06050200 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CONTRAGTORINF'ORIVIATION�`ffi
may...✓l1ti fA.,_,.:!K§ t, aF.:�IR�' 2 S.�•Y :@
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO fW"°'06050200
10500 RID
OWNER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 170 KNOWLE
+E:
SANITARY NO, CONTROL NO.
(408) 379-5500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
80 Z' LICENSED CONTRACTOR'S DECLARATION lob Description
U F I hereby acorn Nam t 1, li¢azed under provisions of CWper 9(commencing P
2 'uj vidiSection713M) Ation3ofine Busnecsand Prolookuu Code.a mylicc=is
s inimseaforce and end5. (.�ce1, INTERIOR DE NT IMPROVEMENT
Ll Lk Lm.g
T. Da¢ Comtazmr
qq ARCHITECTS DECLARATION L�V
f C< 1 un ratio my plans shall W used az public me.mals �GN
tj
odu
Licenced Pmfassional JUN 2006
5 OWNER-BUILDER DECLARATION
E 1 hereby affirm Nat I am exempt from the Contractors Lieeme Law for use
❑O fallowing maven.(Section]ID L5,Business and Professions Calc:Any city or county
3 w which requires a remit m convent.alter improve,demolish,tar repair any rtructum A $25000
_I6 pdorin its issuance.also requires the applicant for such Permit m file a signed statement rb
wine ishatned Parm,mmwptorlsiom orwcantmemn LJeavc haw(CsuPter9 Sq.Ft. ^" Valuation
is (commencing with Section 7000)of Division 3 ofw Businessand ProrcasinM Cade)or
y Nat he is exempt themBom and L e baso for the alleged erempGan Any violation of
Section 7031.5 by Grey applicant for a permit subjects the applicant in a civil pmtahy of er U U Occupancy Type
not come Nan five hundred dollar($$D3),
0 l.m wmrofwpmprny.mmyemploymwiNwaguaz Nehsalemmpcvadon.
will da w work,and the he Cor a not intended or Law
does
a(Sec.]ON,Businw
and property
lou Cade The canlemem, ndwho Law dm net apply to an owner or Required Inspections
prapenywho builds or dO.I.himp,and whorl mtinwork him,elfmtlwugh his
awnempbymiprovided veloven improvementsamne you
mpeesed for ale r.
however,the Wildingarimprovement i,sold within
n, year of completion,wawe of
builder will have w Wrdcn of proving Nat he did not Wild a improv]for purpose of
sale.)
.
El 1,as owner of the property,i m exclusively contracting with licensed can eems.in
conswcl due proton(Sec.Tri Business and Professions Cade:)M Contractor's Li-
..Law dm net apply to an Owner of property wino Wilda of implore]wRan,and,
who contracts for such projeeu with a eons acmrb)licensed pursuant to the Contraemrs
Llmnae Law,
❑I am aunpt under Sec ,B&P C for this tablas
ser Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pedur,arc of the fallowing dxlaretiass:
❑I have and will maintain a Certificate of Content to self-baum for
ss far S3700 of w labor Cade,fm w pWerofrokmcrasnCeeomofpetWn-
wells for which this pemit is issued.
❑1 have and will maintain Workers Compemties Insurance,as required by Section
3700 of the Labor Code,far to poefarmanee of the wart for which his .it is issued.
My Wo r, amPeazati n n1Su trial oil Policy numlbteraare:
Cartier. I 1� at'P19 No.: `5J 1Z-zz--I
CERTIFICATEOFE EMPION FROM WORKERS'
COMPENSATION INSURANCE
(ILO section recd oat W completed if he permit is for one hundred doWas(SIM) r
or leas)
I canify that in Ne Performance of the work fw which this Permit is issued.I shall not
employ any person in any manner an az to become subject to the Workers'Compeltsotion
Laves or califomib Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
btcome subject to Use Warkera Campemauan provisions of the Lab]Code,you most
O forthwith comply with such provisions at Nu permit shall W domed revoked.
'z�+ CONSTRUCTION LENDING AGENCY
I hareb aRm wt there is a com mctins lending agency gettcy far de performanee of
e4> the work rm wrier Nis Perch i,issaed(sal.3897,air.ca
Loader""oma
=z Lenders Adalm
U O 1 cavi%that 1 have mad this application and rise Nat Ne AbOn information is
comet.I agree to comply with all city and county oNisunees and state laws relating m
OU Wilding conslNction.and hereby a uthorimrepresentatives or this city to enter upon the
F51 move-mentioned Pmpcny foninspection purposes.
f~ 6, (We)agree to on.indemnify and keep homeless the City of Capanina against
to liabilitiaturce cnts.costs and or this
may baro way intense Against add City // -�f
U,'Z in co tierce of w granting of Nis permiL Y Dale �. Z J �e7
1 NT
UM
DERST Nf AND WI COMPLY WITH ALL NON-POINT Issued b :
OUR REGULATIO
Z 3OrL Re-roofs
i n ApplicanuiConoratemor D.I.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Use applicant or future Wilding occupanL,mre or handle havardaus material
az dcflmd by the Cupertino Municipal Code.Chapter 9.12,and tW Health and Safety
otic. 25532(,)7
Ely. VNa All roofs shall be inspected prior to any roofing material being
Installed.
Will the applicant or hatm
Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
call havardnus air co unalit u dclmcd by One Bay Ama Air Quality Management all new materials for inspection.
Diatdc17
❑Yes No
I have read Ne bvatdeas otaurbl,nequirementsunder Ompter6.95 of Ne Caliper
ria He.]"Safety Cade,Sectiaa255(15,25533 and 25534.1udersund Natifw Wilding
dao n try nova a tenant t u my bility m testify Lha occupant of Ne
regvi torn bknmapWme tloim r.cerdficaeor cup Signature of Applicant Date
(At a3 aL All roof coverings to be Class "B"or better
Owtrere moriaaa]gem ate'