07010160 CITY C CUPERTINO
BUILDING DIVISION PERMIT e G _�R ItE�IMATIQN'.
PERMIT NO.
BUILDING ADDRESS:
IRT IRR IR T) -$ TE
OWNER'S NAME: TTTrr
,PPLE COMPUTER 1170 KNOW:,ES DRIVE STE 120 01/26/2007
SANITARY NO. CONTROL NO.
e_ONE:
(408) 379-5500
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p 0O LICENSED CONTRACTOR'S DECLARATION Job Description
�m r- I hereby affirm that I am licensed under provisions of Chapter 9(commencing
C-z UW with Section 70(�effec
' Business and Profession/s Code.and my license is TEMP PERMIT FOR INTERIOR ONLY
y in full farce andG? License ass •xtau Dam ( ContractorCT'S DECLARATION
U I understand my plans shall he used as public records
UJ
p.y Licensed Professional
o a OWNER-BUILDER DECLARATION
n V7.t
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
no following reason.(Section 7031.5,Business and Professions Code:Any city or county
t m V which requires a permit to construct,alter.improve,demolish,or repair any structure
u-W prior to its issuance,also requires the applicant for such permit to file a signed statement FC.Floor Arca Valuation
?< that he is licensed pursuant to the provisions o[the Contractor's License Law(Chapter 9 3q $0
xl- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of PN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3572000c.
not more than five hundred dollars(5500).
❑I,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.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does 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 We.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.).
O I,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 Taw 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
-•vner 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-
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 Workers 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�Compensatio°�`�Insurance carrier and Policy numbers am:
Carrier.C44L.CCNGr404J Policy No.: d 7 i Z'ZZ_1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed lithe permit is forone 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 Ute Workers'Compensadon
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
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
a > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Lenders Address
U 0 I certify that I have read this application and state that the above information is
U. correct.I agree to comply with all city and county ordinances and state laws relating to
0 U 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
�q f) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
�+ AP ANT UNDERS D D WILL OMPLY WITH ALL ON-POINT Issued b}
S UR REGULA
� °7 Re-roofs
Sigiiii re of Applicant/Contractor I Dam Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
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.
C3 Yes +((l No
+\ If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminyn�az defined by the Bay Area Air Quality Management all new materials for inspection.
District? V
Yes ❑No
I 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 ten tI
it is my responsibility to notify,the occupant of the
require which must be pr to issu ce of a Certificate if cup y. Signature;of Applicant Date
� a All roof coverings to be Class"B or better
Own uthorixcd agent Dam