07120018 (2)CITY OF CUPERTINO
+ �'mni r r t _171
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BUILDING DIVISION PERMIT
ACU£1'�.C'tUltil!I)UT.tMATif)yNy'"
BUILOIND.ADDf"A TANTAU AVE
1V
SOUTH BAY CONSTRUCTION CO
P�07120018 ,
NER'S NAME;
PERMIT ISSUE DATE
APPLE COMPUTER
170 KNOWLES DR
01/22/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITEC IENGIPMER:
BUILDING PERMIT INFO
COMM' L TI OFC, MINOR BLDG ELECT PLUMB MECH
O O O O
NEW
LICENSED CONTRACTOR'S DECLARATION
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dBiT DBBC(IphOn
Nat 1 am under mm
I thereby affirm licensed er provisions of Chapter 9 (coencing
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with Section 7000)ofDivl.km 3afthc Bwinessand Profession C andmylieenwis
And elf
in roll fosee a 336
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ARCHITECTS DECLARATION
I understand my plans shall be used As public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby 81TIrm Nat I am exempt from the Conuamors License Law for the
following reason. (Section 7031.5, Business and Protessiom Calc: Any city or money
which requlm a permit to construct, alter. improve, demnikh, or repair any structure
prior m its issuance, elan requires rhe applieam far such Permit M ftk.glineJ SUANTIenl
tis, Contracwr's License Law 9
Sq. Ft. Floor Area
Valuation
that he is licensed purmanuo provisions ofthe (Chapter
(commencing with Secdon 7000) of Division 3 cling Business and Profeuim Code) or
1 that he is exempt th delrom and the parts for Ne alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031-5 by any applicant for a permit subjects the applicant to a civil penalty of
Am me. Nan Tiro hundrtd dollars ($500).
0 1, As owner of the property, or my ermployces with wages as Neirsolecampevadon,
Required Inspections
willdo du work and Ne sumcmu is..tintended waff.md (or We(Sec.7W, Busims
and Professions Cade: The Con mmust's Liam use does not apply b an owner of
property who builds or im prow the men, atW w ho does such work himself or through his
own employees, provided Natsuch impre ements art not bounded oroRered lersaht If.
however, We building o6reprovement Issuld within aro year of completion. the owner -
builder will have Na burden of proving Nat K did am build or improve for purpose of
..
Alk.).
0 1, As owns of the Property, em exclusively contracting with licensed comacurs to
coconut the project (Sec. 7041, Business and Profession Code:) The Comessom's Li-
ume law don not apply le an owns of property who builds or impmm Hereon. and,
who x n Latta for such projects with •cagurmu r(s) licensed pursuant u the Continuum's
License Law.
O l am exempt under See . B k P C for this reason
oer Dau
WORKERS COMPENSATION DECLARATION
I hereby all= under penalty of perjury on of the following deciag tions:
0 I ham and will maintain a Certificate ofComent to self -insure for Worker's Camper-
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satlon, As provided for by Section 3700 of the labor Code, for the peff.nnance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Inueaama, as eximmd by Section
3700.(the Labor Cods, for Ne performanuofthe work forwhtcb this permit is issued.
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My Workers ompemloa Wuranceurtierand Polkynumberase:
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Carrier. (/Y Policy No.: 077- 2-7-1-1)
CERTIFI TEOF %EMPI70N FROM WORKERS'
COMPENSATION INSURANCE
(This section and not becmnpleml time permit Isf.rooe hundred dollars ($1 00)
or less)
I cemfv that in the performance of the work for which this permit is Weed. I shall not
employ any "men In any manner an as to become subject to the Workers' Compemdon
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject be deo Worker's Compensation provisions of the Labor Code, you mug
forthwith comply wide such proisiom or this per it shall Is, deemed revoked.
l
CONSTRUCTION LENDING AGENCY
1 t emby al0ren that them is a construction lending agency for dee performance of
' the work fur which this permit B Wised (Sec. 3M. Civ. C.)
Lenders Name
lenders Address
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i I certify Nat 1 have read this applic"m and rut, deg the above information is
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' corms 1 agree to comply with all city and county ordinances and state laws rtlating to
building construction, and hereby authorise reprnenutim of this city to enter upon the
( shove -mentioned property for inspection purposes
(Wc) agree to Ave, indemnify and keep harmless the City of Cupertino agarol
j liabilities, judgme ls. toga and expenses which may in any way mcrue against said City
ccof the
in ca ofof this permit.
granting
AP ICA QQQQQQAAAAAA9�f��fD WWWjjj���L COMPLX WITH ALL NON -POINT
Issued by:6i Date Zz r<vd
S RCEE UrLAT10N� // )//
Re -roofs
' mat
Signuurt o(ApplicgNCan sur Dau
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII cite applicant or (alum building euupanuum or handle haArdom materig
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as dented tie Cupertino Municipal Code. Chapter 9.13, and tis, Health and Safety
Je, Section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
[2y" No
If a roof is installed without first obtaining an inspection,agree to remove
will the anplicam r fuss building occupant use equipment or dcvim which
emit hummmUs aircontsminants A defined by the Bay Area Air Quality Management
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all new materials for inspection.
District?
O Yes (NN.
Ihave rtwd mau0.25533mments underulmmarh.95
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Cods,he srdons
nk Health &Salm Calc, If McCal
2Myrand 25534.1
cat
Wredl dthulfthebuildingoh
does not c hew •tenant t' my respommaihililY b nmtifY Js, cupant_of the
amenn75't
euire nuwh hmuualo. bsmb. .C_nrir.me.r an
require,
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Signature of Applicant Date
All roof coverings to be Class "B" or better
Dam '
Owner or authomnd egcnm