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05090161
CITY OF CUPERTINO BUILDING DIVISION PERMIT aCONTRACTORTWORMATIbN, BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO 3WtT"005090161 10400 OWNER'S NAME: PERMIT ISSUE DATE APPLE COMPUTER 511 DIVISION STREET 09/23/2005 E: SANITARY NO. CONTROL NO. (408) 379-0400 ARCHITEC(ENGINEER: BUILDING PERMIT INFO 0 D PLUMS MECHO 3 0 o LICENSED CONTRACTOR'S DECLARATION UW I hereby affirm that 1 am Reacted under provisions of Chapter momemocine lob Description with Section 7")o(Division 3 of the Business and Prolamines Cade,and my license is ^ mfull(aaeandeffxl. 2 30-DAY TEMP. PERMIT . Z Lleto Clas Lie.N -/ jM' Dem UC-0 ter EXPIRES 10/23/2005, ORIG. #05090056 k ARCHITECrs DECLARATION 1 un aunt my phos sha11 W used as public acorJs y and Licensed professional OWNER-BUILDER DECLARATION .� 1 Malty affirm that I am exempt from the Contractor's License Law for the 0 0 (allowing reason.(Section 7031.S,Business and Professions;Code:Any city or county I� which requires a pvock to convect,altar.improve,dcmolIsb,or mpmir any strucwrc _ 42 prior m =,its Issuance.also requires tite applefor such permit to File a signed wmemm FF G that he is licensed punuanitothe pervislomoftheContractor's LuccaLaw(Chapter 9 Sq.Ft.Floor Area Valuation $0 p�s (commencing with Section 7000)of Division Sof the Business and Profusions Code)or Q that he Is exempt therefrom and the bash for the alleged caemption Any violation of Section 7031.5 by any applicants for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type not more than five hundred dollars(SS00). 31606046 . 00 ❑1,asevoerortik property,ormycerploytes with wagesotheiraleconommation, will do the work,and 1M slrumurt Isnot rounded oronerW forsale(Sec.7044,13.i. and Proreuions Code:The Contmcar's Liana Law does tet apply in an owtmr of Required Inspections property who builds or and who doeeaochwarkhimselforthmugh his ) hman owever,the iprovidedtete wchlmProveremuin are mas leuedodoroBead[heownr.If. I-5/ however,the building or Improvement is sold within ole year of mproe for[heowner. of V builder w10 have the buNan of proving test M did rot Wild or Improve(w purpose of sok.). ❑1.n t owner of the progeny,,B e mess and comaminal with liaised a musses m mesa La sire es not (Bey.7044,Business and property who ons Cade:) pec Communes fid ©.\�+ mese Taw dtsa fiat apply m m owmr or property who Wilde or improves Con and V who ese Laces ray surd%oXete with a cgnV9cmt(a)licensed pwawns mlhe Convanots O l on Law. ❑lam exempt under Sec .B kPCfar Nb moon ner Data WORKERS COMPENSATION DECLARATION I hereby af(im under penalty of perjury oro of the following declarations: ❑I ham and will maintain a CcniOamof C^cent be self-iesure forWorcesCmepe^- as0on,as provided for by Section 3700 of the Labor Code,for the performaxee of the work for which this permit is Issued. ❑I have and will maintain Worker's Compensation Insure^ca,as required by Section 3700 of the labor Code,for the perfamtanm of the work for which this permit is issued. My Warker'a Compen/sp�tion Insuhrmm artier and Polity number am: Carver: ST— YAy 1 Policy Na: hal'LZZ—t I CER71FICATE OF EXEMPTION FROM WORKERS , COMPENSATION INSURANCE (This section read not becompleted if ihe permit is(Monebundad dollars(S1a) or kis) I certify that in the perfmenance of tiro work for which this permit is issued.I shall not employ any person in any manneran as in become abject to the Warrant!Compensation Laws of Calif roW Data Applicant NOTICE TO APPLICANT:1(.after making this Certificate of Exemption.you should become subject to IN,Worker's Compensation previsions of the L mor Code.you most .�- `L forthwith comply with such provisions or this permit Nall be domed revoked. �O CONSTRUCTION LENDING AGENCY [�. 1 hereby afikm that them hi.conswction tending agency 1'or the performance of the work for which this permit Is issued(Sm.3097.Civ.C.) ' 14 Q Lender's Name .7 Z Lendeh Address U Q 1 cerify test I have mW this application and tum then the move Information is D. correct.1 spm to comply with all city and county ordi^uacs and shote laws relating to 0 building construction,and hareby suit representatives of this city to enter upon the {77 move-mentiorcA property for inspection purposes. }Lt, (Wc)agree m— .indemnify and keep harmless the City of Cupertino against „y,n Ilabilides,judgmenu,ensu and expense,which may in my way acrnm against said City („)7 in ca nce of me eu^tin'of Nis Permit. F7 AP ICA of AND LL COMPL LTH ALL NON-POINT Issued by: Date 2 3-4& S URCE ULATIONS. `/�23/, Re-roofs L u AppO HAZARDOUS MATERIALS DISCLOSURE Dem Type of Roof Will the applicant or(inure Wilding compact rare or handle hazardous material ' as deRned by the Cupertino Municipal Code.Chapter 9.12,and this Health and Safety Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu9 0 Will the applicant or rmure building occupant tac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit man haeadnes air ctsminu as defined by the Bay Am Air Quality Management all new materials for inspection. Costr icl77 ❑encs A�Nu readthelt wdouusmamrialemquimmenuunderchapmrG95oftheCalifor- ria I" army Coda Secdm25503,23533ud25534.1unMra "if1M Wilding J not c ndy how a mnam. atts my map mibility a Wdfy tie ooupmt of dm uiarncma Idchmuanbem mossuma acemRe,m7 pansy Signature of Applicant Date -°"� q aS All roof coverings to be Class"B"or better Owner tar awhamted agent Dom