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BUILDING DIVISION PERMIT
AVE
OWNER'S NAME:
APPLE COMPUTER
PHONE:
ARCHriECT/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencer
with Section 70(10) of Div' ' n 3 o f the Business and Professions Code, and my license
in full force and effect 7
License C1 Lic. 8
Date_ Contractor
ARCHITECTS DECLARATMW
1 understand my plans shall be used as public records
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct alter, improve, demolish, or repair any structure
prior to its issuance, also requires die applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 70D0) 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).
❑ I, as owner of the property, or my employees with wages as thew sole compensation,
will do the work, and the structure is not intended or offered forsale (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
property who builds or improves thercon, and who does such work himselfor 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 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 alum under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self-insurc for Worker's Compen-
sation, as provided for by Section 37DO of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I 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 Compen air n Insurancc1e``c--arr q aap1�d Policy number are:
Carrier. �+ C -Popry No.: 0� 1 ZZZ �t
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (SI00)
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 Califomi a. Date
Applicant
NOTICE TO APPLICANT: If, arta making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a concoction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I 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
building construction, and hereby authorise representatives of this city to enter upon the
ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costs and expenses which may in any way accrue against said City
in co erase of the granting of this permit
AP
.
SighweVApplicantl4tonLractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle havardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)? �'11
❑ Yes No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arra Air Quality Management
District?
❑ Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand thatif the building
docs no}}}---�ntly have a tenant a my rcsponsh ' ity to notify the T
nt of the
reyu�r� hectic of O�cu i� -7
SOUTH BAY CONSTRUCTION CO
170 KNOWLES DR
(408)379-5500
PERMrr NO.
07060087
PERMIT ISSUE DATE
06/12/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
DEMO WALLS,CEILINGS, DUCT WORK, FLOORING DOORS.
Sq, Ft. Floor Area $65000 Valuation
31618027 Aftl Number Occupancy Type
Required Inspections
Re -roofs
Type of Roof
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