06030158 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR INF.ORMATIO.N:F '
BUILDING ADDRESS: INUVU PtRioirloo.J6 J3 U 1b8
20730 VALLEY GREEN DR
R'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 1042 HAMILTON COURT 03/28/2006
NE: SANITARY NO. CONTROL NO.
(650) 701-1500
ARCHITECT/ENGINEER: BUILDING PERMryiNFO
BLDG ELECT' PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION
tit I hucby affirm that I am licensed under provision of Chapter 9(commencing Job Description
u
pwith Section 70110 fDoision 3 ofthe Business and Professions Code. dm licenseis
y infuitfortcandcifcc 1 vfOn my INTERIOR DEMO
v�z Liccns CI o L'¢.N
k Dete Contractor -
Z ARCHITECTS DECLARATION
31 U I understand my plans shall M and u public records /
yof Licensed Professional
in g OWNER-BUILDER DECLARATION
1 hominy alrum that 1 am exempt from the Contractor's License Law for the v
00 following mason.(Section 7ID 1.5,Business and Profession Code:Any city or county
<$�i which napfires is Permit to cnnsuucL eltee improve,dcmulish,or repair any si ucture q 5
prior to its issuance.elan requires the applicant for such permit to file a signed statement
< that he is licensed purwant to Ne provisions or the Contractor's Lions Law(Chapter 9 Sq.Ft.Floor Area Valuation
x1-3 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
— Nat he is exempt i1sadefoom 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 UmeC OGGII
not more Ihw roe hundred dollars($500). Occupancy y Type
❑hasowner of the progeny,ar my employees wlN wegn as0¢ir wle compenss0on,
will do the work,and the swcmre is notimendcd oroRead for sale(Sec.7014,Business
and Profession Code:The Conuacor's Liam Law does not apply to in owner of Required Inspections
property who builds or improves unions,and who dmasuch work himselfor through his
own employees,provided that well impwvcmenu art nminud ded oroffertd for sale.U.
however,the building or improvement is mid within oro etas of completion.the ownep
buitchn will have the burden of moving that he did not Wild or improve for purpose of
ale.).
❑1,as owner of the progeny.am exclusively contracting with licensed contractor to
construct the project(Sec.7044,Business and Pmfcssit is Code:)The Contnetor'a Li-
come Law docs not apply to an Owner of pmperty who Wilds or improves Neeson,and,
who nomas for such p r jeeu with a comate or(s)licensed pursuant to the Conuacmr's
License Law.
❑1 am exempt under Sec ,B$:P C fru Nis sawn
Date
WORKER'S COMPENSATION DECLARATION
1 hereby affen under penalty of perjury one of the following declaration:
1 have and will maintain a CeNfieare of Consent in self-insure for Worker's Compcn-
sation,as provided for by Section 3700 of the Isbor Code,for the perfam uses of the
work for which Nis permit is issued.
❑1 have arta will maintain Worker's Compensation Insurance,u required by Section
37W of the L,edr Code,for the paformanct of Ne work for which this peopk is issued.
My Workc' Com nation l •munce carrier and Policy n1p�m-.Waf M: Cl
Cartier. t. �_ _....No.: •.N�(T I �S
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not Ire complcrcd inhe permit is for one hundred dollars($100)
or Ice.)
1 artily that in the Performance of the work for which this Permit is issued.I shall not
employ any person in any mortician as to become subject to the Workcri Comprnsaron
Laws of California Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Compcmtion provision of the Ladrc Code,you most
.J z foMwOh comply with such provisions or this Permit shall be deemed revoked. -
Z'O CONSTRUCTION LENDING AGENCY
[—�4 l hereby affirm Nat thea is a andum cdon lcnding.gcnry In,the performarec of
ai > the work fur which this permit is issued(Sec.3097.Civ.C.)
i17 n~- lender's Name
z Lender's Address -
V C) I certify that I have rad this application and slate that the above colonnade.is -
ly F
coma.I agme to comply with all city and county oNinames and sure laws relating to
building construction.and hereby authorise represenalives or this city to enter uponthe
G shove-ms,judgm propertyset for expenses
pcNon purposes.
(We)agree o save,indemnify and keep hamdess the City of Cupertino against
F'Z in,.ideaju to or do,
,grommd upem tenth. may in any way accoe against avid City
t)z A APPLICANT
of Negranting of Nis pmmll.
SOURCE
RE UNDERSTANDS AND WILL COMPLY WITH ALL pppIIION-POINT Issued by: Date
SOURCE REGULATIODIB',_u
I ` Re-roofs
SrSignatureofApplra _x HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will theappliant tar furan building accupam$tort or bndle hmardous material
,Ijjhdcfincd by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
e.se❑ly.25532(s)? All roofs shall be inspected prior to any roofing material being installed.
Yea IVNt
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or fuwa building occupant use equipment or devices which P g
Inia
t hazardous air contaminants as defined by dm Bay Acta Air Quality Management all new materials for inspection.
tria?
❑Yes )(Nu
I have mal the hasardsws materials myuimmena under Chapter 6.95 of the Califor-
Hcalth@ Safety CoEc,Section 25505,25533 and 25534.1 undersand lha lithe Wilding
s not armed,have a tenane Out tt u my responsibility to nodry the occupant of the
uimmcre.Irfh must bcet pdm i arenatir.certireatetr gggp'ayty. 1(3
6
Signature of Applicant Date'
owner or emh...ed.mm Sln''Whe All roof coverings to be Class "B"or better