01100117 CITY
BUILDING DIVIISIONSIN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20730 VALLEY GREEN DR SOUTHBAY CONSTRUCTION CO INC 01100117
OWNER'S NAME: APPLICATION SUB DATE
APPLE COMPUTER 511 DIVISION STREET 10/23/2001
4PHONE: (408) 379-0400 SANITARY NO. CONTROL NO.
00Z ARCHITECTIENGINEER: BUILDING PERMIT INFO
jw-QLDg,' ELECT PLUMB MECH
O L CI L=_3 LJ
ted
v=mi Z LICENSED CONTRACTOR'S DECLARATION Job Descri on
Inc y affirm thin 1 am licensed under provisions of CTapmr 9lcommecm,,e
rctry Ysiifoename' n]omjar,'viaianJnnneen.meaanalnnresaimsctdaan mye<en.e DEMO.
cyy�
5rc 6ass Licx
Ca or
ARCIi TEC DE .ARATION
I un rsand�j�sh cd public recaNs
i p Licensed�hofe ionll
X o
OWNER-BUILDE DECLARATION
m=m 1 heathy.(firm that ILicense am
?F onexempt f,rom the Contractor's law for the
following miss . tion]oJI.S.Business and Professions Code:Any city or counro which egmrcs apannii t .mut herimprove.demolish.or repair nY structure
y $5000
, 't'
print t Iso ey t ppl cam for sucM1 per nit wfleas tined stmemena -
maihe .l esed putomin to to pnn.,lonsofthe Contractor.License Law(Chapter 9 ' . ayiv't 1-1 LCCrp*y. Valuation
g
(cma. ,On Ssi ]000) fDivision J of the Entire.ane Prpfmwmta Code) Co .t 1.3 1R L �r A[g
- l..
or mat fie ii cxcmpr therzfrom*and the basis fm the allbged alroni bn.My violation
of Section]031:5 by any applicant for a permit subjects me applicant to a civil Penalty
-
Iofnonmorethin Five hanarMdollars(S5o0). NO VMN91ftD INSPECT ONS """' Occupancy Type
D 1,as owner or the propcny,in my employees with wages as their sole compensation,
will do'tc work,and the nruchim is not intended m offered for sale
rBrisineis.nd'Pmfecsions Code:The Conuanor i License Law dices not apply to an Required Inspections" 'a D: -`
owner of property Who builds or impmvas thcrcom,aml who does such wmk Nmttlf
or trough his Own employees.provided that such improvements arc notintended m
(offered for salt.
geb imprme yearn ,
c
aprovei for the owner-builder will have to human of proving that he did not build w t
ve for of sale.. '
improve purpose )
GLasowner(if t.p(So,.7,am exclusBusiness
and contracting*On n Conor contractors 1. r:e.
conswa he pres n ISec. to an Business and property
who
Code:)Them the
or's
License Law aces not apply man owner of propeara who bullas or meimproves thereon,
., a turmse es Liens for such projects with.<ommcmr(0 licenma pursuant to to .. _ .. __ .. _ .. .... .. .... ... .._ _ _.. .. _ __ ._ _. .
Contacmfs License Law.
District,smpt ondd Scc.11 .'�"'•, • .I.1 Jqt B&P C fm this reason - t
_ Owner .. :.;Dzte° ..
,'I " WORKER:S COMPENSATION DECLARATION
t 1 hereby affirm under pevlry of perjury one of the following aedvatianx:
-f D 1 have and will"maintain'e CcniGc.te of Consent to aelf-insurt for Worker's
Compensation, as provided for by Section 3700 Of the Labor Code, for to
'performance of the work far which this permit is isyW. t
DIh crund - Il mainan WorRer C pc to I q" dby set n
37 of the Ial>o Code far the Pen f1haoOk'ftnr which this permit i.
issWMy w h ei Compensation Ins d P l ry urtik are:
..-_. .....
Jtai,
� ih No ' D'2i lZXLO - ._ 0 /Y"' / .• _ . ..ILII•
m't1 R (FICA EXEMPT FROM WORKEFS'i,
COMPENSATION INSURANCE.—-_
'JCt.'nI(This'icciion need not tie emoplered if the permit is for one hundred dollars
(SIOo)orless.) .. ,... t •..
"r j I'cenify.thar in the performance of the work for which this permit iii issued;I ....... - - ;, -- - •_--
ihall nm employ any peon.in arty mannb sic as to berome spbjeo to the Workers
Comp mintion Laws of Caffomid.Iyom"'
.Applicant
NOTICE TO APPLICANT:IL of er making tis Cenifcatt of Exemption,you should
Scrams subject tit the Workers Compensation provisions of the Labor Code,you must
O 0 fonhwithi comply with such provisions or this Permit shall he deemed revoked.
"z" CONSTRUCTION LHNOING'AGENCY
a;' I h byaffirm that therea cm,un t t n lending age cy fo the pe Po'rmance _t'
.. of'me work for hu, tis.permti Is Issued(Sec.J0,9],Civ.CJ Li a`_,
fy'Q 'Lcndds Nitnc
Lendeis'Addoessl" -
V I certify thin I have rendition application Bail sate that the above information is
correct.1 agree to comply with all city and,count ordinances and state laws miming
�..V to building constm<tiom,and hereby emtiorize�epresrmuuivvl of this city to emerupon
�.; the move-memin ted property for in,cclion Purposes. ,
L (We)egme m save:indemnify and kap harmless the City' of Cupertino against
r-V1 IiabBiti .judgtrcnu.ttsu end eapof 11 which may in any way ettme against Baia
U. city < gaenee r me v g an 'E perm t , .. .. ,
APP ICsANT{{'N' )S7d/'tf AND ILL COMPLY isTfH ALL ON-Poy�' Issued by:
s r RE x5 /D 3/0/ .
¢�-TCCC1i' c f',.i �l am Re-roofs
HAZARDOUSMATERIALS DISCLQSURE t
W B the dppl¢anr o f t rc budding up.nr store r.anal naamaoaa mat .I Type of Roof - - e: n1l. - - - - - -- ,
iCal
dcMed by theC pen ao M c (Code.chapter 9.12,aril lM Health and Safety 1� _ ori l.a ,:•a ,.s; s s \'�i a
ode Section 25532(.) ) 1- r 4l.• 7 :
❑Yes ,y �P�9a, , , .t' _ _.All roofs.shall be inspected prior to.any roofing.material-being installed. _
,vrlimc.pPrcamorNtm-'wimiiso«apaaiuseequipme�t,atdeweeswhich If a roof is installed without fust obtaining an inspec[ion;'l agree to remove
mit haazrdous air conaminanb m defined by the Bay Area Air Quality Management
isu;cn all new materials for inspection. Applicant understands and will comply with
s - '. all non-point source regulations.. .
'I ha ereaa the h�ardous materials regmrtmems undcrtCh Chapter 6.95 or Nc
'omiaHealth&SefI Cod etSkrin 2550k25533 and 25534.1 understand that
if "building snot cu 1l eve enanL that it is my responsibility to notify the _ ,n
upam ort m s ich last be mei PH.".issue ce of a Cenifiewe of
Signature of Applicant Date
- l0 fi3 v
All roof coverings to be Class"B"or better
IOwncr r to rzed 19Ont� fight
.. t - OFFICE