07010055 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT C� R��`T�R II®N�
BUILDING ADDRESS: PERMIT NO.
10351 BUBB RD SOUTH EAY CONSTRUCTION CO 07010055
OWNER'S NAME: —=C— PERMIT ISSUE DATE
APPLE COMPUTER 170 KNGWLES DRIVE,._,STE 120 n2/27/2007
IE: SANITARY NO. CONTROL NO.
(408) 39-5500
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
;wr- I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;z'Lu� with Section 70()0)of Division3ofihcBusinessandProfcssiuntCodc,andmylicenseis TI COMN:ERCIAL OFFICES MINOR STRUCTURAL—TEMP
H in full force and effect
z License CI Lic•# PERMIT
in Date Contractor
3 ARCHf[ECTS DECLARATION / . t Yt+�A o #0 7 01016 0 GOOD TILL 02/26/07 .
7 y< 1 understand my plans shall be used as public records e.�V
)aU
'
U.y Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
:00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
$1i which requires a permit to construct,alter,improve,demolish,or repair any structure
z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
s_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
r[ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $300000
i 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 APN Number Occupancy Type
not more than five hundred dollars(5500). 3 5 7 2 0 0 C 9
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7004,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q P
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 Law 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 Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and
Policy number are:
Cartier..C�(PN c t iJ /re'�W tC4olicy No.: "' 03 1 Z2-2't Z
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I 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.11,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
GY, the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
0 z Lender's Address
V 0 1 certify that 1 have read this application and state that the above information is
LL correct I agree to comply with all city and county ordinances and state laws relating to
0V building construction,and hereby authorize representatives of this city to enter upon the
W above-menuoncd property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
�c/1 liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in corse tierce of the granting of this permit �7
t r AP UNDERSTANDPID WILL CO PLY WITH ALL NON-POINT Issued bt': Date Z-Z?
S RCE EGULAT10NS.
Re-roofs
sig`dxure'5fAppIicant/CLm&aEtor Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
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
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
13 Yes VN.
Will If a roof is installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
,mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r Iaterials for inspection.
District?
❑Yes �No
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
do9wftTZbirrrntly have a tenant th 't is y responsibility to notify the occupant of the
uirements which must be met ' r w once of a Ccru ate of Occupancy. Signature'of Applicant Date
Z Z?—o All roof coverings to be Class nBr,or better
Owner or authorized agent Date