08030133 CITY OF CUPERTINO - ap ,a ta. 'ca .i.; a`.1 ' ' ? ' - .W
BUILDING DIVISION PERMITCONTRACTQR INF�QRMATIOIV -"
1,
PERMITNO.
Bull.pltic,5ppp N TANTAU AVE NOVOCONSTRUCTION08030133
OWNERS NAME: PERMIT ISSUE DATE
APPLE COMPUTERS INC 1042 HAMILTON CT 05/01/2008
NE: (650) 701-1500. SANITARY NO. CONTROL NO.
ARCHITECT'ENGINEER: BUILDING PERMIT INFO
BLDGEIEC? PLUMB - PARCH0 0 0 0
goo LICENSED CONTRACTOR'S DECLARATION IOW Description
w 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with� n7000)of DivWon3ofth BusincssmdP fcWam mYlkenseis TI CREATE NEW OFFICE SPACE INCL BEEFING UP
n ° in full forte and ertett O+ /A 1
5�: ucenseclav L/ 1=.g _11 STRUCTURAL MEMBERS TO ACCOMIDATE HVAC .
Via- Dale h�v1�—Conuncwr D CA VLI I6
ARCHITECTS DECLARATION
U 1 undmatand my plan shall he used as public reconts
gd
y C Licensed Professional
5 OWNER-BUILDER DECLARATION
<I 1 hereby aRreiThat I am interrupt from the Contractors License Law for the
0C following reason.(Section 70313,Solution,and Professions Code:Any city or county
e S 9 which o puirca a permit in conamct alter,improve,demolish.or repair any structure
yiy prim in in issuance.also requires to applicant forsmh permit m file a signed statement
< thahcislicensedpunuanuoNcprovisiomoftheContractohlimmcLaw(ChapLL79 Sq.Ft. Floor Area Valuation
Y5$ (commencing with Section 70011)of Division 3ofNe Butircnand Prolicssions Code)or $652538
that he is exempt thmnfrom and de ne
basis for The alleged cmption.My violation of
Sealon 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty ofNumber Occupancy
not mom than five hundred dollen(5500} 316 0 6 0 3 9 . Pane Y Type
❑1,a owner Of the ptoPemy,IX my rsrplayma wdn wagn a Ne'v sokwmpewtion,
and
will Prtheair's ands: he Conusolmsendede awdo(s rut a(Sec.inn a4,Bmarof
Pro erty whobu Code:The improves
th ctors ndwho law dots int apply tf rt owner is Required Inspections
Own
Property who s,provh impratsch imps and who doessuint work bimulrar through his
own employees,pmgor i that oven improvements m not intended of completion.
m leered for ourver,
built= Ncbuilding mhmpmvemant4hat wlNfnet yeaarcompletion,theawncr-
buRdIX will Mve rhe burden of proving that he did net dual Or improve for purpose of
oak.).
❑1,aa owner or the propcny,am exclusively contracting with licensed contratama a
construct the project(Sec.7064.Business and Professions Code)The Coronations U. .
cent law tom eat apply w an asoma of pmpery who Wilda of improves thinner.and.
who contracts for such prejem with a eontracmr(s)licensed punoant to the Conuactors
Lira e"taw.
ianeaemptuuler See ,Bk PCfor M3.n ,.
Owner Dae -
WORKERS COMPENSATION DECLARATION
1 hereby aRbm under penally,of Perjury can of Ne following declarations:
1 hsve and"I maintain a Certificate or Covent t0 self-Imam for Wo bees Compen-
onfim.u provided for by Section 37M.f the Labor Code,for the perform.of the
wmk for which this permit is issued.
Q I ban and will maintain Worker's Compensation Insurance,as repticd by Section
37W of the Labor Cade,for to performance of the work for which Nia permit u issued. '
M o rg,mrtgmalim lnsurom rasarrrier and Polity number,art:
e tl L IDEM1Ylll PoliyNa.:l5 Lf145-L'y /
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mis acelian oned tet W completed if to permil Is formic hundred dollars($100)
or kas)
1 certify,that in the performance of Ne work for which this Permit is issued.I"I not
employ any person in any manner an as in become subject in the Wmkea'Compensation
Laws or California.Dau
Applicant
NOTICE TO APPLICANT:If.after making Out Ccnilicate of Esemption,you should
become sunjecl in the Worker's CompenskUon psevisiom of de labor Code,you mine
.J z rertnwith comply who such Pewmwc m Nu Permit shall W decreed evoked.
zO ESTR
CONSTRUCTION LENDING AGENCY
Thereby-M-that them isacowmctim lcndingagency,for the pefformanceaf
the work for which thmli
s pcl hi issued(See.3097,Civ.C.)
(1J 0 Landers Name
z Lenders Address
U O1 eestify that I have mad thus application asst sun Na the above information u
t7.E coram.l agree to comply with all city and county ordinances and sutc laws relating to
.C) building mnsuuction.Whereby auNmirz rtpmxautiaes of this city w enter upon the
F Owaan -mentioned proseny for hnspectiun purposes.
ve (We)agree to save,indemnify and keep hamless de City of Cupertino against
h liab0ida,judgmcnts.cmis and expenses which may in any way amus against said City
C)z in consequence of the Starting of this Permit.
'--h APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued.b
sOU�pGULA�IONS.
/ Y Dale
Sign M"�contractor ���� . Def. D� 'Re-roofs' i
HAZARDOUS MATERIALS DISCLOSURE Type of Roof sal/
Who the applicant or future Wilding aceupanl nese or handle hanardom material
a defined by the Cupmmo Municipal Code.Chapter 9.12.aM the Health and Safety
Cade,section 25532(a)7All roofs shall be inspected prior to any roofing material being installed.
Cres X�No
tum the, liana or future Wilding occ h ant fire If a roof is installed without first obtainingan inspection,I agree to remove
PP i p rquipmcrl m devices which Pe
t haaWnua
it,cenuminanu a defined by mc Bay Arta Air Quality Management all new materials for inspection.
ct7
❑Yes Nu
I have real the havNouamaerials requiremam under Chman-6.95ofthe Califer-
nia FkalthB Safety Code,Si,ucru2 505,25533 and 25534.1 todi n and Nailtte Wilding
dna t currently have a lmar l the It u e mpa
my responsibility in hroufy tiunt or the
requ'ren
c who amthe Idorm' uvee f.Octurl teofoah Signature of Applicant Date
Ljoq
Owneioramhmisd.,rd Date All roof coverings to be Class'W'or better
c