08060123 CITY OF CUPERTINO � rkw:�.
BUILDING DIVISION PERNIIT .CL=11VTRACT6TRINFORMA.TI01V *�
FERMI''NO.
BDILDIyc4+ROREs ARIANI AVE XL CONSTRUCTION 08060123
NlER'S NAUMEE: PERMITLSUB DATE
APPLE COMPUTERS 851 BUCKEYE CT 06/17/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 271-2425
AR CHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB0 MECH
0 0 0
u00 LICENSED CONTRACTDR'S DECLARATION -'
e I hmeby affirm wl I un Beamed under vmvi imus of Cluvmr 9(commencing Job Description
with Section 70M)o(Diisan J oldie Budnevam Prefessi andmy fcomis COMML DEMO INTERIOR, PHASE 2
°=F in full forte and effm
y z License CI Lk.0
-k-O Dak
Contractor sDECL
n W ARCHDELTS DECLAR ON
e 7 I untlmvan my Plans mall be uxd as public rtmrN
JyU
g LL H Licensed Profcssioml
Sys OWNER-BUILDER DECLARATION
Coo 1 hcrchy.set that 11. exempt from On Contractors Lccnse law for the
Coo fallowing mxson.(Secson RIJ str Business antl m.demob Cade:Any city m county
$ which to u a issuance.ido m conmutes eL alter,nnpdose,h Permit
t ore pair any aned memcm '
prim mslicamdpursarc to die Mm eusums of forsucthe Contractors
Licent sLaw(Cakmem
££ < Uvheuc¢nwoSectimtoNepmviwacm3dieConuinessadProfesonsCodm9 Sq.Ft. Floor Area Valuation
y�3
Oil
is exeming pt
Section7000)said the
basison]ef theeged Business and Professions Any
Code)or $350000
- Nat he u exempt thert(rom and or.Per it the alleged exemption.W Any l paresm of
Section 70.113 by vry red dons fm a permit subjecu ass applicant k a civil pmulty of Number Occupancy Type
not throe din five hundred detect(g5W). 316 2 2 018 .W P Y YP
L the
work.
a d propecty.m my m intended with wage v aefr cek uimpensWon.
and Prart wort,and the fine Co m ml intended a Law
dooffemal fs not apply so
an Business
merof
and property
lou Cede:The Consacmh License Law does not apply f an owner of Required Inspections
own atywha Wiprovidmpmvesch imrommntand u amnotihwadenim,elred umgh his
owe employm,provided or nprthat sen improvemcom ale not ear o cd or latim.the owabursitis.s,
however,diebue Use burden
of proving
ink solawithinoroyear or iminmesion.theowner-
sui.). NB Noe Ik Wrdce or proving Wsrte did rot build mimprove(a puryok of
suit.).
Q 1.as awry of the property,w exclusWy contracting with Iiansed contractors m
cotmruct the project(Sec.7GM.Business and Profrstions Code:)The Camsacmra Li.
came Law does not apply to an owns of property who holds or improves thence.,and,
who conatus for such projects with a eonuaanr(a)licensed punoam to We Committees
License Law.
❑I sm exempt u.da See .B A P C for Mus rtasm
mer
Data
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penally or perjury ane of Me fallowing declarations:
Qlluse aM Nl munuina CmsRak of Consentm elf-insure far Wortm'aCanpem
vtien,v provided for by Section]TDO of the labor Code.for the perfomaae of the ..
work for which Nis permit is issued
Q I have and will mainuin Woulmes Compensation Insuarxe,as Minorcd by Section
]TOO of the labor Code,for1lic performance of the work for which this pmmit is issued. '
My wmr o rota carries anPolicy n b
Carver: �ti nv �a.Policy No.: 4
CERTIFlC OMPEhI ATION IINN FROM ORKERE
COMPENSATION INSURANCE
(This kmbm need rot hecmnple¢d muse permit is fororcnanmed doBvs($100)
or less)
I certify that in the pmformace of the wart fm which thus permit is bond.I mail am
employ anypemon in any monerso as to become object in the Workers'CompevWon
Laws of California.Data
Applianl
NOnCE TO APPLICANT:IL after making Nu Certificate of Exemption,you should
become subject in the Work.'.ComXienti n pon una.of the labor Cat,You mus
.J,z forOmth comply with such provis s.or this pewit shall he seemed meted.
z O CONSTRUCTION LENDING AGENCY
)•• I thereby aftime thv exert Is x...t1m loulmSagemy for tie performance or
G'> the wish for which this Permit Is issued(Sec.3097.Civ.C.)
t[1 0 Lendces Name
z Lenders AM.
U O 1 anifY that I have mad this application and sum that the ahave inmmaam is
IL. torten.I agree to comply With all city and county.rdinarues and utak laws missing to
.8 building construction.and bunchy auhonse mprexntamms ofthu city to cater upon the
W shoeMR
uemd property for inspection Pmpo¢a.
G (We)agree to save,indemnify and keep harmless the City of Cupertino against
y Iind exp""""•Which may In any myurneags lsud City
UZ inngof NupmniL
^ ANDS AND WILL COMPLY WI ALL ON-POINT Issued by: Date
WI
fr2 0b Re-roofs
Si um ofAppli on Data
US MATERIALS DISCLOSURE Type of Roof
Will art cep ort buil ' gaaupantsmrc or haMle havNov mamsal '
v deflated by ft Cupertino Muni. Cade,maple 9.1;and the Holds and Safety
.saven:ss3z(a>TAll roofs shall be inspected prior to any roofing material being installed.
❑Ya o
Will am a liam or fumrc In If a roof is installed without first obtainingan inspection,I agree to remove
PP Ing by ft
P g
--ft
arnanNnv air conuminanm v flnc0 by the Bay Atha Air Quality Management all new materials for inspection.
QYa M Nu
I have thehvallous mucri-is mquimmenu under chapter 6.95 ofthe Califo>
MallalN&��d, ons 21N15.;553]and 755Jd.lunderwsnE thalif a loadwmgov 21N15.2553]and]55J4.IunderwlnE Nnif ehwWing
dam c Nva•Wes Mw it u mY impossibility as mdfWa it u and ff a pant of deo pant of do
hch mus cl pricer m iuvancc of a Catifc o eco
�i �� Signature of Applicant Date
OW ,m aothos,ca a Dam All roof coverings to be Class ins'or better