05100012z
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CONT=RACTORf11'_ MATIONn s
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
NOVO CONSTRUCTION
PERMITNO.05100012
2052
ER'S NAME:
PERMIT MUE DATE
APPLE COMPUTER
1042 HAMILT
05
NE:
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
licensed under provisions Chapter 9 (commencing
1 hereby effrm that 1 an M
with Sermon ]exp of Divis' 7of the Business; and Pr—ofusium Code. and myliccmc is
fail bona,
in fullclass he0ect. O22
TI-LABS/CONF. ROOM/OFFICE SPACE
L Class Inc. x
Dem
EDELCr
T'S DECLARATION
ARCHITECTS LA re ION
I undenunJ my plata shell k used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section ]W 1.5, Business and Professioas Code: Any city or county
which requires a Permit to construct, alms improve, demolish, m ¢pair any structure
$188096
prior m its issuance, also requires me applicant for men permit to file a signed statement
than k is licensed pmmaat I. the Provisions of me contracUms Urn:¢ Law(Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70DO) of Division 3 of the Business and Praressiom Cadc) or
that the Is exempt therefrom and do basis for the alleged exemption. Any violation of
Occupancy Type
Section 70313 by any applicant for a permit subjects the applicant m a civil penally Of
not mom me hundred dollars ($513lr
an
01,uownerofinepmpcny,mmyemploy wirewg wtheirsolecompenatian.
will eo mcwork, end me muclum is not intended oroRered forsalc (Sec. 7(ta4, Business
Required Inspections
and Professions Cade: The Contractors License Law does not apply to an owner Of
property who builds or improxes thereon, aha w ho does such work himself or though his
for sale.
Own employers, provided that such improvements are not intended nnpImo
however, Ne building or improvement b hath within one year of completion, the owe ,-
.
will haw me Wrdcn of proving that k did not Wild or improve for purpose of
of
sak.).r
sale.).
0 1. as owner of the property. am exclusively convsting wire licensed conumemrs to
construct the project (Sec. 7014, Business and PmGssioos Code:) The Commoner Li
%
cense Low docs aut apply ban he, Of,.,ny who Wild, Of Improves marem. and
O
who contracts for neh proj<cu wire a contractor(s) licensed pursuant m Ute Conuamors
Lice co law.
0 l am exempt under Sec. ,B At PC fools reasonel
Dae
WORKER'S COMPENSATION DECLARATION
L hereby affirm under penalty of perjury one of the following decimations:
1 Its and will maintain a Cenifeam of Covent c self -insure for Worker's Cooper.
hadon, u provided for by Secuon 3700 of do labra Code, for me performance of the
work for which this permit is issued
0 I have and will maintain Wmkch Compevadan Insurance, as hap irtd by Section
37M of me Labor Code. for the performance of the work for which this permit is issued
My Workc' Compensation mu`nnm canner and Policy number me:
Carrier. bIK. (ilYs'Vf^f�7'oliryNo.: "e7�904
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mulsectinn need not k completed if the Permit is for one hundred dollars DIM)
or loss.)
1 cenffy, that in me performance of me work for which this Permit is issued. I shall not
employ any person in any manner an u w become subject to do Workers' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Cmilicate of Em.Nion, you should
became subject to mC Workers Compensation provlslons of me, Lake Cods. you mum
raMwith comply with such provisions or this Permit shank deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that mem is a constmeton lending agency for the performance of
the work for which this permit is issued (Sec. 3099, Co. C.)
Lenders Name
Lender's Address
I unify that I have rue this application and sue that the akve information is
cancel, 1 agree to comply with all city and county ordinances and some laws relating to
building construction, and hereby moborme mprousenulives of this city to caner upon the
akw-mcnudgm Property for i purposes.
(We) ogee m ssve, indemnify and keep harmless the City of Cupertino against
liabilities. judgments. expanses
eapemv.which they in any way scree against mid City
o the granting
in cortscquence of me grsnling of this permit,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R TIONS.
Re -roofs
19 AO
Signature of App icenV ono Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building Occupant mom or handle heosendous material
as defined by the CuMnino Municipal Code. Chapter 9. 12. and me Health and Sa(ety
. Scotian 25532(47
❑Yat ✓✓✓ttt
hO rvu
.c
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or deaths which
If a roof is installed without first obtainin an inspection, I agree to remove
g P g
u
nth hpxardous air contaminants asdefined by Ik Bay Arta Air Quality Management
all new materials for inspection.
DisuictT aaa���
0Yes XNu
1 have mal the hamolux smawrialacquiremen s under C7tapter6.95 orae Calitor
nia Hcalm h Safety Code. Senior 25505,35533 and 25534.1 understand thaifine Wilding
does nsL'u fly havea mmol, mot it is my reapormbility m madly de occupant Of ow
mgo'vEmc kµchm my xjnet prior m issuance of a Cmdricae oroccupancy.
Signature of Applicant Date
,J
All roof coverings to be Class "B" or better
Owner or mffimn.d agent D,e