVISION--ADD SKYLIT/CHG WALL TO 6" WALL
j i Liccnu Clone Lie.p
(a / p contranthr a}o BAN.eatA.. RECESSED NICHES BUILDOUT
EE
I undemunJ my plans shall he uused.,.bit.,.PuARCNITECARATIONhlie rerecords �^ NO NEW PERMIT ISSUED/ORIG. #05080255
zi C
oyp
io. Licensed Professional
5 OWNER-BUILDER m Ce Contractor's
onte ON
E<O hereby effort,that 11. exempt from the C Professions
Co c:enseAny C Law for the
o O following mason(genion TCD s d.Business and Pmfe tions Cale:Any tiny or county
''$�i which requites a pnmit m mnswn,spec nt forve,demolish,or repair any ssmcmrc
tam Patlic its iensedpauumgo Jim theapplicantfor tach Perrot wfTruse Law pChamcm
< (com incing with cdpuntion7")ofDivision
ivisiiu 3ofOn unroof andPrYlaonsCoolm9 Sq.FL Floor Area Valuation
Y~S (commencing and of Diaiii for the
OnBusiness
ars MyonsCMe)ur $100
Netto u 31.5b therefrom and Ne Per forthe subjects
eumptian.Any violation of
Sedan 70]1.5 m sty,applicant for.permit subjects Ne applicants m a civil penalty of APN Number Occupancy Type
nm tenon Nan save boname dollars($soo). P Y YP
❑1,u owner of the proporty,on my employees wish wages as On,tilt compemaahm.
will do the work end de awctu,is rut intended or ofCmTh,.a1C(Sec 7044,Business 33:62203:8 . 00
and Profusions Code:The Convacmr's License law does tont appy or an owner of Required Inspections
property who builds or improvm thermn,and woo does such work himself or through his
Own employees,provided that such improvements are mot intended cronesed forsake.If.
however,the building or improvement is sold within one year of completion,the owner
builder will bats the burden of proving that he did not Wild Or improv fa purpose of
sale.). A
❑1,as owner of the property.am exclusively contracting with licensed common to
construct the project(Sec.7014.Business and Profession"Cade:)The Convacmri Li.
acme Law does not apply to an owner of property who builds or improves themon.and �—
who contracts for such pmjects with a con"actor(s)licensed pummnnn the Contractor's
LxLaw. � ,
El I sere exempt under Sec. .B k P C for this mason �
Owner Date
WORKERS COMPENSATION DECLARATION J�
1 hereby affrm under penalty of perjury One of the following dulanniom:
I ham and will maintain a Certificate of Consent m ulf-insure for W ed cesCompcn-
szoon,ss provided fa by Section 37M of Ne labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,m myuimd by Section
3700 of dm labor Code,fez the performance of de work for which this permit's issued.
My Workar"cmupenutionfnsurar,ce artier and )icy numMram:
Curter:ST' Agatwa o.: rn
CERTIFICATED EXEMPIONFROMWORK S
COMPENSATION INSURANCE
(Thu action need not becompleted ilte permit is faone hundred&Jim(SIM)
or bass)
I certify Out in the performance of the work for which this Permit u issued.I shall not
employ any person in any mannerso as b become subject to tM Workers'CompemiOn,
Laws of ci liromie.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifine of Exemption,you should
become subject on the Woracr s Compcnsndon provisions of the tabor Code,you must
.J z forthwith comply with such provisions or this Permit shall M deemed revoked.
zCONSTRUCTION LENDING AGENCY
[—� l hereby ulnrm Our Nem is a comwmimn lending agency for the perfumom.of
lY
be work for which this permit u issued(Sec.309],Ci,C.)
Lt1 Q Lerida',Name
7 z Lcndcr's Address
U 0 1 cenify that 1 bate mad this application and Jose,that the abovs information is
U,P correct.I agme m comply with all city and county on inames and sone laws relating to
DU building canawctum,end hembyaubmim mpruenutivssof this city to enter upon the
above-mentioned Pmpcny for imPection porPntes.
We)acme to save,indemnify and keep harmless the City of Cupcnum against
h Ilabilides,jos gments.ems and xpcmm which may in any way accrue sgaimt rid City
U z mcomeq of Ocg tin of Nis permit.
" APPLICA UNDER A DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE EGU S
o
Signazur of Applic VCmARDOr Dem l Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant err furan:building occupant role mhaMle Health an materiel
m do ncd o the Cupenlno Municipal Code,ChaPtcr 9.if,end Nc Health and Safety
C . Ely. 532(')7 All roofs shall be inspected prior to any roofing material being installed.
�Ym 1rfi No
"r If a roof is installed without first obtainingan inspection,I agree to remove
Will the air comm or future banding by de,B talc equipment or devices which . P g
.tell havardnus air contaminans as dcfited by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes I Nu
Ihav >v Neh srdous mae,rialsmyuimmcns under ChaP¢r6.Y5 of Nc Califoo-
nix Ha]INk cry Cade. do 505.25533ea 534.1.ndcnntM irf building
Jos tet cu ndy have• an Nan it u my_W ihilitY m notify th occupant of de,
mquimmen which must m phormissuanccofaCerficaeofO' aney. Signature of Applicant Date
wnern wmndxed cm 13,iu, All roof coverings to be Class "B"or better