08020078 CITY OF CUPERTINO nT� .,q�i.+�✓:I/<:�>Zpf'�1wo
BUILDING DIVISION P�1 R1Y11T CONfRAIG-11"FORMI'B,TI N
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BUILDING ADDRESS: PERMIT NO.
10300 N TANTAU AVE SOUTH BAY CONSTRUCTION CO 08020078
W NER'S NAME: LINL PERIAT ISSUE DATE
APPLE COMPUTER 170 KNOWLES DR 02/13/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 379-5500
ARCHTECrAR140INEER: BUILDING PERIAMNFO
BLDG ELECT PLUMB MECH
"oo LICENSED CONTRACTOR'S DECLARATION Job Description
yF 1 hctcby am.that i am licensed under provisions of Chspler 9(commencing
n �l withSation7W0)ofDi an7ofNCBminesandProfmuiomCodcwdmyliccratis REV,ADD 3 CONF RMS TO OPEN CONF.
in full forte ad e(few r 'j ��.
?18 LkenaClas Lic.g AREA—ORIG#07120018
F Dam_e �—Contractor kQ.f.c
e f ARCHITECTS DECLARATION
y I understand my plans shall be used a public mcnrN
2W0
G Licensed Professional
b y m,Ia.OWNER-BUILDER DECLARATION
ConTIDN
to I hemby.(sero on 1 em exempeJmm the Contractors :Any c Law far the
10 0 whicfolloh rP mnson. er it t 703 1.5.Business and vC.de ons Cale:Any city or county
z$ which itsinuapcrush recnrstheplot Wpmvo,dcermitt rare a sig anymumum
x P„' prior b its iumae,elan mguime the Applicant fo Co permit to Ole a U.(Chapter
< thalIm ncemenadpusttion7f)ofDivlouofdoCanuayr''anwvcltaw(CNpc9 Sq.Ft.Floor Area 0 Valuation
tham a is exemilmpt
with Swdaoun and of Division 3 the
the egad Business and proon.Anyavi Code)of
Nal io r eru5b my applicant
tab the aper for be alleged exception.to Any it penalty
of
Session WBLS five
ury eppliwll fora permit subjects the applicant la a civil pendty o! Number Occupancy Type
not mom than rice hundrtd dollars(5100). 31618 0 2 5 7�dNl
Q 1,u owner of the property,a my=ploy=with wages u Her rule compensation.
will do the wok and themuctme Is not intended or offered for ask(Sm.] .Busineu Required Inspections
NWns
d PIofCnCade:The Can11K1oYe License U.duces m N MI apply .—Of 9 P
pmpeny who bYllda afimpmwe Ill[reAn.and who doeseach work hrnalfar Iheugh his
oweemployen.provided that such improvements see not intended araQerd for Ws.IL
however.the Wilding or Improvement is sold within one year dcamprtim,the.
builder will haw tins burden of proving that M did tat Wild or improve fa purpose of
ssm)L
Q I,m owncr of the progeny am exclusively contracting with licensed tmntractom y
construct the project(Sec.7044,Business and Professions Cude:)The Cmum7eel Li-
roue law does not apply to an owner of progeny who Wilds or improves Nemon,end
whoeonuacts for such projects with a amnurutor(s)licensed pursuant to the Contractors
Lieenru Law.
❑I am esemp,order Sm ,Bh PC W this maxon
ale W RKER COMPENSATION Dau .
ATION DECLARATION
1 hereby affrm under penalty of perjury cane of the following deelaasi ms: ..
Q l mve end will msinWn a CeNOwts of Convent y selFinsum fa Workers Compen-
uthm,u providad for by section 3700 of the labor Costs,for the performance of tha -
work for which this permit is issued.
Q 1 have and will maintain Workers Compensation Insurance,as required by Section
3700.(the labor Code.for the peRaossam. fthe work for which this permit is load '
My Workers Compensation Insurance carrier and Policy number am:
Carden Policy Na,:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This aNm need tyle W camplesd lime pesmll rformc hodAddo Lara($100)
or leas)
I wruh, that in the performuw of the work for which this permit Is bound,1 shall nm
employ any mann in any mortar an u to become abject to Pe Worked Compensation
laws of Caiifar if. am
ApplianI
NOTICE TD APPLICANT,IL eller matinthis Ceninwm of Exemption.you should
become subject be the Wasters Campcnuti provisions of the Raba Code,you muss
.JO forthwith comply with such provisions or this permit scall W deemed revoked.
r► CONSTRUCnON LENDING AGENCY
[—t I hemby affirm that then is a construction lending agency for the performance of
fx .moi the work for which this permit is issued(Sec.3097,Civ,C.)
Q ]antlers Name
= z Lenders Add.
f,0 1 Certify that I have road this application ad sup that the above information Is
W coma I agree to Comply with all city and county oNlnataxs and fur laws relat ng In -
-p Wilding Construction.and hemby authorim MpocanWivea of this city to enter upon the
W above-mentioned property for hupection Purposes
0. (We)agree to uve,indemnify and keep humle s the Cly of Cupertino against
len liabilities.jutgmcnu,coast and expenses which may in any way scasuc against mid City
t„)7 in conaqucnce of the granting of Nr Permit. —2
w1- APPLI UNDERSTAND D W�bL COMPLY WITH ALLorom NO Dale
,P ! Issued by:
sig plicmVConUdmr .te Re-roofs
Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building acupanlston,or handle haadous material '
as deamd by the Cupertino Municipal Cade.Chapter 9.12,and the Roam and Safely,
.
Section 25532f.n �1 All roofs shall be inspected prior to any roofing material being installed.
Will the.ppliarut Or sal\ore building aCeupant use equipment or devices whish If a roof is installed without first obtaining an inspection,,I agree to remove
emit hanAnus air comamirunst as defined by the Bay Area Air Qua ly Management all new materials for inspection.
District?
QYesu
I have read the ha ndwnumularrcquimnrcms under LTapmsb.95 ofthe Califs-
rale Hut"Safety Cob,Satins 25505,25533 am125534.I understand thatiftic Wilding / / X /�� t 3( t)
baa t' I, Nat It' m cJfdIhY b notify do o Clam of the yyCC..JJ
rtqulrttnva6vdcIt mom he met la;ar afaC Tecate-( I 8.. Signa of Applicant Date
/ �,�µ/ 3
Owner agent Doth All roof coverings to be Class"B"or better