05090056 CITY OF CUPERTINO -�-
But
DIVISION PERMIT CONTRACTORINFORMATION
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO 3Y4rT NO-05090056
10400 RIDGE
OWNER'S NAME: PERMIT ISSUE DATE
10 APPLE COMPUTER 511 DIVISION STREET 09/29/2005
11WEi SANITARY NO. CONTROL NO.
(408) 379-0400
ARCHI'IECWENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION
w I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
,Z, with Section 7")of Division 3 of NC Business and Professions Calc.md my licensea
'<o Pct N full forte and effect. 1 TI-OFFICE SPACE
1y0 License C1 Lk.il s h l f'� 2 CHAMBEflAALED
;rc Dam B �ConDECL T-BAR/NEW DOORS
ARC all be u el DECLARATION
�� I understand my plans shall be umd m public records
JyU
Lw� Licensed Pmfcssiomol
00 5 OWNER-BUILDER DECLARATION APRi5/
—
LOOU<I 1 hereby alum to I am exempt from the Comrutah U.nu Law for the
o O following mason.(Section IID 1.5.Business and Prefee on,Code:Any city or county
i m which requires a permit to construct,eller,impm m,demolish,or repair any awcture
prior m its issuance,also requires the applicant forsuch permit in fin a signed statemcm
S
<
that he is licensed pursuant to the provisions of Ne Contractor's License Law(Chapter 9 Sq.Ft.Floor Area 06
.1-0
~0 (commencing with Scctirn T)nd du Division l of the Business and on.Any
Code)or
Net he is eumpl therefrom end Ne bus for the,alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjecs the applicant to a civil penalty of APN Number Occupancy Type
net mom 0.five hundred delta.($5101f. 31606046 . 00 p y YP
❑1,as owner ofthe property or my employ=wish wages as their sole compensation,
will de the work and the swan¢b notinm and ora@red forsake(See.7044,Business
and Professions Code:The Conuxmrs License law des roin apply an owner of Required Inspections
progeny who builds or improves thereon,and who does such work himself or through his
own employees,provided that Inch improvements am not intended aoffr ad forsak If.
however,Ne building or improvement is sold within one year of completion,the ow er-
builder will have the tanden of proving that he did not build or improve for purpose of
sale.).
❑I,Is owner of the progeny am exclusively contracting with licensed contractors in
construct the project(Sec.7144,Business and Profcwius Code:)The Contruuri Li.
cc""Law dean not apply b an ower of propcny who Wilds or improves thereon,Ind.
who contracts for such projecs with a contractor(s)licensed pursuant to Ne Convectors
License law.
1 am eaempt under Sec. B&P C for this..on
car Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following decimations:
❑I Moe and will maintain aCenifnmof Conunnoulf-imoureforWorkersCompen-
snion,u provided for by Section 3700 of the labor Code,for Ne performance of Ne
work for which Nis parmit is issued.
❑I ban and will maintain Worker's Compensation Insurance,an required by Section
3700 of the labor Code,for the performance of she work for which this pemtit is issued.
My Worker'a Compensation Insuran¢carrier and Policy number are:
Carrier. V-A,ri f+l a Policy No.: V110?100oDt�
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Obin union need Trot be completed if rhe permit isforooehundred dollars(5100)
or In..)
1 certify Nat in the performena of use work for which Nis permit u issued,I shall not
employ any person in any manner so as m Memin Subject o th"Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject in the Woher's Compensation previsions of the tabor Code,you mum
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
Ihmeby.M.WS Vert iso ecastrwrtinn lendingigency,for the perfunnin¢of
ai she work for which this permit Is issued(Sce.3097,Civ.C.)
alender's Name
.7 z Under'$Address
C.3 Q 1 minify that I have mad this application and ram Nat the above information is
!g,r' correct.I agree to comply with ill city and county ordinances and sum laws miming to
O U building construction,and hereby auNoris Lepmsenutives of this city venter upon d"
F Gabove-mcmioned progeny for inspection purposes.
(We)agree m save,indemnify and keep harmless the City of Cupertino against
h Iiacoitiequenc of be cents and expenses Permit. may in my way accrue against said City
(„)z A consequence of she granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL CO Y WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signuumo A(.
HAZARDOUS
Dam rca
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII theeCupmttor future Wildinge.Chapter 9.1mIn to Health and
U defined io the Cupertino Manic' 1 Code.Chapter 9.12,end the Health and Safety
Calc,Section 25532(a)?
pyo N� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future WildingaccuWnt use equipment our devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conteminan�fincd by the Bay Area Air Quality Management all new materials for inspection.
Diasict?
❑Yes Nom
I have mad the hanrdous materials rtquimmena under Chapter 6.95 of Ne Califer
nin Health&SafctyCodc.Secvas 25505,25533 and 25534.1 Lnderman that if the Wilding
doer not cwremly have a"mora that it is my reaponsihility to nrtilY the acupert of the
mquiremcnu which mum W an r to iuuaac ofa cmurma"of Occu Signature of Applicant Date
��s All roof coverings to be Class "B" or better
Owoero rigid agent Dam agent Da"