01040093 (2) CI'rY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IIUILrJItlG ADUH455'. 1'ERMI'INO.
OWNHR'S NAME; APPLICATION SUB 1
—APPLE GGMPUTER 511 DIVISION STR
1'BONIa ❑'ARO NO. ( R
RI ARCBI'DiCI'/HNGINEER (41218) 3713 0400 BUILDING PERMIT INFO
F BLDG Ii1.1i(LL' "LUMB MITCH
F d E I C=1 I=] IJ 1—I
2a
_ Lrint that
iII CON'nHACrder r DECLARATION .IOb Description
I heresy anon thus I n 3ofthe B under find Praf,of n,Chapter Code.(commencing
�wl–w
with Section70(10)of Division inflhe Business and PmR•,sions Code.and my littn.w
I
,in full force and cllcct.
Liacr,cclay, Lie'» DEMO EXISTING SOFFIT B• INSTALL NEW T—
s'J P�"" Dutc Canmuwr
m a o nacurn;cr's uE[chnann°N (N) ROOM.
1 undcruvnJ my fila,shalt le maul a.,public maned,
a.
am O Licm,wd Pur innnl
r a �o, OWNCH,11,aam lCli UIiCLARA'HON
til 1 hereby uftinn,but 1 anexumpl from the 0 uravmr',Licmrc lalw An,the
(=L< ❑showing reason.(Section 7031.5,Business and Pndes io,Code.Any city or cnunly
`e j which aspires a pearrinit to construct, La p denualish,or repairy Ta arc
u°6J 3 m
prior to itsIw requires the applicant h ental to rile a signedstatement
hat In,is licaal,ed....... 1
atm IT < It c t :L I (Chapter9 Sy. FL Flo Area Valuation
(antIng wnln Scmlon7(1 Xu,I Dir do„3nf Moho, , ,d 1'r cies,:...,Cade)
or Shut basic exempt tmy applicant
and the assns fns the alleged exemption.Any violnalty
01 Section,than by any applicant fora permit subJrou the aPFlicam m a civil penalty Typ
mf a,a 11mrc man r,z nonarcd dollar,($sE.n. APN Number Occupa$YTyp00
Chats owaernl'O ePmiscrty or my employees ant wages as lheir,nla con.pano., n. `:YID
will do the work,and the stmcwrc is nol Intended or offered for sale(Sec.9044.
Bins,and I'mfcssinn,Code,rile Contractor',Licnrcc Law does not apply in ane(F,,6ed Inspections
owner of,ars enY Who builds or improves Merron,and who does such work hlmwlf 326 1004 1 . fl'G1
through has own employees,provided that such improvements arc not intended or
Transit for wle.II'.Ia T,Ion handing a au, col 1,,old wlmin one yea of
n11pm1on.meow,rf yrle,lr will have dtetnumen in�pro,ing mai l,e aid n°t hails nr ^2+04 — UNDERFLOOR FRAME
improv utpnm o
,a,owner of the proleny.;an,ewsi,'cly commertng with licensed commcWri in 301 — ROUGH PLUMBING
naruct the pnfcct(Sec.71.14,B,iors,and Pn11'esvons Coale:)the Contractors
.ieenxe E uw doe,it,),apply m annowner of rollarly who,runs or improv,,mercotl. 303 — ROUGH MECHAN I CAL
nil who contract,In,,a ,meet,w;th a eourneunrca rcen,ed punuanl m the
Coatmemr', .; low 304 — ROUGH ELECTRICAL
❑lame r B&PCfnrmi,relsn 505 — FINAL ELECTRICAL
owrl _ ,o_ : rcoMPrrriAr�r��lcLA�nnGN 507 — FINAL PLUMBING
hercnyafim, merperaltyofperjury one orthe foHowmgdcelanni ,: 508 — FINAL MECHANICAL
0 I bas mal ,It nnain a Cenireane of cnn.ertt t,eco-ia,aa nor Worker, 514 — FINAL PUBLIC WORKS
Compcn.awm, as prowidni for by Section 3703 of the Labor Cala for the
performance of the work tor which this pemlit is issued.
❑1 have and will maintain Worker's Conllernutlon Insurance.as required by Section
3703 of the Luh...Code,Gr the panonnanre or it,work for whleb Ibis pcnuit Is
sued.My Worker's Cou,s nation Insurance canner and Policy nanber arc:
Carrico policy No.:
cBRrIPiCAI'ION(S EXEMFCLON FROM WORKERS'
COMPENSATION INSURANCE:
(This section need not be completed if the Nam,is for one hundred dollars FINALE D
(111)or less.)
I Certify that in the Iarfunnunm 0 the work fur which 1IN per at is i„red,1 JUL 0 3 2002
,hall nm employ any person In Tiny manmn m v, In necmne'chil,t o-1 Ian Wakcri
Compensation haw',of California.Date
Applicant
NOTICE TO APPLICANT:II,after making this CeniGcme of Exemption.You,hmlA
Q Qumbem s thioct no the Wor kers Cmmpvnsmiom provlsiann of the Labor Code.you most BUILDING
Ibnhwim eo,lyny with such pmvl,don,or IIni parinit,hull he dacntem mvokm.
Z .
'n
CONSTRUCTIONtamma num InMNO AGENCY
a ' 1senor winch that thereiss coned:Sec Icnding agency for the perfomlanve
nano,',N mr which mss Penna is isencA(See.3037.Civ.C.7
Q Lender,Name
z IsnJcr',AJArcss
t.7 1 reality that I have read this application and vale that me mane intimation.is
W [^r coma 1 agree In comply with all city and county ordinances and state laws relating
V mhuildogcroo,flon,and hereby author ire rcprc.... sol lhi,,.,y to enter upon
theabm<nu7nlnnedproper furins,melinn Purposes.
E}„ y (We)agrccrosavc,i cmnify xnJ keep harmless the City..-Cupcninn again
V1 Iivhiline,p • cot, d and cxpcnas which may in any wa accmc 6ainv,aid
V '^, Chy In m rt t g' tiny phis hermit. Y�
APP 'I' t SANDII WILL COMPLY W TL�OINT Issued by: Date
gat 6 npphcanvcn anor nate Re-roofs
HA l RDIIUS MAIHRLM.S DISC.OSUR.
Will 111—ppraal or lntum bod goccopant,tor:or handle lnoamoas,ontedal Type of Roof
vat Js mea by me Car,mro Municipal Cod,Chapter 9.12,and the Uealnt and Safely
Come.Section]35320)!
❑Yea ON,, All roofs shall be inspected prior to any roofing material being installed.
Will maapplielTmafnlumhaud'ng,wca, t.,en,mpmerlad,viacawhich If a roof is installed without first obtaining an inspection, 1 agree to remove
emit h ounlou4 to,comanlina d,,darned by the day Area At,Quallly Muwgamet,
[)i,rire all new materials for inspection. Applicant understands and will comply with
O yes 0 N all non-point source regulations.
I have read the ha,an nu,materiel,rcquirnnenn under Vha,tv,b 95 of the
Cali l'am4 llculth,k Satiety Coxae.Season,25515,2553}unJ 25. 4 1 un cnwnA d,w
ifmcbuildin• t' ly von mnvm.Ihm it i,my rcs nl,ihilil In nonil'y the
o ccupanrclama a be met prior I is a of Cenif eme of
Signature of Applicant Date
-w
net a I;aac ."at CC Data All roof coverings to be Class `B"Or better
OFFICE
® CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO
0730 VALLEY GREEN DR OUTH BAY CONSTRUCTION CO INC 01040093
OWNRR'S NAME:
1
A0
PPLE COMPUTER 11 DIVISION STREET APPLIlsV9'�F001
PHONE( (408) 379-0400 SANITARY NO. CONTROL NO.
-0 O ARCHITECT/ENGINEER:
wBUILDING PERMIT INFO
� —
a u G BLDG ELECT PLUMB MECH
Nzu
Z Z ores i LICENSED CONTRACTOR'S DECLARATION Job Descript'
Oz—e Section
innyhereb )of lite lam Ofthe dunderprovi sionsof Chins,9nd mmccense
F=tZom is in full lone and effect,Division me Business and Profenionz Code and my license DEMO EXISTING SOFFIT & STALL NEW T-BAR
a az C is in full force and ellen.
�� a Lioenseclas. Lice (N) STORAGE ROOM.
X 3 i U Dam Connazmr
0y a I undersmnd my plAanRsCsHhaITll EbCe uTs'SeDECLARATION ECLARATIONs r
1 WgR rowE3
n d p O Licensed Professional
a�o(ii OWNER-BUILDER DECLARATION JUL 0 3 2002
I hereby affirm that 1 am exempt train the Conuaaor's License w for e
t-Z (oilowing reason.(Section 703 L5.Business and Profession,Code:Any city or county,
{ o which requires a permit to convect,alter,improve•demolish,or repair any someone
3� ..Inicion,if, c Iso'claims h-slioltfar n Parnal toile a,ionediaineream 50000
malhel bc<ns<dpury u ;t 'th pro s° fineC t lwsLeenselaw(Chpi 9 S
(co e g thsao 7009) fD 3 flhBusiness and Pramic bn.Cod ) I'�)i SS's '..J.,L 5 i'\ " :,'Vi 'S'�' S.,> I Valuation
o tot he Kcal nPl tit fmm.ed the hat,lin the allsgcA esengti an`,Any violation - - ' - 1
of Section]031.5 by any applicant for a permit subjects the applicant to civil penalty
lir wt nem man five hundred dngara 15soB). APN Number -' Occupancy Type
D1.as uwnerof Ota properly,or my employees with wages u,lheirsole contp<nsmian, — UNDERFLOOR F E
Him
do he'work.-aad'the' comorm'is..I intended w wffoc for salc(Sec:70w;
Business and Professions Code: c Canno ade',License Law dues not,apply to an 3 01 - ROUGH PLiR94UrWinspections
owner of property"'no builds or Improves thereon,and whit does such work himself
or through his own employee,.provided that such improvements arc ma inera l or 3 03 — ROUGH MECHANICAL
'oifcmd for sola.If,how<vei,the building or imyrovcment is sold within one year of
completion,the ownccOlmdoter win have,the burden of proving that he did not build or 3 04 - ROUGH ELECTRICAL "..."..
improve for purism of vole). 314 — T—BAR CEILING
D1,ainw'let ofm P:npeny.3inmifusiv,lye°ntrahingwithevenedcamtndoman 505 — FINAL ELECTRICAL1
consnuct the pmjea(Sec.7014,Business and Professions Cad,The Carl.,."s -
License Law does not apply m an owner of impact,woo build,or improve,thereon, 507 - FINAL PLUMBING "
cntruenes Licensets�Isaw. n proieati.wnn a conteaurrV licensed Pursuant Ito me 508' - -FINAL MECHANICAL .. . . ... ..
oiam e.emPt unad see.- ,B&P C for his reason 514 - FINAL PUBLIC 'WORKS"
Da1C516 - FINAL BUILDING
WORKER'S COMPENSATION DECLARATION
I hereby,affirm under pen°by of perjury one of m<following decloonom s:
D I have and will maintain a Certificate of Consent to self-insum far Workers
Compensminn. ;is provided or by Section 37W of the Latin- Cal<, for the
perfomtance of the work for which this permit is issued.
D 1 have and will mountain Worker's Compensation Insurance,as required by Section
37W of the Labor Code,for the perfomtonce of the work for which this permit is
issued.My Workers Compensation Insurance carrier and Policy number arc:
Currier+''1 t !' r f-.,r t L L.,,,Polley Na: `, t . .. ... .... .. . . . ., _........ ...,.....
:. CERTIFICATION OP.E%EM"ION PRDM.VC,KERS rJ•x.f a`�,4.ti, t ',•:^ i�J''', ]i1 s•1:-0 t <I,
COMPENSATION INSURANCE s si
(This section need not h completed if the permit is for arm hundred dollars I
($I W)or las.)
1 certify mm in Person
in any m nn the wart for which this permit a issued,1
shall nm employ boy pcnon in any manner in as to become subject to the workers
Applicaunt-
Compensmion Lows of Califomia.Dec
Noon,aROAPPr,to he W.,ka L thermal,ins ohpp oboomme of Escmpione,you ould
become vmjen to me Workers Campematmn provision,of the Lhnr Code,you must
z Q Innhu im'comply wire such pnsvi,inn.lir this permh,hall be deemed ev°ked.
Z
" COt'he" l rIONLENDINGAGENCY --
a " e I kfol ohitm that mere is n mnamamn larding s.C.) fonhe peth;6rmnce
yof me wwrk for which this permit is issued(Sec.1097.Civ.Cl
z 11ro 'Mame-
= Z xndcr',AJdrea - '
WQ 1 scarify that 1 have read this application and state that the shave infarmmion is
[r calico,I;tgme in°imply with all city olid county ordin:mccs and nine law,rclming
..Q U mbwldbtg<omm:clion:red hemh'awhnrirt rcprcunmtives lir mi,city m<ner upon
-}W ohc a,sve-memioned property'far impecoion purposes.
(Wel ag...to' a,e.indemm"aiW keep harmless the City of Cupertino against
Zl liahilitics.luJgmc in cosh unJ expenses which ores in nnY way acme agmina sail
'.0
z1: n consequence of the geeing of rets permit. - f
• SPPLICANT U]'DHRSTANUS AN'D WILL CObIPLI'WITH ALL 60NPOINT 1
sDuucr ar:cuL:....Ns. Issued by: Date
.Stgwmrt of APPbcanvennomcror Dam •�
HAZARDOUS MATERIALS DISCLOSURE Re-roofs
Will the applicant Lir nure(wilding occupant store lir handle ba=allous material Type of Roof
as de fired by the Cupertino Municipal Cale.Chapter 9.12,and the Health and Safe,, - - - - "' --
Code.Section 25532)°1' -)''1 t ti.::I..', t'�(. i t s Y : p n
ave, • ': ❑No i \i•i. • All roofs'sFiall be inspected prior to any roofing material being installed.
Willad applkom or fnum atilding occupaotosccquipmemof devices which If a roof is installed without first obtaining an inspection,'I agree to remove
emit hasarJ�iuI car chum mars as defined h)the Bay'A8..i1ir Quality Management g
D1inai'
°Ye °`° all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
('have read the haaallons nmrerials requirements under Chapter 695 of the
Califomia Health&Safety Cede.Section,25505,25513 and 255311 understand that
if file building does not amanOY have a lenunemao it is my responsibility to notify the
occupant of the requirements which must be mel poor a isuare,of a Ceniftci a of
• .. Occupancy.
Signature of Applicant Date
owner or aamnn=m agent D„< All roof coverings to be Class "B”or better
OFFICE