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CITY OF CUPERTINOBUILDING
DIVISION PERMIT
CONTRACTORINF®$MATIQN
BUILDING ADDRESS:
NOVO CONSTRUCTION
PERMIT NOO5O1OO87
20525 MARIANI DR
OWNER'S NAME:
PERMIT ISSUED ITE
APPLE COMPUTER
1042 HAMILTON COURT
01/13/2005
E:
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECfIENGINCER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
In o 0 0
LICENSED CONTRACTOR'S DECLARATION
I hereby Chapmr 9
Job Description
affirm that I am finned under prgvisi s of (commencing
with S� i(g noasaAnAMs)of Dwision3of NC Busiraas IDRProfc .Co dc, mdmylicenscis
mfWl fo dcOea V N1RZ
TI --SOUND LAB/TEST CHAMBER
LiccnLic.N
Dam Cum r C
ARCff ITECTS DECL ION
understand my plans shall he used u Put ¢cords
V
Licensed Professional
OWNER BUILDER
mDECLARATION
I hereby affirm thin 11. exempt (tom the Contractor's taw for the
i Co e: Any c
following mason, (Section ]101.5. Business and Professions Code: Any city or county
maso
4
1 which rtyuires a permit to construct. alter, improve, demolish, Or mp.w any mm
ruure
�2 J O O O
! prior to its issuance. also requirestbe applicant rot such permit to file a signed stamment
that he is limned pursuant o the pmvisiatunf he Conlrumr's License law(Chapter 9
Sq. Ft. Floor Area Valuation
{ (commencing with Section 700B of Division 3 M the Business and Professions Civic) or
Bud he is exempt Ncmfrom and the basis for the alleged ettmplion. Any violation of
Section 7031.5 by any applicant fon permit subjects me applicant to a civil penally of
GrOCCU
Occupancy
Type
not mom man five hundred calla.. (5500).
y
❑ I. u owner of the property, or my employees with wages as men sole compensation,
will dome wart, and One swctum is not intended or offered for sale (Sec. 7044, Burnout
and Professions Code: The Contractor. Liconue Law daea not apply to an owner of
Required Inspections
property who builds or improves meroon, and who doessuch work himself or through his
own employees, provided that such improvement arc not intended or offered for sale. IL
however. the building or Improvement is sold within mre year of completion. me owner
builder will have the burden of proving that be did not build or improve for purpose of
sale.).
❑ 1, as Owner of the property, am exclusively contracting with Tic oxxd contractors to
construct One project (Sec. 7044, Business and Profusions Cade:) The Contractor', Li.
come Law does not apply to an owner of property who builds or improves thaman, and
who contracts for such projects with a moratoria) licensed pursuant to Be Conuagar's
License Law.
0 l am exempt under Sea ,B&PC for his mason
Owner Data
WORKERS COMPENSATION DECLARATION
1 here¢R
by om under penalty of perjury one of rhe following declarations:
I haw and will maintain a Cemfieam of Comsenuo self -insure for Worker's Compem
sation, m provided for by Section 3700 of Be Labor Code. far the performance of the,
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compenation locurace, u bequired by Section
3700 of thef[,1,amor Code. for me performance of the work for which this permit is issued.
on Ida
My ompenntiCATE rano coria
oll Mr—
Ell W
WORKERS' 'RTIFICA
FROM WORKERS'
ATIONI
• COMPENSATION INSURANCE
.
(This section need not the completedifthe permit is Assume hundred dollars(V00)
or Ica.)
1 mrtify that in the perrormmec of the work for which this permit is issued, l shall not
employ any Necon in any manner us as Up thommc subject o the Workcri Compcnsalism
Laws of coliform.. Dam
Applicant
NOTICE TO APPLICANT: If, still making this Ccrtl EOalc of Exemption, you should
become subject to he Worker's Compensation provisions of me Ichor Codc, you most
forthwith comply with such prowhiom or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them its mostruetion lending agency for the performance of
work (w which this permit u issued (Sec. 30D, Civ. C.)
Le
Lender's Name
Under's Address
��..
I modify that 1 have read this application and $um that me abon information is
correct. I agree 10 comply with all city and county ominances and stain laws resting to
building conmmctimn. and hereby authorise mpraemarves mf hit city to enter upon me
abovomcntiuncd props for imprmion
(We) agate tp ase, indemnify and keep harmless me City Cupertino
of against
costs
liabilities,judgmente craning of thisextremists which they in any way eccme ¢Salon aid City
which may
in consequence of the granting of this permit.
/t
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date %
�/
S URC ATIONS.
`^'!/ KJV
I
Re -roofs
Si ammo ppiicanV ontrutor Dam
HAZARDOUS MATERIAIS DISCLOSURE
Type of Roof
Will the applicant or future building occupant cmc or handle hasarduus material
as defncd by me Cupertino Municipal Code. Chapter 9.13, add the Health and Safety
Code. Section 25532(a)?
❑Yes y(Na
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
I h,umnus air contaminant defncd by the Bay Area Air Quality Management
iuricO
all new materials for inspection.
❑Yes Nu
1 have mm the hvamnusmamrials my.imm m. under Chapmr6.95 of the Cabinr-
nia Health & Safety Code, Sections 25505,35533 and 25534.1 understand thnifhc snoring
'
docs raw currently have a ¢nam, mat it is my rmpomibiliry w nndl'y tbe me.pat of Ne
rcyuirc which monk nprior w' mrcc ofa Ccnifms- fQmpacy
'
Signature of Applicant Date
part 65
All roof coverings to be Class "B" or better
Owner or authorised agent