08040117 CITY
Buaowc mvlsloN PERMIT CC1N CRALGTQR7NE�RM�1xI ' N
M;,
BUIlDINO ADDRESS: PERMIT NO.
10300 N TANTAU AVE SOUTH BAY CONSTRUCTION CO 08040117 .
NER'S NAME: .PERMIT I%"DATE
APPLE COMPUTER 170 KNOWLES DR 04/24/2008
HONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
ZREPAIR EXSTNG PRTL FNDN BLDG ELECTO �UM MECH
O O
Sop LICENSED CONTRACTOR'S DECLARATIONfaff REP Job Description
rd 1 hereby.M m that un
1 sm licensed der provisions of Chapter 9(mmmeO
minl
with Secdon l000WDIAslon 3of Ne Bualaca xod Profensslum C pe.and my licemc is
e in full force and off- bvl
l.kxrsaCl LIC.I
Dau Conuacsm TYv,
o ARCHITECTS DECLARATION
3(
u I uMers.nJ my plans Mall ho ueJ as public records ,
y heti�
Licensed Professional
m OWNER.m'EmoUILDERDECe Coninel
<i ION
I horeo ,(Sean Nu 11. exempt from the Cessom Co License taw for the
O O whip mr dres a permit
1 Icon 1.5,Bualacas and pmfcetinm Calc:Any city m county
9 whichrtqukranpefmh mconaroelalkc.ImPmw•demmili orrepaira sig emy duuctum
Z t'r prior b its iumme,also n to the the Provisions
for suchCon permr's Lac am signed sukmem -
< tmmumelnwit pursuant 70th)pmrisisio of Ne Conuackrillcenscls (ChapterCode)
Sq.Ft.Floor Area Valuation
$D chanmeain{with Suction scultf Division rof the Budnwugon.ProfessionsmC.de)of
Na be k comps Ihortnme end the bask for Ne alk[ed eaemptiafL My viol.ton of
Satoh 7031.5 by an,applla.t per.permit subjects the applicant m,civil pemlty Of APN-Number Occu ane T
het mom than fiw hundred dollars(SSW). p Y Ylre
❑Luewnaofthepmpcny,omyaoploymwuhwgaatobmlecempensvden,
and P°oerfout Code:The Conan.I kumse Lawme:mWaarm,,to sm of Required Inspections
property who buildsaimpmwa NermeaM whodeessuch warthimelf aNmvgh his
earn employer,provided that such imprewme.0 art amt intended aoRefed(mule If.
howew,Ne building or Impmwmml Is mid Whin am year of compledon,the owner-
Wilda will ttsw use burden of proving that he did rot harm or improv for purpose of
sale.).
❑I.as owmr of fro property,the acluuwly con.Nng with licensed contractors to
comtsuct the projem(Ser.TON,Buunea am Prakaslons Code)The Contractors u-
ecme Law does not apply in.n owns of property who Wilds or Wprova Neeson,and
who contracts for such projects with acon.etar(s)Remand pma.nt in the ContnemM1
uxne Law.
❑lamexerrimunderSee .BAPCfothuresaom
Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pemlty,of pajoy arc of the following deckaWone
❑I Itsw end rill munWn•Catfiam of Camcnt m elf-Insure fa Waiters Compere
earth;as pmvided for by Satoh 37W of than Labor Cade.for use performance of Ne
work for which this permit is lamed.
❑1 haw and will maintain Worters Compensation Insueance.as rtqulmd by SecOon
3TW of the labor Code.for the peaformanceof Ne wart for wbich tis pe.I,is luued. '
My Worlme.Conpeesatoo Inatratce aria and Policy number am:
Cartier. It17Gka.S'n L'17 J J d" 61cy No.:2OOJ3'DL/9'5 a_D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mda seed®aced rot becamplcted Ifthe permit Is faoehundrd dollars(SIM)
or lesa)
1 certify that In the perfotmmeo of the wart for which this permit Is Wood.I shall nm
employ any person in any manacrsa as in become subject to the Workers'Cmmpenutan
Laws of California.Dau
AppBant
NOTICE TO APPLICANP.IL after making NB Ce timate of Exemption.you shcuW _.
become subject to the Workers Compensation previsions of the Labor Cads you most
.,0forthwithfowith comply with such PMVhOOM or this Permit W deemed revoked. -
,zt 5; CONSTRUCTION LEADING AGENCY
[-� I hereby affum that them u.construction leminf.peney fa the peefomapecd
C> the wart I.which Nis permit is issued(Sec 3097.Cir.C)
W�p Lender{Name
7 z lenders Address
U O[ 1 muufy that 1 Mw wad lids as,llwiwmailumagree,m wish as "the show information is
ty U camccL I agree, comply wall city and entrance,std county entrance, state Ors mute
missing
Wilding construction.and hereby mutation representatives of this city m enter upon to
[27 abo c-mentioned property for inspect.pupwet
�' py (Wc)agree to saw•hhdc rmly and kap harmless the City of Cupertino against
y liabilities•judgments•cord and expenses which may in any way seems agalal said City ///
in confeq of the[rant"{of LossJ�mhlL �C
^-' APPLI Nr NDER�N�S ANp WIMPLY WITH NLy ON-poo Issued by: Date l
SOU REGU .170Ns, r/1 I/1�—yT/IJ' O
Signatureof ApplicaeVConuacmar Make Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne appliam or fuuue Wilding occupant score aMe&N.sdou,material
as defined by the Cupertino Municipal Cade.Cbapur 9.12,and the HNN and Safety
saran 25532(.)T /
❑Ya No All roofs shall be inspected prior to any roofing material being installed.
ff]
WIII Ne applicant or fm Wilding occuWm sae equipmm�t a hviaa Idled If a roof is installed without first obtaining an inspection,I agree to remove
emu hoard..ale conumimnu as denoted by We Bay Arta Air Cathy Mm.gement all new materials for inspection.
District?
pyo 0
1 hew mrd the haaNws maudals requirements um@r ChapW 6.95 of to Cahlor-
nkHealth kS.faycad0.Savor 25505.25533 mJ 25534.lundersufhd Naifdte building •S /�
does ntY Nw.tenant it k aespens tulitY k mtify peau t of Ne
pcxpd mer. 1d`1=bcmet a aae.r.cerina a cu Signature of Applicant Date
f fy �a �� 4.Y 4 All roof coverings to be Class'%¢"or better
Owns moved agent Dam