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04070022LIZ YYaC <ZVZ 4� z� 3pFip�,4 yC .yet �OC ae$�+ W�v r2> F€C CITY OF CUPERTINO BUILDING DIVISION PERMITBUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO MIT"'04070022 7 OWNER'S NAME: PERMIT ISSUE DATE APPLE COMPUTER S11 DIVISION RTRRRT WE: WE:TROL ' SANITARY NO. N0. CON (408)379-0400 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 LICENSED CONTRACTOR'S DECLARATION Job DCSCrIpIIOn 1 hereby affirm that I am licensed under provisiom of Chapter 9 (commencing with Sealant 7") Of Oiv'ion3ofthe Busir,e and Pfofessinns Code andmylicenseis in mE core End effact. 3�j License Cl Lic.x REV I S I ON- - VG03 DOOR .ENTRY 0 NEW PERMIT ISSUED ORIG. #04010076 Dam Contractor ARCHITECTS OECLA TION 1 understood my plans shall be used as public records Licensed Pmressianal OW NER-BUILDER DECLARATION 1 herhy affirm thatam exempt from the Contractors License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city Or county which requires a Permit to consrra n, alcor, improve. demnlb h, or repair any struaum prior m its issuance. aim requires the applicant for such Permit u file a signed statement that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation$35 (commencing with Section ]0110) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and fee basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty Of not mom than five hundred dollars ($50R. 32610047.00 ❑ 1, as Owner of the property, or my employ= wife wages u their sole compensation, - Required Inspections will do the work. mdthe snewmiaOut intended oroffered fnraale(See1044,Business and Professions Code: The Comment's License Law does not apply Wan owner of e q P properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended oroRered forsale. If, however, the building or improvement is sold within one year of compledon, the owner - builder will have the burden of proving that he did not build or improve for pool.of IL sale.). 1, as owner of the propeny, am exclusively contracting with licensed contractors on /A V mostmct the pmject (Sec. 7044. Business and Professions Code:) The Contrecmrt U. cense law does not apply to an owner of pmpenY who Wilda or Improvm theron, and, who convects for such projects with a contractors) licensed pursuant on the Convenors C License taw. ❑ I am/e/xempt under Sec. . E & P C or this reason OwnerData 4 I D - W-r�f GRKERSC«OMPEINS/f0DECLARATION hereby M. under penalty of perjury one Of the following dxeantions: I have and will maintain a Certificate ofConsenl to self -Insure for WorkersCompcn- 1.1 etion, as provided for by Suedon 3100 of Ne labor Code, for the performm,en of the work for which this Permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, m required by Section 3100 of the Labor Code, for to performance of the work far which this permit is issued. My Worker's Compensation lnsurans, carrier and Policy number am: � Carrier. IJO IIUYI\C TnN A/...r"Iplicy No.: �'7 I ZZ vel T� ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not be completedlithe permit isforom hundred dollars(SIM) or less) I certify that in the performance Of the work for which Nis permit is issued, I shall not employ any person in any mmanerso a5 to become subject to the Workers' Componsation Laws Of California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject m the Worker's Compensation provisions of Ne Lmor CWc. you must forthwith comply with such provisions or this permit shall W deemed invoked. CONSTRUCTION LENDING AGENCY I hemhy affirm that mere is a construction lending agency fm Ne Performance of me work far which this permit is issmd (See. 3091, CO, C.) Lenders Nmnc Lender's Address 1 cenify Out I have and this appliemion and nota that the above information is correct 1 agree w comply with all city and county ordinances and state laws reading to building convection, and hereby authorim mpresemadvef of this city Or enter upon me shove -mentioned prnpeny for inspection purposes. (We) agree Ire save, indemnify and keep harmless the City of Cupertino against liabilitieajudgmenls, casts and expenses which may m anyway same against mid City an' th homrag ofiblNp ANTeUf WIL COMPLY WITN AL NON -POINT Issued by: Date E RECULATI) I D \1 Re -roofs Type of Roof ti pufT. of ApplieseC.mrsoci, Der HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant score or handle havardom material as de0md by the Cupenino Municipal Code, Chapter 9.12, and the Hcalm and Safely Cole, Section 25532(e)? ❑Yes []No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant Or ruwm building occupant use equipment or devices which it humerus air contaminants as Outland by the Bay Area Air Quality Management all new materials for inspection. iatric,? Max 9O I have mad the havardous mamrialsmquirements unJcr Chapmr6.95 Dime Califon nia Halm&Safc,yCO ,Sado.25505.25533md25534.Iundcmmndmotifdm building dos o m mdy have a tenant, ths is y rasp miloy to nobly factor., of dw mgci tawmtnmaatbc pri missuance a cobficamoroct,n ' Signature of Applicant Date All roof coverings to be Class "B" or better ow ra ri,edagcn, me CUPERTINO ICTY OF CUPERTINO �J / 7 PERMIT APPLICATION FORM o � � �,> v 2-2- APN # Date: Building Ad e'sd 2 o-740ill Mailing Address (if different from building address): Owner's Naafi Phone #:cX �Q r g G, Z Contractor � �� License #: Contact Phone: r'') PQo`c.�-- Fax: Cupertino Business License#: Building Permit Info: Bl Elect ❑ Plumb ❑ Mech ❑ Job Descriptor �e1 o e- \jGo3- C�,�1 is � e Residential Commercial Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project,A ' 0 Occupancy Grou . X2 Type�gf Construction: c/� — Please check th b the pr 'ect is a second -story adds Project Size: Standard ❑ Large ❑ Major ❑ BBOILER5 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING �- 2 `2- 1of3 3�eQ-S-6 *ITY OF CUPERTINO 0 �l o PERMIT APPLICATION FORM CUPEI,TINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTMEE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool -PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM StomVRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENLA RHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREIVIMISC Misc A aratus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 a�,-Tvo�� CUPER,TINO CITY OF CUPERTIN(# PERMIT APPLICATION FORM Quantity Fee ID ' Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special hWection BUILDING BSVvgM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3