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CITE' OF CUPERTINO
DIVISION PERMIT
BUILDING
BUILQIj$G1A,QgR9hLLCO PARKWAY
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NOVO CONSTRUCTION
PERMIT NO.
07080091 -
OWNER'S NAME:
FERMITISSUE DATE
APPLE
1042 HAMILTON CT
09/27/2007
PHONE:
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECI7ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) ofDividon3o(theBusinessrofcssionsCode. and myliccnscis
REVISION - SITEWORK IMPROVEMENT (REPAIR PARKING
in full force and effect. M
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LOT TO MATCH (E) CONFIGURATION) ADDITIN OF
License Clan• e.#
Dale b COnlractnr Flrl7 Fil-re -
ARCHITEC7SDECLARATTd
ELEVATOR IN LOBBY -NO SANITARY REQUIREMENTS.
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any stricture
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prior to its issuance, also requires the applicant for such permit to file a signed statement
the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area$
Valuation
that he is licensed pursuant to the provisions of
0
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
1 that he is exempt therefrom and the bass for the alleged exemption. Any violation of
3 2 6 2 0 0 7 4 Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
.
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the stricture's not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Conuactor'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 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 eonaactor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Date
_
WORKER'S COMPENSATION DECLARATION
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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 Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as required by Section
'3100 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Work Com a sad nsurance camer and Policy nunIber arc:
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Carrier. olicyNo.:���y�
RTIFICATE OF EXEM ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed i( 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: 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.
j
" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
y the work for which this permit is issued (Sec. 3097, Civ. C.)
'
Lender's Name
,
r Lender's Address
I certify that 1 have read this application and state that the above information is
' correct. 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-menduncd property for inspection purposes.
4 (We) agree to save, indemnify and keep harmless the City e( Cupertino against
P) habilitics,judgmens, costs and expenses which may in any way accrue againslsaid City
in consequence of the granting of this permit.
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APPLICANT UNDERSTAN I L COMPLY WITH ALL NON -POINT
1
Issued by: Date
SOURCE REGULATIONS
Datc
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will dee 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)9
All roofs shall be inspected prior to any roofing material being installed.
❑Yes �p 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 contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
yes dil.
❑
I have read the hvardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand thatif the building
does not current v a tenant that it is my responsibility to notify the occupant of the
myuirem-t
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Signature Of Applicant Date
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