07080108CITE' OF CUP)NER"ITNU g� �y��g�+
BUILDING DIVISION PERMIT
DE ANZA BLVD
OWNER'S NAME:
APPLE INC
PHONE:
ARCHITECT/ENGINEER:
Z LICENSED CONTRACTOR'S DECLARATION
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� 1 hereby affirm that I am licensed undo provisions of Chapter 9 (commencing
UW with Section 7000) of Division 3 of the Business and Professions Code, and my license is
UW
°-in full force an cffeet.
Z License CI s Lic. a
p Date Contractor
RCHITECTS DECLARAT N
1 understand my plans shall be used as public records
U
Licensed Professional
y
OWNER -BUILDER DECLARATION
� I hereby affirm that I am czcmpt from the Contractor's License Law for the
O following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
r'r prior to its issuance, also requires due applicant for such pctmit to file a signed statement
a
� that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
o (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).
❑ 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. 7044, Business
and Professions Code: The Contractors 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.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contracules Li -
cease Law docs not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a conrracior(s) licensed pursuant to the Contractors
License law.
❑ 1 am exempt under Sec. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I 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
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's ompens ion Insurance carrier and Policy number
are:
Carrier:
FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
1 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 Califomia. 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 most
,Z forthwith comply with such provisions or this permit shall be deemed revoked.
0
CONSTRUCTION LENDING AGENCY
14 I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Civ. C.)
QLender's Name
Lender's Address
0 1 certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
U building construction. and hereby authorise reprcseniauves of this city to enter upon the
W above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
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(n liabilities, judgments, costs and expenses which may in any way accrue a aiastsaid City
> Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOUR`
Signature Ap ican on ctor Date
H ZA OUS MATERIALS DISCLOSURE
Will the appli 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)?
❑Yes
No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Manzgement
District?
❑ Yes �Nu
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 dte building
docs not cummly have a tenant. that it is my responsibility to notify the axupant of the
requirements whit o(Occupancy-
Owner or authorized a"lil U Date
CAL -AIR INC
1555 S 7TH ST
(408)283-2300
PERMIT NO.
07080108
PERMIT ISSUE DATE
09/14/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
REPLACEING 3 COOLING TOWER, 1 HEATING PUMP (HVAC
3) CONDENSING PUMP
Sq. Ft. Floor Area
31602105:
Issued by:
Re -roofs
Type of Roof
$405000
Required Inspections
Valuation
Occupancy Type
All roofs 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.
Signature of Applicant
Date
All roof coverings to be Class "B" or better