06030155BUILDING DIVISION
BUILDING ADDRESS:
20705 VALLEY GREE:
`TER'S NAME:
APPLE COMPUTER
PHONE:
ARCHITECTIENGINEER:
PERMIT
J
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of th Business and WO , a�y license is
M full force and
License C,
Date Contractor '
p Hr ECTS DEC
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolish, or repair any structure
prior to its issuance• also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) 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 to a civil penalty of
not more than five hundred dollars (5500).
I, as owner of the property, or my employees with wages as their sok compensation,
I do the work and the structure is not intended or offered for sok (Sec. 7044. Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however. the building or improvement is sold within one year of completion. the Owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
cense Caw does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor s
License Caw.
0 1 am exempt under Sec. B & P C for this reason
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,er Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
ation, as provided for by Section 3700 of the Labor Code, for the performance of the
vork for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section
1700 of the Labor Code, for the performance of the work for which this permit is issued.
Vly Wo r s Compensation Insurance camer Poll i be are:
wrist 11tryLL� a.::
CERTI C OF E7 EMPTION FROM 0 CERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 100)
Lir less.)
I certify that in the performance of the work for which this permit is issued. 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
correcL I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection Purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way scene against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTAN�ANDILL MPLY WITH�ALLNON-POINT
PPLIC ULA ON Signature of Applicant/Contrale
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12• and the Health and Safety
,de, Section 25532(a)?
0 Yes e
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
0 Yes Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that h is my nsibility to notify the occupant of the
uirements h m be met prior, o certificate o(Oc�pafIcy.
O
Owner or authorized accnt II 11 ate
ICOM M: P CHAN I CAL INC PERMIT N°. 0 6 0 3 015 5
PERMIT ISSUE DATE
477 BU 2KE STREET, 04124/2006
SANITARY NO. CONTROL NO.
(4 08) 792-2292
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
INSTALL (N) 5 TON HEAT PUMP & RELATED DUCT WORK
;q. Ft. Floor Area
Issued b3:
Re -roofs
Type of Roof
Type
Required Inspections
Date
All roof: shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signatur, of Applicant
All roof coverings to be Class 11B" or better
Date