06090210 CITY OF CUPERTINO 7 :::7 �-""
BUILDINIPLIVISION PERMIT �xCONTRACTO,R TN,E,ORMATION,
BUILDING ADDRESS: RELIABLE CONCEPTS CORP PERMIT NO.06090210
19310 PRUNERIDGE AV
OWNER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 954 CHESTNUT ST 2006
SANITARY NO. CONTROL NO.
(408) 271-6655
ARCHRECT/ENGINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
0 0 0 0
imp 0p LICENSED CONTRACTOR'S DECLARATION IOb DeSCiI tion
m❑ 1 Waffirm N
mby aal 1 am licensed under provisions of Chapter 9(commencing P
iiW with Salon70110)of Division Sof Ne Business and Professions Code,and my license is
>>N Nmirms amderrect. l m TI- CONVERT OFFICE INTO ARCHIVE STORAGE ROOMS
ar�z D.`1 li: contractor NON-STRUCTURAL
F-p Dam `P f�,¢{jLF�ARCH—nECTS DECLA i TION
i¢ 1 undcnunJ my plans shall W uutl u public,cnrds FINALE
p6°
,Dy Licensed Professional
OWNER-BUILDER DECLARATION
1 bermy affirm Na I am exempt from the Contractor's License Law for the
:2C following mason.(Sectian 7031.5.Business and Professions Calc:Any city or county
i m which requires a permit to cnnsvubL alcor.impow,demolish,or repair any swcturt
�xi pdorto its issuencc.also requires Nc apPlicam forsuch permiva flc asigncd summcm _ -
< Nath'isliecucdpursuanlinOnpos,him .(t he Contractor'.Lice.Law(Chapter 9 Sq.Ft.Floor Area UU Valud$iUrS250
(eommetrcing with section 7000)Of Gritin.3 of On Business and Pmrcesms Code)or
that he is exempt Ihe,from and thm basis for the alleged erempdon.Any violation of
Section 7031.5 by any applicant for a permit subject,On applicant to a civil penalty ofQ3p Number t( Taney Type
not more Nan five hundred dollars(5500). 3 1 O l7 6 0 51 • 00
❑i.uowar of Ne praperty.amy employees with wagesu Nes sole compeuathon,
will do the wok,and the structure is not Wended or offered for min(Sec.1044,Business Required Inspections
and professions Code:The Com eaeror' n s License Law dotot apply ad.owner a e q ns P
Property who Wilds or impoasthroson.and wW doessuch workhimxJforNmugh his
Own employees,provided that such improwmanu art notimended oro02red forsala.If, -
howemr.the Wilding or improvement U sold within ow year of compwtion,she owner-
builder will base On Wmden of proving that W did out Wild or improve for purpose of
cob.).
1,as Owner of use,property am exclusively contracting wish licensed con ractors to
construct the pmjcm(Sec.7044.Business and Professions Cade:)The Conmcmr's Li-
rease Law dao out apply 0 in owner of property who Wilds or OrPM s thereon,and
who contracts for such projects with a contractor(s)licensed Pursuant to the Contractor's
License Law.
❑lameacmptundn See .B&PCfathureason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby aRmtunder penalty of Perjury orm of the following deelarelw or
I have and will mainuin aCerdfinm of Conserv to self-insure for WorkctSCompem
salum.as provided for by Section 3700 of the Labor Code,for she performance of the
wok for which this .it is issued.
❑1 have and will..let .Wm1mri Compensation Insorm..as required by Section
3700 of dm Labs Cade,for Ne N formumt of On wok for which We Penni,is issued.
My Worker's Compensation Insurance Insurance carrier and Policy number are ;/
carrier.ZU )--6ry fimc'��POCfry No.:G�L� 2 7 �c
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rho inion need not W complemd if the Permit is forow hundred dollars ISHII)
ter less.)
1 certify shat in she pe,itmo nee of me work for which this permit is issued.1 shml not
employ any person in any mumcrso as to become subject to Nc Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Out Cenifinm of Exemption,you should
become subject m the WmlxYs Compensation proWsiou of dm Lmror Code,you most
., O forthwith comply with such provisions m this permit shall W deemed remked.
Zuj CONSTRUCTION LENDING AGENCY
Ce I hereby alFrm Net Ne,iso consued..lending agenry for the pe,fmonance of
C'5: the work for which this famnit is issued(See 3M.Civ.C.)
Uj A Lender's Name
Liv Undies Address
U 0
U O 1 ttnee that I have mad this application and sum Net the shoes information is
0 F^ bunco.1 agreetoComply withal.city and coumyominances and laws col,.mingto
OU ah.wbuild-gmimid proNnd hc.byhones, cti,mpilmrinc,prcxnutivn ofmisciryso cnmrupnn tW
,hove-(We)a agree
for imnPenion Imcf)hs.
Hy (Wc)agmet.cost,indemnifyandkeep hay inmtWywor Cupenst id City
(q liemismume menhe gruud expenses
ron. they in anyway accrue against said City
r V z A consequence of the WAN of this permit.
^ APPLICANT UNDE 81'ANDS AND WILL COMPLY WITH ALL NON-PO NT Issued by: Date S 2
SOURCEIjCGUL O �_ 571--Z
/ /
inca / /'/ Re-roofs
Signawrt of ApplmenVComcoctor pea
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store m handle haurduus material
u defined by dm Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Code,Sceden 25533(a)7
❑Yes m'NO All roofs shall be inspected prior to any roofing material being installed.
Will she applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
n ha,amnns air emmarn oanu u defined by the Bay Arco Air Quality M...gcmtnl all new materials for inspection.
Dietri,t7 / P
❑Yes �No
1 have road Ne ha,amsrusmamrials mqui,menu undcrCWpmr G95 of Ne Cs.ifor
nizKmil &Safety Cade,S =25505,3S533a M534.1undcrsmndthmifthm Wilding
does MI cuncm.y haw a m anL Nat n u my rnponsihi.ity m roof,dm.,open,or she
reyui`menuw ichor rLtp'a toiuuan¢sfaCertificate O� , Signature of Applicant Date
Owner ar anNmrved ag,mt D,m All roof coverings to be Class "B"or better