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