08030020 CITY OF CUPERTINO ���t. r{�� � 77'��t -�7t,[{ xxTT
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BUILDING DIVISION PERKS'IT "CTOR lt�f"�L�1YJ N
PERMIT NO.
Bu"T1WTT'i1RUNERIDGE AVE #RC07 XL CONSTRUCTION 08030020
OWNER'S NAME: PERMIT ISSUE DATE
APPLE INC. 851 BUCKEYE CT 03/05 2008
PHONE: (408) 271-2425 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
O a LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing - Job Description
O with Section 70()0)of Division 3 of the Busincu and Professions Code,and my license is - C OMM r L DEMO, 7 6 8 0 S Q
Li full force and effect / �„F'i 0
y? License CI Lie.N v
F p Date3���—o pi-- Contractor Y. Cv w s b,..
ARCHITECT'S DECLARATION
a< I understand my plans shall be used as public records
aV
O y Licensed Professional
y OWNER-BUILDER DECLARATION
a f 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p OeC following reason-(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct.alter,improve,demolish,or repair any structure
.Z y prior to its issuance,also requires the applicant for such permit to We a signed statement
_< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area $ Valuation
in
t_ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 6 2 0 0 0
! that he is exempt therefrom and the basis for the alleged exemption.Any vtolai on of
Season 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more man five hundred dollars(ssom 316 0 6 0 51`q BpN
(N_umber Occupancy Type
❑1,as owner of the property,or my employes with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Btrsioess
and Professions Code:The Contractors License Law doe not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or tbmugh his
own employees,provided that such improvements are not intended or offered for sale If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
❑I.as owner of the property,am exclusively contracting with licensed contractm to
contact the project(Sec.7044.Business and Professions Code:)The Contactors Li-
cause Law does not apply to an owner of property.who builds or improves thereon.and.
who contracts for such projects with a contractar(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of petjtrry one of the following declarations
❑I ham and will maintain a CemiGeue of Consent to self-Insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the I, Code,for the performance of the work for which this permit is issued. '
My a`'*WorkcesssCompensation Insurance carrier and Policy number arc:
Cartier. LCr Policy No.: a+ G*1 1 It 1.b"Fi if
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed lithe permit is for one hundred dollars($100)
or less.)
1 certify that in the performance of the work for which this permit is issued,t shall not
employ any person in any manner so as to become subject to the Workers'C:ompe nsatica
Lavers of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption•you should
become subject to the Workers Compcuaidon provisions of the Labor Code,you must
z forthwith comply with such provisions or this permit shall be deemed revoked.
O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
Y, > the work for which this permit is issued(Sec.3097,Civ,C.)
:L7 Q Lenders Name
= z Lenders Address
�)0 1 citify that 1 have read this application and state that the above information is
,� ■-' correct 1 agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way acme against said City
U Z in consequence of the granting of m't' permit
'—' APPLICANT UNDERSINMS AND WILL Y WITH A11.NON-POINT Issued by: Date
SOURCE R ATIONS.
3 f ' Re-roofs
Signature of A ntractor Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Sectioa 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �o
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
emir hazardous air contaminants defined by erean Bay Area Air Quality Magcmcnl all new materials for inspection.
District,
C]yes ( No
I have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 aril 25534.1 understand ihat if the building
does not currcntl have a tenant that it is my responsibility to notify the occupant of the -
requircmc h rca-h_ e nn-nr-t nr to T Fd:tn of as^^ifieaue o(Oe�p arc.
3/Sc g Signature of Applicant Date
Owner or au onzcd agent bate All roof coverings to be Class "B"or better