06040171 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 4 CONTRACTOR�INFORNTATIONk`,
BUILDING ADDRESS: s SOUTH BAY CONSTRUCTION CO "NO06070171
10400 RIDGE VIEW CT
OWNER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 170 KNOWLES DRIVE ST 120 07/25/2006
SANITARY NO. CONTROL NO.
(408) 379-5500
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION
m I hcseby affirm Nat I am Incomes under pmvisiaiu of Chapser 9(mmmewiing (1
liE with Section7c)(K)af0Business and n 3 ofthe Busiand Profeuiad,Code,and my license is
<d in fullfartc ndUf t BUILD LAB AND 2 COMMERCIAL
License Coir ,
p Dam Contractor 1 /
Ivy m ARCHITECTS DECLARATION
i m< I undcrsu y plans shall W tied u puhlic recoNs v)
?yU
;oG Liucmcd Pmfcssional BUILD OWNER-BUILDER DECLARATION fktci}_QI!(tl
1<i I hereby affirm Not I am exempt foam the Convacmrs License Law for the
.c c fallowing mason.(Section 703 LS,Business and Profeuiom Codes:Any city at county 'fgggsssJ���'���aaa�ft t(yg7g
a which mquima a permit m conduct alcor,improve,demolish,ar repair any swnure w C7 $100000
prior m its issuance.Alm requires the applicant for such permit to rile a signed statement
< theM islk,macel pmsum to Nracm
ac provisions of the Contrs liectue Law(Chapter 9 Sq.Ft.Floor Area Valuation
�i— (canmencing with Section 70()0)of Division 3 of the Business and Professions Code)or
IRE Nat m u exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicator for a permit subjects the applicant to a civil penalty or er Occupancy Type
not more Nan five hundred dollars($SW).
Q 1,as owner of the property,or my employees with wages az de's code compensation,
will do the work and the structure u not intended or uttered for aak(see.7044.Business Required Inspections
And Professimp Code:The Canuaes cmea License Law doout apply m e ns an owner of q p
property who Wildsorimpmm thereon,andwM dassuch work hineselfor Eluough his
town employees,provided that such improvements me not intended oroRered for sale If,
however,the Wilding or improvement is sold within can year orcompletion.the owner.
builder will have the When of proving that be did WE WHO Or improve for purpose of
sale.).
❑1,As.caner or the properly,And exclusively contracting with licensed contractors m
construct the pmjem(Sec.7W.Business and Professions Code:)The Codvamr's U.
cense law does not apply m an owner of prepcny who Wilds or Improves thereon,and.
who comracu for such pmjecu with a conuacmr(s)licensed pursuant as the convectors
License law.
❑ I am exempt under Sec ,B&P C for this mason
Owner Dam
p1WORKER'S COMPENSATION DECLARATION
1 hereby All under pcvally of perjury tone of the following declamations,,
Mae and will maintain a Canifncme of consent o self-insure for Worker's Compen-
sation,u provided for by Salic.3700 of die Labor Code,for the performance of de
were for which this permit s issued.
Q 1 haw and will maintain Workers Compensation Isuuraruc,az mquimd by Section
37M of the lama Code.for Ne performance of the work forwhich this permit is issued. '
My Workers Compensaq.Yon InsunnF canierr knd licy number am:
carricr:�LQdfP�do/J fi KatiepolsGiy d 31
CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(Thda smite wed Mt W completed if the permit is foredo hundred dollars($100)
or less.)
I Canify Out in the performance of Else work for which this permit is issued,1 shall tool
employ any permn in my manner an az m become subject m the Workers'Compesuawn
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificatc of Exemption.you should
become subject m the Workers Compensation provisions of the Lather Cade.yen must
.,Q forthwith comply with sech provisions or this Permit shall W deemed rewked.
'z" CONSTRUCTION LENDING AGENCY
Ihereby.from that thore is a construction lending Agency for the a6droaac of
6i the work for which this permit s issued(See.3W7,Civ,C.)
W�Q Lender's Name .
.7 z Lenders Address
U0 I certify that I have mad this application and sum this the above information s
Iy F" Correct.1 agree m comply with all city and county ondinaaes and state laws elating to
O V building concoction,and hereby authorim representatives of this city to enter upon the
�gf7 alavc rwwoad p.,rEy for inpcction purples.
(Wes)agree to saw,indcmm fy and kap hosmleu the City of Cupertino against
fA liabilities.judgmcns,costs and expenses which may id any way Accra,against said City
V z inc.negveae of the granting of this permit `
^ A NT UNDERST AND WILL COMPLY WITH L NN-POINT Issued by: Date
Re-roofs
of ApplinDt Dates
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupant
t ast..one orm handleHealloamaterial
AA defined by Elne Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Code,Second 25533(a)? `/ All roofs shall be inspected prior to any roofing material being installed.
❑Yea �7 Na
it
Will the applicant.,Fund.Wilding occupant um egvipment ar Jcviaa which If a roof is installed without first obtaining an inspection,I agree to remove
Distinct�ous air conumirmalsas defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes y No
SalcyCI
ria hawrealtheadhc a,Soncti tmhemtrialem55
q3u3imvmc7.5ns534.1 aWpmrd ifthe Wilding
J al rtSwim bowaesict.that ItAmyreponshilitytt wary the pec-partmftW
re immenuwhichmuvWmet cr uaacof Ccnita.wof m Signature of Applicant Date
tzif 7
er or a .nxee ogre ry,te. All roof coverings to be Class"B"or better