07080136CITY OF CUPEKITNIU
BUILDING DIVISION PERMIT
BUILD 6 YWS : TAN -TAU AVE
OWNER'S NAME:
APPLE COMPUTER
ARCHI ECTIENGINEER:
Y Z
00 LICENSED CONTRACTOR'S DECLARATION
U �= 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z w with Scetion 70(1)) al Di ion 3 a! the Business and Professions Code. nd my license is
a e in full force and effect 7
yZ License Cl s 1 Oc.+ L
s- p Date. Contractor
ARCHITECTS DECLARATION
w¢ 1 understand my plans shall be used as public records
av
w y Licensed Professional
OWNER -BUILDER DECLARATION
'4 I hereby affirm that I am exempt from the Contractor's License Law for the
❑ 0following 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
Z ¢prior to its issuance, also requires the applicant for such permit to Glc a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Fz- m (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 rive hundred dollars ($500).
❑ 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 Contractors U.
cense Law does not apply to an owner of property who Wilds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
F]1 am exempt under Sec , B & P C for this mason
Owner 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 Compensation / Insurance carrier and Policy number are:
Carrier. t_-19" 5rf ptO) Polity No.: bbl ZZZ ��
CERTIPICATE 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, 1 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
z lonhwilh comply with such provisions or this permit shall be deemed revoked.
O CONSTRUCTION LENDING AGENCY
�-+ I hereby affirm that there is a construction lending agency for the perforTnm= of
the work for which this permit is issued (Sec. 3097, Civ. C.)
i1 Q Lender's Name
1+
z Leaders Address
�
J Q 1 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
Ubuilding construction, and hereby authome representatives of this city to enter upon the
w above-mcmiuncd property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
�-4 in liabilities, judgments, costs and expenses which may in any way accrue againstsaid City
z in c
arc
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes 61 No
Will theapplicant or foto .building occupant use equipment or devices which
emit hazardous air Camaminan defined by the Bay Arca Air Quality Management
District?
❑ Yes No
I have reard the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & cry Code, Sections 25505, 25 3 and 75534.1 understand that if the building
docs not
Date
PERMIT NO,
SOUTH BAY CONSTRUCTION CO 07080136
170 KNOWLES DR
(408)379-5500
PERMIT ISSUE DATE
SAMTARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
NEW OFFICE SPACE, INTERIOR MODIFICATION,
PARTITIONS, CEILINGS, ADDED, ELECTRICAL, DATA AND
NEW FINISHES
Ft. Floor Area
$100000
3 16 18 02 5 '.°1 Number
Required Inspections
Issued by.
Re -roofs
Type of Roof
Valuation
Occupancy
Date `11YA
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