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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFO'k-MATI�ON,y,
BUILDING ADDRESS:
SOUTH BAY CONSTRUCTION CO
N "'TN'03100165
i
'.R'S NAME:
511 DIVISION STREET
PERMITLSUEDATE
APPLE COMPUTER
10/22/2003
HE:
(408) 379-0400
SANITARY NO. CONTROL NO.
ARCIIITBCT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
0 0 0
LICENSEDCONTRACTOR'S
Job Description
1 under provisions or chapter9 (commencing
affirm that I am licensed Under pmvisions ors
p
with Section 701M)7 of Division 3ofJm Burin «1 and Professions G&JL. and Cry license is
ion 7 Code,
In fell fmm.nd affect.
'REVISION --REVISED SITE PLAN
License Clens Lie.#
Dam Contractor
NO NEW PERMIT ISSUED/ORIG. 403080166
ARCHITECTS DECLARATION
I undormad my plena shall be used as public records
Ni;Cn#CdPmfcssional
OWNER -BUILDER DECLARATION
hcmhy affirm that I am exempt from Nc Contractors License Law for the
following mason. (Section 9031.5, Business and Professions Code: Any city Or county
which requires a Permit to construct, &lair, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such Permit to file a signed arsenical
that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation $0
(commencing with Section 7(k70) of Division 3 of the Business and Professions Code) or
Thu 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
er00
Occupancy Type
P y YP
not mom Nan five hundred doll.. (8500).
❑ I, six owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended oroffcred for sale (Sec. 7(1 Business
Required Inspections
and Pmfessiona Code: The Contractor's Li¢nse Law does not apply to in owner of
property who builds or iarpomes daemon, and who doessuch work himself orthmugh his
own employee, provided that such improvemenu are not intended oroRered Russia. If.
however. be building or improvement is cold within am yeti of completion, the owncn
builder will have the burden of paving Nat he did not Wild or improv purposeforpurposeof
salede
❑ I, as no, of the property em exclusively contracting with licensed contractors to
/
Constmet the pmject (Sec. 7044, Business and Profession Codi The Contractor'. Li.
`
cense Law does not pply to an owner of property who Wilds or impmvu daemon, and
7 whocmmcm for such projects wi acontnnor(Q licensed p .... at to Ne Convectors
tem
- Law.
m exam r , B & P C for his an
V
!0 D
0 C PENSATION DF.CLARAT N
1 hem a7mt under ally of perjury dm of the fol awing declarations:
l,l,
ve and will maintain • Ceri kerne of Consent to self -insure for Worker's Cumpen•
as provided for by Section 3700 of the Labor Code, for the Performance of One
or which this permit is issued.
ove and will maintain Workers Compensation Inu.nce, as required by Section
of the Labor Codc. for Ne performance of the work for which this permit is issued
My Worker's Compensation Insurance carrier and Policy number ere:
Cartier. Policy No.: _
CERTIFICATE OF EXEM P ION FROM WORKERS'
COMPENSATION INSURANCE
(This sermon nmd not hecompleted Him North h formic hundred dollars (Sltl))
or less.)
1 certify Not in the performance of Ne work for which this Permit is issued. 1 shall not
employ any Person in any manner an as to become subject to the Workeri Companiation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: IL after making this Ccnifieme of E.Cudp imn, you should
become subject to the Worker's Compensation prevision of the Lather Code. you must
forthwith comply with such provisions or this Permit shall he deemed rooked.
CONSTRUCTION LENDING AGENCY
I hereby M. Out ft. is. Construction leadingagercy, for the Performiof
the .,it for which this Permit 4 Wmd (Sri. 3097, CO. c.)
Lenders Name
finders Address
I certify that I have mad this application and soon the the abort information is
core,. I agree to comply with all city and county ordinances and sum laws relating to
building convection, and hereby n1flu tis MPmsenooives Of this city to enter upon the
abovo-mentinned pourany for inspection Proposal.
(We) agree to save, indemnify and keep harmless the City Of Cupertino against
Haul holes, judgments, costs and expenses which may to any way accrue against said City
n.
tins Permit.
v
AND WILL COMPLY WITH AL NON/ DINT
Issued by: Date
EWHAZ�.OZ006S
Re -roofs
Type of Roof
�0
or au
US MATERIALS DISCLOSURE
Will enc applican tar future Wilding OCCUPant nom or handic harudous material
finedby the Cupertino Municipal Code. Chapter 9.12, and dao Health and Safuy
OYes rion 33512(x)?
All roofs shall be inspected to any roofing material being installed.
Nu
N.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or bmildiag occupant use equipment or devices which
h humodous air contain, a Is dc0ncd by the Bay Area Air Quality Management
all new materials for inspection.
ict9
❑Yrs o
I have mad the haver r smaner' Ismquimmenmunder Chipmr6.95ofthe Calirnn
Health&Safety Code.See 25 5 5533md25534.1u11dernsmundifthc Wilding
Nes not cuncml t a my marionsidlity t nul'y tW mcupant of N
rcyuiof a anceofacMniOca rOceppeney
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner huiaasisg,n,ew