08040125 CITY OF CUPERTINO +q,«r�?.t;R .ts "^ �°r" ` °` •` ',° "
BUILDING DIVISION PERNIIT CONCRACTOR TNFgRMAT ONS.
i rt
RUINING ADDRESS: PERMIT NO.
10435 N TANTAU AVE SHOOT NOVO CONSTRUCTION 08040125
41 NER`Siq*M#; PERMIT ISSUDATE
APPLE INC. 1042 HAMILTON CT 04/28/2008
PHONE: SANITARY NO. CONTROL NO.
(650) 701-1500
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECTPLUMB MECH
t� s
300 LICENSED CONTRACTOR'S DECLARATION - Job Description
hereby ararm Out 1 un licensed under provisions of Chapter 9(commencing
wILa S«tion TgM))of0i'tian 3of11rc Butinev uW profea¢ivm Co o, mylkenmu REV,MISC ACSTCLL UPGRDS COML ORG#08010037 FILMNG
^� In full forts aha off
04 LictsnanCl Les-{ () STUDIOS,NEW WALL TYPS&STRCTRL UPGRDS;ORIG MSSNG
'
Dam Gan DEcL LD
ARCHITECT'S DECLSRATI n PLN CHK SHEETS A.3 , .4, 1 . 0, 3 . 0, 4 . 1, 6 . 1&9 . 1—NO NEW
6I-
U I understand my pla^a shed mr
he used u Public mds
JcweOJ LicensedProfewonat
-]]
OWNER-BUILDERex.roprm.the RATION.
C t I harem.Rem that I am exempt from the f..im*Co Lleenm Law per mm
p o following moon.(Smdan 703 Business and Profnu..l Code:Any dry stcounty
5$ which rtquirea•permit m miresComment,since.ptic ImProw,aeermit t ri repair any suuetum
2�^ Pdaro its inuanm,rsurequimts theappucant far such CmIsmemiuoemen Lmdmesmcat -
$< twhmtsRangwishSeaaammmepmaesion3othe canwcmrwenmubmaCo&)or Sq.Ft. F7otirArea Valuation
maths Iusln{with Suntane70DO)and tof he but&f7 of then ed axe and Pm@sauna Cade)of 100000
.. Nat o ts exempt 0mrefmm and Ota:buss for the allege,exemption.Any violation of
Section a Buts five
hmr,undred
red dont r«a permit anhjecu mo applicant la a doll penalty ofOccupancy TYP
not roam Wn Ow hvedred dollen(SSW1. 316 0 5 0 5 6 . �IM3�Iber e
0 1,u Comm of the property.or my employes with wages as Lack sets compemadon,
will do the waft and the su«nute is rot immuded«offered forsubs(Sec.7114,Business
and Profeselom de:T
Cahe Contractor,l nnnm Law done ant apply m an owner of Required Inspections
pwPerry veno wua«impow Laumn,ana whaaaesamn wort n:..,-rr«mroayt
his
owes employee;provided that sush improvements art cat Inmeded oroffcrtd fmsale ff,
huikko .the buil the uunprowmantisantee didnot )ear or Improve
for
Ereosse of
build«will haw Ore hmdm of proving Wt k ala not tided«improve f«puryase of
tale.).
❑1,u owes of the property,am exclusively contracting with licensed conuanon in
mmtraet the project(See 1014,Busioeu aha Profeulam Cade:)The Contomm's U.
come law does not apply m an own«of property who builds or improves thereon.and,
who contracts for such projects with ammnnmf(s)licensed pursuant in Lae Contractors -
Lke ed Law.
❑Iameaamptundm See .B&PCfar Labsmmm
ter Dam
WORKER'S COMPENSATION DECLARATION
I thereby affirm under penalty of perjury ones of Lae fallowing deelarulonc
I ham aha will matmam a Certificate.1 Comem to self-home for Workers cmnp
codon.u povka for by Section 3700 of the Labor Code,for use performance of the
work for which this permit is iunea.
❑1 haw and will momal Workers Compensation insurance,u required by Section
3700af the labor Code.for rhe peNormanm of to went for which mu permit u issued. '
My Wafke/s CompeuatInsurance In� nceartier aha Poling number tae:
C-d-9ETrJpjC.IC cl PoIIry No.: I51nLt-1-01
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisxctlon used smhaco mpmesd trusts Permit isfarma huedrtddoOan(SIOO)
or leu)
1 mrtify that in the performance of the waft for which this permit Is Iumtl,I shall not
employ any person In any manner so u he become subject to the Worked Compmamon -
Laws of CaaforulL Dam
Applicant
NOTICE TO APPLICANT:If.after matin{this Continues of Exemption,you should
become subject in the WortrYs Compcuktion provisions of the labor Code you moo
vJ O faMwith comply wire such provision or mu Permit mail I be doemol revolu
i2'.~N., CONSTRUCTION LENDING AGENCY
F I near ararm that dorm I..mu usca.leedm{.germy Pon ft porr«manen or
C> Ore wort for which mis permit Is mora(Sec.3091.CN.C.)
Q Landers Name
z Icoal Adams
U O I ceNfy Nat I haw mad this application W sum that the show Information is
correct 1 spm to comply wias all city and county oNlumn and A=laws rtlatin{In
.O building censwction,anW hereby authorise representatives of this city m new upon the
til me"-mentioned Property for inspccuan purposes.
LL (We)agree to an,indemnify and kap harmless the City of Cupertino against
r CA liabilities,judgments.cats and expenses which may in any way atom agaiut said City
U Z In consequence of the Swung of tits permit
ti
APPLICANT UNDERSTANDS AND
�WILL/COMPLY WITH ALL
NON-POINI' Issued by: Date
SOU-G MUY'�I N�Ya'1 W11& -1 L?,qj dI
Re-roofs
Sigmn ofhppliesa onuassr Dam
at /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WILL the applicant a Rome building oempaot.«hanak hansom material
u aefo d by Bre Cupertino Munn Code.Chapter 9.13.and the Hu1N and Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0Yex No
WIII she applicant or future building Occupant use equipment or devices Thick If a roof is installed without first obtaining an inspection,I agree to remove
emit luuNnm air castandts u fiord by the Bay Ann Air Quality Management all new materials for inspection.
District?
❑Yes ONo
I haw read the hwNms materials requirements underChapmrd.95 of Lae Calirary
m.H.hh&Safmy CCaC.Suetiau 0505,25533 and 75534.1 understand!thulrthe Wilding
does rot currently hew a Consul drat it Is my mspouthllity m madly the mcuPant of the
mqul n hick uv he tpiar{niywOmoaCcstifamof0c v SignatureofApplicant Date
Ownerar authorized agent w Daes All roof coverings to be Class'W'or better