07060086 F
F CUPERTINO DING DIVISION PERMIT
�ESS: TANTAU AVE SOUTH BA'C C�V AME: 06/12/2007
APLE COMPUTER 170 KNOW--iES DR
SANITARY NO. CONTROL NO.
'NE: (408) 379-5500
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PL
UMB MECH
ce Zo LICENSED CONTRACTOR'S DECLARATION Job Description
ui I hereby affirm that I am licensed under provisions of Chapter 9(commencing DEMO OF HALLS, DOORS, FLOORING, CEILING,
Z m with Section 7000)of Div}�on 3 of the Business and Professions Co e,an my license is
!=y in full force and effect. V �, ! MECH/ELE--T DISTRIBUTION.
Z Lbcen�Cl ii Lie•ii
ads
E tp DaeContractor
Gs 1 s H cTs DECLARA J
i a< I understand my plans shall be used as public records
>yU
m H Licensed Professional
•O< OWNER-BUILDER DECLARATION
3 a I hereby affirm that 1 am exempt from the Contractor's License Law for the
,no following reason.(Section 703 1.5,Business and Professions Code:Any city or county
e o which requires a permit to conswct,alter,improve,demolish,or repair any structure
r Nrior err its issuance.also requires the applicant for such permit to rile a signed statement S Ft.Floor Area Valuation
.Z-"
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 9 $105000
H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
J that be 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 31618025Number P y yp
not more than five hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as thew sole compensation, Required Inspections
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code-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.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 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 Contractor's
License Law.
❑1 am exempt under SeB&P C for this reason
Sec.
Owner DHte
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 bsve 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.
❑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 Compye-nsation Insurance Carrie and Policy number arc:
Carrier. �D^r�J�O 1 �r'' icy No.:
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(chis 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.Dae
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 forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
p!> the work for which this permit is issued(See.3097,Civ.C.)
W QLender's Name
0Lender's Address
U C) l certify that I have read this application and state that the above information is
V. — correct.I agree to comply with all city and county ordinances and state laws relating to
rJ U building construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
).-q liabilities,judgments,costs and expenses which may in any way accrue against said City T
U 2 in co uence of the granting of this permit. Date
Ut �1
AP I NT UNDERSTA AND W LL COMPLY
S UR REGULATI Re-roofs
WITH ON- INT Issued by:
O
ofAppli I/Contractor ALL Da1c T Of F.00f
HAZARDOUS MATERIALS DISCLOSURE Type
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
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
I have read the hazardous rials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building
does no rcntly have a tenant that'W!T
fy the cup I of the Date
requi which must be Friof Sec pa�.�� Signature:of Applicant
(' All roof coverings to be Class"B"or better
O uthorized agent D