07050087CITY OF CUPERTINO
BUILDING DIVISION PERMIT +e�iciR�rtT�4:
7.
BUILDING ESS: PERMIT NO.
1919 VALLCO PARKWAY NOVO CDNSTRUCTION 07050087
'ER'S NAME: PERMrr ISSUE DATE
APPLE 1042 HkMILTON COURT 05/10/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
INTERI DR DEMO—OFFICE SPACE BLDG ELECT PLUMB MECH
194 LICENSED CONTRACTOR'S DECLARATION
UI hereby affirm that I am licensed under provisions of Chapter 9 (commencing
.Z, with Section 7000) of Division 3 of the Business and Professions Code, and my license is
ga. in full force and eft t Z
z L;cense C ass LIC. ff q 1 l5 2
E Date – _ Contractor _ dV
ARCHITECTS DECLARATION
da I understand my plans shall be used as public records
>yU
U. in Licensed Professional
N OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
COO following reason. (Section 7031.5, Business and Professions Code: Any city or county
V which requires a permit to construct. alter. improve, demolish, or repair any structure
Z y prior to its issuance, also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractor's Liccnse Law (Chapter 9
cep
41- $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U.
cense Law does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec B & P C for this reason
.r Date
WORKER'S COMPENSATION DECLARATION
I hereby of inn under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workees Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrierand Policy nurp�b Kw.
Carrier ge malar (C Tna?2aat 1.'PMiey .: 1 S1649
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 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 at 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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction 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. I agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby authorize representatives of this city to enter upon the
ahovc-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 consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
�4,.bt.— rj,%� i"– f U - G'l
Signature ofAppl' 1/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
'e, Section 25532(a)?
❑ Yes CYN.
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? �y''
C] Yes (}Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requirements which must be met prior W issuance of a Certificate of Occupancy. .}
U 1
Owner or auth 'zed agent Date
Issued by:
Re -roofs
Type of Roof
3q. Ft. Floor Area
Number
Job Description
Required Inspections
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
32
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CITY OF CUPERTNf O
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BUILDING DIVISION PERMIT
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ESS:
BUILD N��A
PERMIT NO.
1D,p
y� VALLCO PARKWAY
NOVO CONSTRUCTION
07050087
OWNER'S NAME:
PERMIT ISSUE DATE
APPLE
1042 HAMILTON COURT
_05/10/2007
PHONE:
SANITARY NO. CONTROL NO.
ARCHITEC IFNGLNEER:
BUILDING PERMIT INFO
INTERIOR DEMO—OFFICE .SPACE
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby I licensed of Chapter 9 (commencing
Job Description
p
affirm that am under provisions
with Section 70110) of -Division 3 of the Business and Professions Code, and my license is
in full force and efregt. C1 1 U 2 Z
License Class n Lic. p
Date.. ' IU - t% Contractor A: O'Q
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 703 L5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, "repair any structure
prior to its issuance, also requires the applicant forsuch permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number
Occupancy Type
not more than five hundred dollars ($500).
P Y
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
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 border 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 Contractor's Li-
cense Law does not apply to an owner of progeny 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 affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain aCertificate of Consent to self -insure for Worker'sCompen-
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 Worker's Compensation Insurance carrier and Policy number am:
� q
Carrier Rent'llil t, .411e)'LF`t oiicy`No.: i SZL
� CERTIFICATE OF EXE PTION Fi20M W ORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is foranchunilmd dollars ($100)
or less.)
I 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 Workras' 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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a conswcdon lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ, C.)
Lender's Name
Lenders Address
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
building construction, and hereby authome representatives of this city to enter upon the
ahove-mentioned property for impccdon purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabil i ties, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Signature of Appli�anUContractor ❑arc
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes C3�40
Will the applicant or future building occupant use equipment or devices which
trait hazardous air eontarninants as derined by the Bay Arca Air Quality Management
District?
Q Yes 6Nu
I have read the hazardous materials requirements under Chaptcr6.95 of the Califor-
nia Health & Safety Codc, Sections 25505.25.533 and 25534. I understand that if the building
docs not currently have a tenant, that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Ccrtirrc= of Occupancy.
Required Inspections
EXPIRED
l
Issued by: Date
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