04100123t
I
a
CITY OF CEI ERTINO
""-' -77,
BUILDING DIVISION PERMIT
-,CONTRAGT,OR INFORMATION `-:
O
BUILDING ADDRESS:
CONSTRUCTION
PERMIT N®4100123
20650 VALLEY GREEN DR
OWNER'S NAME:
PERMITISSUEDATR
APPLE COMPUTERS
1545 BERGER DR.
10/19/2004
NE:
SANITARY NO, CONTROL NO.
(408)283-8663
ARCHITECfIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MRCH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
9
-
Job Description
I Wreby affirm that I em licensed and mvisions of Chapter (commencing
3 with cctiun ](k1U)nf Di ision3of NCB s, s OPrufessinns Co dc. en it license is
ml canis If S
REVISION -IN HOUSE USE ONLY
5 see eC x Lie_»
Dam
NO NEW PERMIT ISSUED/ ORIG. #04070097
NnwtjT
3
ARCHITECTS DECLARTFIUN
a I un rsmnd my plans sM1all W used as public records
' Licensed Professional
S OWNER -BUILDER ON
Ce
E 1 hereby affirm m Cmila em s License Law far he
exempt from the Cniouns
I70
umthat
1. C
D following reason. (Section ](lJ LS, Business and Profcseinnx Code: Any city or county
which repines a permit m construct, strut. impreve, demolish, or repair any structure
prior m its issuance, also myuims the applicant for such permit o rile a signed statement
that he is licensed the Contractor's Lice Law (Chapter 9
Sq. Ft. Floor Area Valuatio 35
pursuant o the provisions of nsc
(commencing with Section 7(M) of Division J or the Business and Professions Code) or
.. that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number -
Occupancy Type
p y YP
not mere than me hundred dollars ($500).
32601053.00
El I, as owner of the prafterty, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Comuacto's License Law does not apply to an owner of
Required Inspections
property who builds or improves thereon, and who does such work himself or through his
'
own employees, provided that such improvements are not intended or offered for sale. If,
however, But building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not Wild or improve fur purpose of
4s�
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Co rtamom's Li.
cense 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. t
❑ 1 am aempt under Sec. , B & P C for this reason
Owner Data
WORKER'S COMPENSATIONDECLARATION
1 hereby affirm under penally, of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's Camper
ration, as provided for by Section 3]00 of the labor Code, for the performance of the
work far which Bits Permit is issued,
❑ 1 have and will maintain Worker's Compenxalion Insurance, as required by Section
3700 of the Labor Code, for the peRormancc of the work for which this Perrins issued.
My Workkee�r'/s�Compensation Insurance carrier and Policy am:��..CC��
��nnnumber
arias. �i%EGET1s.7Pro
Y o No.n/>'�(e�
CERtTIFICuAT OF EXEMPIIO FROM WORKERS'
COMPENSATE URANCE
(This section need not M1e completed if the retail is Orone hundred clothes op)0)
or less.)
1 canary Nat in the performance of the work for which this Permit is issued, 1 shall not
employ any person in any manner so m in become subject to the Worlo ri Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: if, after making this Cenilicmc of Exemption, you should
became 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.
CONStRUCT10N LENDING AGENCY
I hereby afrvm that there is construction 30 lending agency lir the Peelurmevee of
' Ne work far which this permit is issued (Sec. 3(197, Co, CJ
s ed
Lender's Name
e Lcndct.
1 comfy that I have read this application and stem that the above information is
I agree is
building 1 agree m comply with all city and county ordinances and state laws relating
of
amhorim representatives of this city to enter upon the
e
building cottoned pro, and for
above-mce).9mpmperty forinani fy an keep hose
(We) agree m save, inticmnify and keep harmless the City of Cupertino -gains[ ainst
jllitic ,jud g
gran¢ cos and cxpcnses which may in any way score against xmitl city
r
ron yucnce of the n of this permit.
''��,,��
g APP CANT UN DS A ILL COMPL>rrn ALL NON -POINT
Issued by:4tQ� Date
SOU CE REG
Re -roofs
ol'AppliSoIlConthictsir Date
?nature
f{pygR000S MATERIALS DISCLOSURE
Type of Roof
Wil store handle us al
futurebuildingCode,
teCurecmut
as dchncd by the Cupertino Municipal Cada, Chapter 9.12, and the Health and Safety
Chapter Heals and Safety
Code, Sc❑ctY.25532(a)?Nn
All roofs shall be inspected to any roofing material being installed.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or uT lure building occupant use equipment or devices which
It hazardous air conmminanke defined by the Bay Area Air Quality Management
all new materials for inspection.
attics?
Q Yes Nu
I have mad the hmardous materials mcliremcn¢ under Chapter 6.95 of the Califor-
niaHealth&Safely Code, vans 25515,25533 and 25534. 1 understand that if lM building
docs no omrently he a Bim it is my remmnsibil iry m ratify the occupant of the
mqu' cake ich topoor mIts cnraCiottiofCreupaney.
Signature of Applicant Date
All roof coverings to be Class "B" or better
wncrorauthori'rc en
Date