06120047 CITY OF CUPERTINO
BUILDING DIVISION PERMIT j,CONT RA.CTORYINFOIM ATION �
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BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO TNO'06120047
OWNER'S NAME: PERMITISSUEDATE
APPLE COMPUTER 170 KNOWLES DRIVE, STE 19 19,1" 12906
JE:
SANITARY NO. CONTROL NO.
(408) 379-5500
ARCHITECTIENGINEFB: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
.,z LICENSED CONTRACTOR'S DECLARATION
useJbDItGn
F 1 hereby ern m Nm 1 am licensed under provisions of mO85Cr3P Chapter 9(com
encing
�Zty with Section]IXIO)af 0ividon 3a(Ne Buvineu an�,P imuceds.aM PYIi<come u _ ..
r<e in full fora am eRett :L/. Y REMOVE EXISTING DOORS & WALLS TI INTERIOR ONLY
oyvf? License C,taz Limc.N
ac
•Fp Dam I tui Ctrmr INSTALL NEW DOORS & WALLS
ARCHTIECTS DECLARATION
i I underemnd my plans shall W used as public records
1yV
aQt; Licensed Pmf.ional
g OWNER-BUILDER DECLARATION
if I hereby affirm that 1 am amorp,from the Contractors License Law for the
00 following reason.(Section 703 IS,Business end Professions Code:Any city nr county
fm which mamma a permit to construct,also.Improve,demnll h.ser mini,any aaructum
Z< prior to its LtLnal,ec,also mQulrei Na applicant for each permit m file a signed samomenr
that he is licensed pursuant to the provision of the,Contractor's License,Law(Chapter 9 Sq.Ft. Floor Area ValuojbT 000
s�0 (commencing with Section7(00)of Divuion3nfthe Businessard ProfessionsCedc)or
ey$
that he is exempt therefrom and the Ensu far the alleged er<mption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil Penalty of APN Number Occupancy Type
net,ream than live hundred dollars(1100). 31606046 . 0 0
❑1,as owner of the proprny,ser my employcns with wages u their sole campemation,
will da the wart.and Ne structure u noainstu dederaRered torsade(Sec.70th•Busitrse
and Pmfcssimu Code:The Contractors License Law laves not apply In an owner of Required Inspections
properly who builds orimproves thereon,and who doessuch work himselforthrough his
owmcmplayecs,provided that such improvements art not interWM aro@r•L for sale.If.
however,We Wilding or improvement is sold within one yea of completion•Ne owner.
builder will have the Wrden of proving that he did Wt WW or improve for purpose of
sale.).
1,as Owner of the property,am exclusively contacting with licensed contractors W
construct the project(Sec.7061.Business and Profeesiom Code:)The C-ntra:WrS Li-
come law does not apply an an owner of properly who Wilda or improv thereon,and.
who<.mracts for sash projects with a scrausctar(s)licensed pursuant to the Contractors
License Law.
❑1 am tempt under Sec ,B&P C for this moon
caner Dau
WORKER'S COMPENSATION DECLARATION
I bercby aim under pcmlty of perjury one of the following dalareians:
Ihave and will maintains C,r6Bcma.fConsemtasel6insum far Workers Compen- -
seian.az provided for by Section 3](10 of one labor Cade.for the perfarmance of the
work for which Nis permit is issued.
Q I have and will maintain Workers Compensation Insurance.as required by Section
3700 of the labor Code,for Ne perfarmmea of the work far which this remit is Issued. '
My Worker` I nInzu aomiet and Policy number am:
Cartier.Cl/.t:;M0/t 56cy,No.:QIP._
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not he completed if the permit is Intone hundred dollars($100)
or lass)
I certify ths,in to performanec of the work far which Nis Permit is issued.I shall nm
employ any person in any mannerm m In Wcoem subject to the Workers'Compensation
laws arcaNfomia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject an the Workers Compensation provisions or the laWr Cade,you most
,J O forthwith comply with such provisions or Nu pemiuhe]W dccmad mvokcd.
Z C CONSTRUCTION LENDING AGENCY
[•+ IherobyeRrmthnswc
at,hart is a counn landinftgagency for re(mossoce of
1.4> the wart for which thus permit is issued(Sec.3091,Civ.C.)
fA a Lenders Nampo
z Lenders Addroas
V 0 1 certify the 1 have read this application and state Nat the above mi.mo sun is
f^ comm.1 agree to comply with all city and county aminanae and sum laws relaung to
O V Wilding construction.and hereby authoma repreacmatives or this city to enter ulmn the �( /�tyr�(/ /
yAbove-memiuncd property for inepcaian purposes. `w
(We)agree tp save•indcmruly and keep hawed.the City of CuPenino against
f/) limiliuu.judgmenu.ccesandexpcnsnswhichmayinanywayaccmcagaimtaai"a
C)z :.%PPLsequenc Uf the RRran' got AiND,WILL COMPLY WITH ALL NON-PO Issued by: Date
Re-roofs _
gn r T pili HAZAQ GUS MATERIALS DISCLOSUREluCror or 0"' Type of Roof 1/
YII the applicant or forms Wilding=a,.,atort or handle hazardous metrial
as deflated by the Cupenino Mu cipaI Code.LTaprer 9.13,and Ne HcaIN and Safety
40 Code,QYa 35313(6)? No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant o�m building occupant tau gepmmt m dcvicm which If a roof is installed without first obtaining an inspection,I agree to remove
-mit harardnns it contaminants u defined by the Bay Arca Air Quality Ma^agement all new materials for inspection.
District?
❑Yns
I have mad the havrdnus materials reavirmnru under Chapau6S5 of the Calif..
nit Hcahh&Safety CadcSmions 505.23537 aru135530.1 under„,""thaifNe Wilding
docs nm c ntl ha t u my nsponsihilitY m notary do Occup t of tooreyuirtm t h r veemarta-arac-rdfir,ma tm Signature of Applicant Date
!z
Owner azed agem DamAll roof coverings to be Class"B"or better
'