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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
4CONTRAETOI2INFORM TIf?N
„ . .
BUILDING ADDRESS:
PERMIT NO.
10435 N TANTAU AVE
NOVO CONSTRUCTION
08090161
OWNER'S NAME:
PERMIT ISSUE DATE
APPLE COMPUTERS INC
1042 HAMILTON CT
09/24/2008
PHONE:
_
SANITARY NO, CONTROL NO.
ARCHITEC [ENGINEER:
BUILDING PERMIT INFO
T.I COMMERCIAL NON
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
I hereby licensed Chapter 9 (commencing
STUReTURAh
Job Description
affirm that I am under provisions of
with Section 7000) of Division 3 of the Businessrofessions od and my license is
in full force and effect -Gf`
License CI Lic. 11 t O
S -
Date Contractor 7 — uc
ARCHITECTS DECLA ATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance- also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
_
Occupancy Type
P Y YP
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars (S500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 7D44, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds orimproves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended oroffered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
_❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
ccase Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Worker's Compensation Insurance carrier and Policy numbsr are
hJ
.Carrier. �')L' �f%1.� 3'�Policy No.: 2
CEPTIRCATEOFE EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (SI00)
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensaion
Laws of California. Dale
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construetirn lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lendch Name
"
Lender's Address
I certify that I have read this application and state that the above information is
correct I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
lia i es, judgments, costs and expenses which may in anyway accrue against said City
ucnce f the of this
i coT"
or Date
HAZAR OUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as d toed by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
Yes ❑N�/'
All roofs shall be inspected nor to an roofing material being
P p- Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
Yes eNNu
I have ad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Ih sty Code, Sections 25505.25533 and 25534.1 understand thatif the building
d96s nCk
a Certificate of Occu ry.
Signature of Applicant Date
All roof cover)nEs to be Class "A" or hetter