07050014CY OF CUPERTINO
BUILDING DIVISION PERMIT
Bu1LTIf6SLES�RUNERIDGE AVE PERMIAN BUILDERS INC.PERMrr NO.
07050014
OWNER'S NAME: - PERMIT ISSUE DATE
APPLE COMPUTER 4125 CLIPPER CT 06/20/2007
PHONE, SANITARY NO. CONTROL NO.
(510)979-9081
ARCHrrECr/ENGINESR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 o LICENSED CONTRACTOR'S DECLARATiON
I baaffirm
cby arm that I era licensed under provisions of Chaplcr 9 (commencing
Lu with Section 700(I) of Division 3 of the Business and P%-ott4 Code, and my license is
a in full force and effect /TJ8
i Llcertsc 1 Lie. R
f- Date Contractor
ARCHrTECTS DECLARATI
< I understand my plans shall be used as public
qU
a y Licensed Professional
y; OWNER-BUILDERDECLA RATION
<:F I hereby affirm that ! am exempt from the Cntnctors U Law for the
co following reason. (Section 7031.5, Business and Pmfessions Code: city or county
which requires a permit to construct, alter, improve. demolish, or repair any structure
Z y prior to its issuance, also requires the applicam for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractors Liccitse 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 70315 by any applicant for a permit subjects the applicant to a Civil penalty of
not mot,: than five hundred dollars (5500).
❑ L as owner of the property. or my employees with wages as their sole compensation,
win do the work, and the structure is not intended or offered for sale (Sec. 7044. Business
and Professions Code: The Conuactoes License Law don mot apply to an owner of
property wbo builds or improves thereon, and who does such work himself or thrmrgb his
own employees, provided that such improvements are not intarded 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 Conttxroes L.'t-
cc= Law does not apply to an owner of property who builds or improves tberecin. and
who contracts for such projects with a contractor(s) licensed pursuant to the Comueefs a
License Law.
❑ I am exempt under Sec , B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirmvnder penalty of perjury one of the following deelaraa r
❑ I have and will maintain a Certificate of Conscnt 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 Workers Compensation Insurance carrier and Policy number arc:
Carrier. %�WO1614C �IJar �policy No.: 60 2rf
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
0-his section need not be completed if the permit is for one hundred donna (SIOG)
or less.)
i certify that in the performance of the wort for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Worker' Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you sbould
.become subject to the Workers Compensation provisions of the Labor Code, you must
D Z forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
... I heir -by affirm that there is a construction lending agency for the performance or
: the work for which this permit is issued (Sec. 3097, Civ. C.)
4 Q Lender's Name
Z Lender's Address
J O 1 certify that I have read this application and state that the above information is
correct. I a&= to comply with all City and county ordinances and state laws m1aling to
U building construction. and hereby authorin representatives of this city to enter upon the
W above -mentioned property for inspection purposes
(Wc) agree to save, indemnify and p harmless the City of Cupertino against
L, Cn liabilities, Jtdgmcu�S.
anyway accruc against said City
J in consequence of
APPLICANT UPLY Wrn-1 ALL NOyrPOAiT
/ /
Signature oQ,a,6p1 i Dale/. '
((�� ��TCuF�5
MATERIALS DISCLOSURE
Will the auilding occupant store or handle hasardous material
as defined by thep}ICode. Chapter 9.12. and tune Health and Safety
Code, Section 25N
❑ Yes a
Will the applicant or future building occupant use equipment or device which
emit hazardous air contaminants as defined by the Bay Area Air Quality Mamag=CnL
District?
❑ Yes Ewo
I have read th a0'1�1—;O=U�I-ly
der Chapter 6.95 ofthe Califor-
niaHcalth&Sir Aunderstandthatirthebmlding
does not cum a to notify the occupant of the
Job Description
COMMERCIAL TI. CREATE 1 HR LOBBY & CREATE
SEPARATION FOR SUBLEASE TENANT
Sq. Ft.
31606033-
Issued by:
Re -roofs
Type of Roof
Area
Valuation
$106801
Required Inspections
Date
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.
C
Owner
Signature of Applicant Date
A]I roof coverings to be Class "Br' or better