07080092 777777777777777
CITY OF CUPERTINO
BUILDING DIVISION PERMIT �� TRATCIR INECRMTI "1
PERMIT NO.
"'LQR�YRI�tEA TANTAU AVE SOUTH BAf CONSTRUCTION CO 07080092
l�J S 11(J 1V PERMIT ISSUE DATE
OWNER'S NAME:
'APPLE COMPUTER 170 KNOWLES DR 09/04/2007
SANITARY NO. CONTROL NO.
er jNE: (408) 379-5500
BUILDING PERMIT INFO
ARCHITECIYENGINEER: BLDG ELECT PLUMB MECH
0 0
°C Z LICENSED CONTRACTOR'S DECLARATION Job Description
aUrI hereby affirm that I am licensed under provisions of Chapter 9(commencing —
Z w with Section 7000)of Division 3 of Ute Business and Professions Code,a d my license is REV I S I OiV FRAMING DETAIL FOR 1 HOUR ASSEMBLY ET
ZD y in full force and ef143 Lic# 3 j ELECTRICAL ROOM -
v�z License CI `�'�/
y p 4, 12
Date Contractor
ARCHITECTSDECLAR I ORIGINAL #07060032
i a I and tand my plans shall be used as public records
;WU
U.I Licensed Professional
0, OWNER-BUILDER DECLARATION
} r
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
o O 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
i m prior to its issuance,also requires the applicant for such permit to file a signed statement q•Ft.Floor Area Valuation
z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 •' $0
tz$ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
? that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 31618025 . Number
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 Cade: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 sale.IL
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.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors 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 Contractors
License Law.
❑1 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 Warkces Compen-
sation,as provided for by Section 3700 of the Labor Code,far 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 Worke ore nsauon Insurance carrier and Policy number are:
Camey. � (4 Policy No.. V7`ZZZ •'C
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: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 R CONSTRUCTION LENDING AGENCY
C/) 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.)
W Q Lender's Name
Lenders Address
U O l certify that I 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
Jbuilding construction.and hereby authorize representatives of this city to enter upon the _
U above-mentioned property for inspection purposes.
y a (We)agree to save,indemnify and keep harmless the City of Cupertino against 111
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
APPLIC STANDS AND IL COMPLY WITH ALL N P NT Issued by
SOUR REG An S.
Re-roofs
Sign re of xc ret/Contractor Type of R oof
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
lode,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or tutu building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
Yes ° �E���f/
1 have read the hazardous materials requirements under Chapter 6.45 0(thc Califon-
ria Health Safety Code,Sections 25505,25533 aru125534.I understand that iCthe building
Z-mc
cu ly have a tenant,th 't i y responsibility to notify the occ pant C the
n w' must be met p t suance ata crtificatc of Occu Sign a of Applicant Date
All roof coverings to be Class "B"or better
authorized agent D to