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07050195CITE' OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: 10400 RIDGEVIEW CT. OWNER'S NAME: APPLE COMPUTER PHONE: ARCHITECT/ENGINEER: o a LICENSED CONTRACTOR'S DECLARATION ;� i= I hereby affirm that I am licensed under provisions of Chapter 9 (commencing YJ with Section 7000) of Div' ion 3 of the Business and Professions Code, and my license is a ° in full force and effect. 75 � q —7 y? License CI 5 Lic. # ./ [— p ,Date Contractor- r3 ontractorll ARCHITECTS DECLARATION to a I and tarfd my plans shall be used as public records yU u. H Licensed Professional OWNER -BUILDER DECLARATION <� I hereby affirm that I am exempt from the Contractor's License Law for the m oC 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 Z } prior to its issuance, also requires the applicant far such permit to Glc a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 o(commencing with Scction 7000) of Division 3 of the Business and Professions Codc) or c4 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 their sole compensation, will do the work, and the structure is notintended or offered forsale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds orimproves thereon, and who doessuch 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 Li- ccnse 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 Contractors 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 for Workers 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 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 Compensation Insurance carrier and Policy number are: Carrier. Pb C r1J,9u�.Vr'fLPolicyNo.: b3jLZ2-1 CERTIFICATE O�fh IFEX ION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 1 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 forthwith comply with such provisions or this permit shall be deemed revoked. Q CONSTRUCTION LENDING AGENCY H -+ h--� I hereby allinn that there is x construction lending agency for the performance of L > the work for which this permit is issued (Sec. 3097, Civ. C.) Ta Q Lender's Name li z Lenders Address � 0 I certify that I 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 DU building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against ~ -,cn liabilities, judgments. costs and expenses which may in any way accrue against said City' J z kOURWIE onc of thegranting of this omit. UNDERSTANDS A WILL COMPLY WITH ALL/Qg11ON--PPOINT iLATI /J // !J 7 HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 (�/ ❑ Y. No 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 District? ❑Yes No 1 have read the hazardous ma rials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25 33 and 25534.1 understand that if the building docs n ntly have a tenant, that it responsibility to noufy the cupant of the M rement hich most be met prio i s cc of a C fhcate of CJ gu ancy. C au orvcd.Cent Date " PERMIT NO. SOUTH BAY CONSTRUCTION CO 07050195 170 (408)379-5500 PERMIT ISSUE DATE 06/18/2007 SANTI'ARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description INSTALL NEW CHAMBER, DOUBLE DOOR, RAISED FLOOR -NO SANITARY REQUIREMENTS. Sq. Ft. Floor Area 31606050' Valuation $92970 Occupancy T Required Inspections Issued by:�� Re -roofs Type of Roof. Date �j �( 4- _/ 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