04060245CITY OF CUPERTINO- ::' '. -,
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BUILDING DIVISION'
PERMIT
c TRACTOR INFO p ,
BUILDINGADDRESS: -
PER""'04060245
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2070
OWNER'S NAME:
PERMIT ISSUE DATE
APPLE COMPUTER
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
I ho, tiff om that 1 on licensed under p visions of Chapter 9 (commencing
Divisin Sof NC Radial Profcha... Co ndmyliccnmia
-10
wiNse n7010)af o
mon
LlcenacC eLic.p ��f�
TI INTER. OFFICES_
Dam _Connector �16*4VIA:-
CONTRACTOR: RANGER CONSTRUCTION
ARCHffECPS DEC�t•A,TION
1 understand my plans shallrecords w used as public
Licensed Professinnel
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Convector's License Law for the
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following mason. (Section 7031.5. Business and Professions Coda: Any city or county
which requires a permit to construct, alcor. improve, demolish, or repair any smrmum
prior sea its issuance. also requires the applicant for each permit to rile a signed statement
that he is licensed purechin, to the provisions of the Cintracru" U.. Law (Chapter 9
Sq. Ft. Floor Area
V"t�000
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is eacmpt thcmfrom and the basis for the alleged esernishm. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of
not mom than five hundred dollen ($500).
32610046'00
01, a a owner or the property, or my employees with wages as Neirsole compensation,
Required Inspection
will do the work, and the suaclure is not intended or offered for sale (Sec. 7044, Business
and Professions Cade: The Contractor's License Law does not apply m an most of
property who Wilds or i mprovm thereon, and who does such work himsel f or through his
own employees, provided th nsuch improvememasre notimmded aroffered foreak. 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 propose of
a..>�
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sale.).
❑ 1. as owner of the property, am exclusively connecting with licensed contractors to
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Consumer the project (Sec. 7044. Business and Professions Code:) The Camiscun s Li'
ConsumerConsumer�
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cense law was not apply can owner of propeny who builds cr improves thereon, and
who conquers for such projects with aconmector(s) licensed pursuant India Contractor's
License Law.
❑ I am exempt under See ,B&P C for this mason
Owner Dam
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WORKER'S COMPENSATION DECLARATION
1 hemhy aDirn under penalty of perjury one of the following decorations:
I have and will maimem a Cenificam of Conaam to self-imum for Worker's Compcm
action, as provided for by Section 3700 of the Labor Code, for the performance or the
work for which this permit is issued
❑ I have and will maintain Workers Compensation Insw sire, as required by Section
3700 of the Labor Code. for Ne performance of Ne ..,it for which this permit is issued.
M Worker'sCompensationInsurance mum ran Poll; icysfnu'mMr am:
itt.VlL l� icy No.:N'i
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
Thissection wed not Ire complcmd tithe permit isforom hundreddulbox ($101)
m lea.)
I Certify that in the performance of the work for which this permit is issued I shall net
employ any person in any manner so as he become subject in the Wo6mrs' Cempensalion
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Laws of California. Dam
Applicant
NOTICE TO APPLICANT. If. after making oils certificate of Exemption, you should
become subject to Ne Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shat] be decmcd rowkcd.
CONSTRUCTIONLENDING AGENCY
1 hereby thi that there is a omb lending agency for Ne performance of
which Wood ((acorn
the work for which this permit Is issued (Sec. 3097, Cie CJ
Lender's Now
Lnndere Address
I certify that I have read this applicmion and sum that the shove information is
correct. I agree to comply with all city and county ordinances and sum laws relating to
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building Contraction, and hereby authorise representatives of this city to toter ulna the
above-mentioned property for inspection purposes.
l (We) agree to cove, indemnify and keep harmless the City of Cupertino against
j Iiabilitice,judgments, costs and expenses which may in any way accrue against said City
or C' naequi n an of thegmming of this permit.
AP LICANT U DER TANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
5 RCE RE 'L S.
Re -roofs
Type of Roof
son A I tr r � Deln
ARDOUS MATERIALS DISCf:OCHRE
Will Neap mom or future building wcupam a tam or handle hmadous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, SCCUW 8532(.)?1/•`d-fir/".1)1�,
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
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
It hamplous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes Nu
ihavem.dthe a.aN)usmamria]smquimmenuundcr Chapmr695ofihc Califor'
niaH Its&Surety ,Sections 25505.2553] hJ 25334.1 undersand thuiftim Wilding
dw of curt ve a mnan4 that it is my reslonsihi]ity, m notify the occupant of the
re mmcn mustxmctpriarm when of a Certificate of Occupancy.
Signature Of Applicant Date
:91
All roof coverings to be Class "B" or better
cant orirs rat Dat
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