02120097 CITY OF CUPERTINO
BUILDING DIVISION PERMIT zC0NTRACT0RjNF0RMATI0N ,,'
' 99'.`. t5i. •:':...">Z¢Yr. `:: fv.. ,�LaY54'2 .�h.f
BU I LDING ADDRESS: SOUTH BAY CONSTRUCTION CO N EMIT NO,
20760 VALLEY GREEN BLVD 02120097
ER'S NAME: 511 DIVISION STREET APPLICATION SUB DATE
APPLE COMPUTERS 12/26/2002
PHONE: (408) 379-0400 SANITARY NO. CONTROL NO.
ARCHITECT/ENCINErIt BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
s000 LICENSED CONTRACTOR'S DECLARATION
U F 1 torch,arNm that I am licensed under p inns of Chapter 9(commencing Job Description
yZu� with So1IKm7O00).f Diviainn3nftheBusinc.end Qryfexamnscrad and ylicenve is
I_`o�'n in mB fnrfn Orr«L �— DEMO
Oi�? License Cl Lien
— Date Contra.
F l2 t: ARCI I ITECrS OLCLA TION
s;c J I understand my plans shall he used e,public records
X
,dV
w 3 w t, Licensed Pinfica anal
FLL�e OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
m r 00 fallowing reason.(Section 7031.5,Business and Professions Code:Any city or county
&E which requires a permit it,construct,alter,improve,demolish,Or repair any structure
u+ prior us its issuanm,also requires the applicant for such Permit o file a signed statement
that he is licenxd purnaunuo the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $201900tlon
iron$ (commencing with Section 7kk0 of Division 3 of the Business and Professions Code)or
.. that 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 In a civil penally of PU Occupancy Type
rain more than Eve hundred dollars($500). P Y YP
❑1,as owner Of the pmpcny,Or my employees with wages as their sole compensation,
will do the work,and the structure is not intended nr offered for sale(Sus.7044,Busimas tie AssietiEBI --1
and Professions Code:The Contractors License Law does not apply m an owner of require nspectlons
property who builds or improves Iherfon.and who does such work himselfor through his -
Own employees,provided that such Improvements ore not intended or offered for aalp„I[ i
however,the building or improvement is sold within one yearyyf mi pletioO(ttt Nco o{r-
builder will have the burden of praying that he did nut build impnrve fl7 jmrppou'0 0,J sale L
❑1,as Owner of the pmpeny,am exclusively contracting xlih linen coact ors if
construct the project(Sec.7144,Business and Professions C Illi: ommlitnY� I ,
censelawdocsml,pt town ownerof ptapeny sob a beffds i'improves NNppr��m`' d
whOcomponaortachpmjects withacotim, (a ]icensetlIF mnothe Ohdit
License Law.
❑lam exempt under Sec. PC or Nis reason
After Date
14 IF WORKER'S COMPENSATION DECLARATION
1 hereby aRm,under penalty of perjury one of the following declarations:
❑1 have and will maintain a Cer ifeate of Consent to self-nsum for WorkehCumpfn-
anion,es provided for by Section 3700 of the lahar Code,for on,par om once of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3700.f On labor Cwse,for the performed.Of on,work for which Nis permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier. &/+ &T-e_ Policy — ——
ERTIFIC� ATE'OFMEMPnONFR RKERS
COMPENSATION INSURANCE
(This section nand nm becompleted if the Permit is for one hundred dollars($10iff
or leas.)
1 certify that in the perfoorre ce of the work for which this permit is issued,1 aging not
employ any pers,m in any manner so M m became Subject n the WorkersCompensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Ceniticate of Exemption,you should
become subject In the Wmkers Co.periodic.pm.iaiatrs of the Ulw,Code,you..at
OO forthwith comply with such provisions or this permit shall be deemed revoked.
Z t"' CONSTRUCTION LENDING AGENCY
[-+ nN-t I hereby affirm Nal there is a consuvaion lending agency lin the Performance of
Ratti the work for which this permit is mucd(Set.NA17.Co.C.)
Q Lender's Name
z Lenders Address
V 0 1 certify deal I have read this application and sate that the above Intimation is
correct.1 agree to comply with all city and county ordinances and scute laws relating In
V building construction.and hereby authorise representatives of Nis city to enter upon the
{kt above-mentioned pmpeny for inspection porpoxcs,
G (We)agree to saw.indemnify..it keep harmless the City,,(Cupertino against
ti T� liehililffllvl�
nss,costs endespenseswhich yin any way accrue against said City
V APPILthe pro gUSthu' roll" CO WITH ALI"NON-PO NT Issued by: Date
SOU
Re-roofs
HAZARDOUS MATER LSDISCLOSURE
11 rm Type of Roof
P,I,cam or future building Occupant score or handle harallous material
defCupertino Municipal
Code,Chapter 9.13,and the Health and Safety
R. s3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
u
pplicant ser future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
cont hazardous air cont nidi nts m derincd by the Bay Area Air Quality Management all new materials for inspection,
District?
❑Yes w y
I have rtad the hevardnus mamrialsmgtormomes under Chapter 6.95ofNc Celifoo
ma Hexlth&Safety Crede,Sections 25505.z5533and3ss34.l understand lhn iftle building
does nal.romm y ve a ew at it ism s hili madly tbe ocrupan of the
rcquireme man 'ono' ace 0 au,.f0.c CucY. Signature of Applicant Date
sonar a uthorized reg /?-, �,re - All roof coverings to be Class"B" or better