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08110080 CITE'OF C UPE RTIN ... .� PERMITBUILDING DIVISION . o : BUILDING ADDRESS: PERMTr NO. 10300 N TANTAU AVE DEVCON CONSTR OWNER'S NAME: PERM17 ISSUE DATE APPIR C OMP-1 IT P JR re.11() G-LBRAT.TAR DR PHONE: CONTROL NO. (408) 942-8200 ARCHITECTYENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH U o p LICENSED CONTRACTOR'S DECLARATION w I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z w with Secdon 7000)of Division 3 of the Business and Professions Cad,and my license is n�0- in full force and effect. 3 TEMPORARY PERMIT FOR COMM'L TT,RMVNG WALL&DOOR D n? Licensc Class Lic.# BET nH❑ Date��- `"e- Contractor '12 L4■- ARCHITECT'S DECLARATION a Q I understand my plans shall be used as public records 2 RMS TO CREATE A RF CHAMBER RM;OR T G #08100172 JWU i W Licensed Pn�fessional PERMT T GOOD THRU 12/20/08 C OWNER-BUILDER DECLARATION n r" I hereby affirm that i am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to rile a signed statement �z� that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 Sq.Ft.Floor Area Valuation F- (commencing with Section 7000)of Division 3 of the Business and Profcssinns Code)or y .-• that he is exempt therefrom and the basis for the alleged exemption.Any violation of $50000 Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of ApN Number Occupancy Type not more than fire hundred dollars(5500). 31618025 . 1&2 ❑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 and Professions Code:The Contractor's Licc=Law docs not apply to an owner of Required Inspections 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 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 contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. ,B&P C for this reason 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 forWorkcesCompcn- 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 Workees 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 Compensaaan Insurance carrier and Policy number Carrier. �-'�'S Policy No.: ( " 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 manncr so as to become subject to the Workers'Compensation Laws of California.Date Applicant NCMCE 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 forthwith comply with such provisions or this permit shall be deemed rrvokcd. V] CONSTRUCTION LENDING AGENCY V] [--+P.-4 I hereby affirm that there is a constrict.inn lending agency for the performance of P4 ? CITY OF CUPERTINO TEMPORARY PERMIT CUPEkTINO PERMIT APPLICATION FORM APN # � i � � PO I h Date: f L� Original Permit# O Building Address: j� goo �/ ��j,�� • �V� Owner's Name: Phone #: �Y� Contractor: Phone #VCCIY7 e"111- 5 YV c 41c.-" ellak Fax #: y2 � Contact: Phone #: Contractor License/4.. Cupertino Business License #: Job Description: /1��✓i� c� cv�v�- e,��- �a�.�c�.�n �-c�� .ems -fir, �x�� Valuation (cost of project):• Type of Construction: /w/v Project Size: Over the Counter Quantity Fee ID Fee Description . Fee Group Permit Type 1TEMPPMT Temporary Permit B 1TEMPPMT (Flat Fee) Commercial only) CITY OF CUPERTINO ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: -patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31618025 . 1&2 DATE ISSUED. . . . . . . : 11/20/2008 RECEIPT # . . . . . . . . . : BS000006670 REFERENCE ID # 08110080 SITE ADDRESS 10300 N' TANTAU AVE SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . : OWNER APPLE COMPUTER ADDRESS . . . . . . . . . 9 : 1 INFINITE LOOP MS-26 MO CITYISTATEIZIP . . . : CUPERTINO, 95014 RECEIVED FROM . . . . : DEVCON CONSTRUCTION CONTRACTOR . . . . . . . : FILIZETTI, GARY LIC # 11068 COMPANY DEVCON CONSTRUCTION INC ADDRESS 690 GIBRALTAR DR CITYISTATEIZIP MILPITAS, CA 95035 TELEPHONE . . . . . . . . : (408) 942-8200 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - 1TEMPPMT FLAT RATE 1 . 00 366 . 00 0 . 00 366 . 00 0. 00 TOTAL PERMIT : 366 . 00 0. 00 366 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CHECK 366 . 00 #52494 --------------- TOTAL RECEIPT 366 . 00