05100166 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � ,CO,NTRACTQ,R�INFORM'ATI
ENN
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO 3r1` '00.05100166
10400 RIDGE VIEW CT
R'S NAME: PERMIT LSBUE DATE
APPLE COMPUTER 170 KNOWLES DRIV
1AI'CHTTECTIENGINEER:
E:
SANITARY NO. CONTROL NO.
(408) 379-5500
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � � 0
Ac" LICENSED CONTRACTOR'S DECLARATION
I hereby affirm Nat 1 am licensed under provision of Chzpar 9(commencing Job Description
wection]0(fU)of Division 3af NC Budnesaand Professions Code,arm mylicenseas
in full fume and effat. ORIGINAL PERMIT 05090056
License Class Lm.p
Dam Contractor REVISION, DELETE 2 ROOMS/MODIFY MECHANICAL
1 ARCHITECT'S DECLARATION
I, I understand my plans shall he used as public records
)0,U
a G t' Licensed Pmfcssional
1 OWNER-BUILDER DECLARATION
2 c I hereby affirm Nat I..cxcmpt from the Conoamm's Liccnsc Law far the
-00 fallowing reared(Sccllon 7113 LS,Business and Professions Com:Any city or county
<SZ f•! which requires a permit to smounc4 alcor,imPmw,demWtah.or repair any stratum
prior m its issuance,also requires the applicant for such permit to rile a signed sutsmem
'< that he is licensed pursuant to NC Provisions of NC Conlmnur's License Law(Chapter 9 Sq.Ft. Floor Area Valuation $1
r'.v
yF�
(commencingwith
arefum7t100)th DookianroftMBusiness
xe and Professions Cade)ser
•° Nm W u exempt therefrom and the bazu for the alleged exemption.Any violation of
Section 7031.5 by any applicant(or a permit subjects the applicant o a civil penalty of pane PN Number Occupancy Type
re th
nut moan five hundred dollars($500). 31606046 . 00 - p y Yp
1,as owner of the popany,or my cmploycs with wages as their sale compensation,
will do the work,and thcawcmre is not intended or offered for ask(Sec.7044,Bulinus Required Inspections
and Pmfcsslens Code:The Conuucmrs License Law dors e out apply ta an owner or q p
progeny who builds or irepons thereon,andwhodocssuchwork himsea f serthmugh his
own employers,provided that such improvements art not intended ora@red forsale.IL
however.the building or improvements sold within one year of completion.the owner. <!
builder will have the Mm W Nof proving that did tat Mild or improve for purpose of
sale.).
❑Las owner of the Ste.704,.B exclusively Professions
with licensed contractors m \�
0 1.as the Owner
the
(Sec.]044,Business and contracting
Code:)The d contr cttr to
cove Law does not apply in an owner or popeny,who Milds or implem thereon.and.
who commcm for such projects with a canonicals)licensed pursuant to the Contractor's
Lice a,Law.
❑1 am cxcmpt under Sec .B&P C Por Nu reason
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the following declarations:
❑I have and will maintain a CeniGrvm of Conscnuo adbinaum far Worker's Compcm
sawn,is provided for by Satan 37W of the,labor Cade.for the pinformartce of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as ruptured by SCCtian
37W of the tabor Cook.far the performance of the work for which this permit is issued. '
My Worker's Compensation Imunntt carrier and Polity number are:
C.nn,.. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need oar he completed if the permit is for one hundred dollars(51100)
nr less.)
1 certify that in the performanee of the work for which this Permit's issued,l shall not
r_mploy any person in any manner so as Or become subject to NC Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.after making this Ccnificam of Exemption,you should
become subject to the Worker's Compensation provisions of Nc labor Cndc you mot
faMwiO comply with such povomm;an Nu permit alta]]W deemed revoked.
CONSTRUCTION LENDING AGENCY
V
tri r. There by aRtm Uw them usumd(Sec.3097,Chu. agmmy for the Performance of
D i �� he wish Nur which Nu permit a usucd(Sec.3097,Civ.C.)
r'4 ladder's AName
dd
(=� Lender's Address
G,
I
3�i I cenee Nal 1 haw rad this y and county
ty o sure Nm Jm aWw iwsmmating u
canon,l agree m comply with all city and caumy ordinances and Cute laws mating to
(y�i
buildingconstruction,ion,and forebyacuorinrcprescnatives of this cirymcnmrupon Ne �(`Q/ryv�/\1/fy(/, /////�/7
,(1] zhovo-mrnuuncd Popcny farinspccuon purposes /`^C/�JV
(we)agree to save,indemnify add kap hmmless the City of C.,nine against
!•J lq inciliues,judc of the granting
eapcnsecmit. may In any way accmc against said City
`y APPLICANTcUNDERSTANDS AtNDrWILL COMPLY WITH ALL NON-POINT Issued by: Date
.SOURCE REGULATIONS.
Re-roofs
Signazum of ApplicaHAZARDOr Dam
HAZARDOUS MATERIALSDISCLOSUREURE Type of Roof
Will dee applicant or future building occupant r 9.1 or handle hmardoue material
defined by the Cupertino Municipal Cade.Chapter 9.12,and the HCdlth and Safely
.Sccuon 25532 my?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
Will Ne aPp]icam Of(uture Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus air contaminants v dcGncd by the Bay Arca Air Quality Management all new materials for inspection.
District?
by. ❑Nu
I have mad We hantdras materials requirtments under ChaPmr 6.95 order,Callror
nice Hcalub&Safety Codc.Sections 25505,25533 and 25534.]undcrsmnd thdSthe Wilding
does not cunendy have a tenant Nat it is my responsibility or ratify the aaup.,of the
requirements which must W met prior III issuance ofa ccmficam of Occupancy. Signature of Applicant Date
Owner ar,uthoriardagent Data All roof coverings to be Class "B"or better