07120289 CITY OF CUPERTLVO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
e
BUILDING ADDRESS: PERMrf NO.
10300 N TANTAU TA01 - SOUTH BAY CONSTRUCTION CO 07120289
OWNER'S NAME: PERMIT 15513E DATE
APPLE COMPUTER 170 KNOWLES DR 12/21/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITELT/FNGINFBR: BUILDING PERMIT INFO
TEMP PERMIT FOR COMM' L TI BLDG
O PLUMB MECH�
�cd' LICENSED CONTRACrOWS DECLARATION m undo ns lob Description
uJ 1 leach,affirm W 1 Me licensed Provisioof Chapter 9(enm
menetng
with Section 7IXIU)af Divinanl uwtMssandPmfeaI Conical myhcrncu
^�N in full(Dace and w. L„a
F p Dale ConlsaOor
e 7W
ARCH RELTS DECIA 770th
e W U I undmaanJ my plans shall W used u public reenact
a G L; Licenced Pmfcsamost
e 3 OWNER-BUILDER DECLARATION
vs
1 Wrthy mfim that I am exempt from dee Convenors License Lew for the
C o G following mason.(Section 7011.5.Business and Pmfersiom Cde:Any City m Cnumy
C
er W cb mquiru a Mumil m emlatroLt alles.improve.dcomilm,M MPair My carom e
iy trip'b its i also require Ne applicant for such Permit m noewiped salemem
< lhelheislicensed licensed PursuanttoNeprevision ofNeConusclor'slJms�lsw(OuplvP Sq. Ft. Floor Area Valuation
r�m (commencing with Section 7")of Division)of she Business and Pofessiom COME)or
Net he u esernpl therefrom and the hash I.the alleged earmpolors Any violation of
Section 703M by any aPpllcwn for a permit wbjecu Ne applicant m a evil Penalty of APN Number Occupancy Type
not mom Nan Gs hundred dollars(5500).
❑11 at owner of the Property.or my employees with wages u deb role=peosadw.
will do WE,wok and the saucmm is not Intended or Mctd for ask(See 70th,Business Required Inspections
and Profesdons Code:The Umxwrs Use. Iaw does Out apply W an Omer Or q P
property who Wilds mimpmses dlermn,andwMdou tuck work hiwelfwN Bb his
ownemployce5.provided der such improvemme,am n^timelded mo0esed fm sale q
however.We Wilding^rimprovemenr It aid within once yaw,orcomPinsism.die mavens-
Wader will in"We Wadoe of proving that W did net build M Wirmve for PmPEEM of sale.).
❑1.as Owner Of dee property.am ne i sivej,Mao adng with licensed Msnsamws W
coma et We pmjem(Sm 70".Business and Profesdons Code:)TIM COMMMra U-
E.Law does not apply m an owner ar property who Wilds Or Wpoves Noreen.and.
who conuuls for such pmjecs witha canuacamrs)licensed puraceanl in We Comramel
License
[:)leaneaemVtundw Sec ,Bis PCfardsis n
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aQnn under pertakY Of pEdouY nae of the following dedaraumac
❑Ihsaandwlmeinuin,CcafioMof CansenLWwlf-iu=fw Workers CamPme -
.don,ss provided for by Sedon 3700 of dee Leber Code,for We performance of We
work for which u u permit is issued
❑1 have and will maintain Workoes Compensation Imuran¢,as Xqm d by Semina
37IXI of We LAEar Ude.rw We pE'fO—of the work for which deer permit is lssd
u
My WMMrCompenwioa h son carries ad Polley numbersae:
Caries. JS Polity No.: r7%717--(3
CE Fl TEO IXEMPTION FROM WORKERS
COMPENSATION INSURANCE
frEW anion and mt W.empleed ifft permit Y foram hundred Wiser(Slow
or leu)
1 esrufy that in We performance of We work for which this permit is Lamed.I shall not
employ any person in my manmr a u to become mbjeca m tl,Worker'Umpwallon
Laws of Califomia D.
Applicant
NOTICE TO APPUCANr:IL after making this CeNnote of Eacmption.you should
become sub]en m We Workers Compensation pmvittons of Ne Labor Code.you mum
,JO rmthwiW comply with such provisions or this permit shall W derd mrevoked
z73 CONSTRUCTION LENDING AGENCY
1 hereby aifum Nat Wert is a construction lending agency for the,—run.once of
ly' We work for which Was permit h issued(S¢.7097.Civ.C)
LTJ Lenders Nene
2.2. ,Z (ender.Address - -
U O 1 certify that 1 have rod this application Md sate der dee aWre iNamaum h
Lu P comet I agree m co-PEY wide all city and c^unlY onfinsnces ad awe Was relating te
CU Wilding commecuon.and hereby authosiae mpmsen•,^-•of this city m Mass upon the
r 121 .1mve-mcnuond property for impemion purposes-
F y (We)agree in ave.indemnify and keep hamlea the City of C.Pcrano.0cn
y li.bilities,Judgments,coo andeape•...which may in my way uauc against said City '
U Z, incon ce of the gran song or this pemla
^� APP A UNDERSTANDS AND I COMPLY WITH ALL NO
Issued by: Date Z t
S RCEREGULATIONS.
DI J . � Re-roofs
Si umo Unoxmr Da¢
a HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will yeeC.,camfuuuehu.lCode.O rst pW emarandWe Haddous marcid -
a enured by We Cuperano Municipal Code.Chapin 9.12 and We FINN ad Safety -
Code,Section 25572(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yon
Will We applicant or future Wilding Occupant tax equipment w ties=which If a roof is installed without first obtaining an inspection,I agree to remove
..it hamANom air ennumlnsnts an,darned by the Bay Am All QNity MmagemMt all new materials for inspection.
Diarict7
❑Yes
Ihrvc wre^pa(v�a/d NQe hN5aba mnuudcr CTapMrd.PSofdue Califon-
,
l
,Seclons 25505.25533
505.733soul 557 .lud se building
o
�nuHcalthdSafelyCoac ^
Z—/L( /(
don out /eorEnm a enant then It h my nsiblllty m our,dee colpm of We /
mqumm -m enu Wmca pnoa aceOfkupm � Sature of ApplicatT
��/
Sign Date
4
All roof coverings to be Class "B"or better
0wner or zd.go., DOM
0-7t
myOF, CITY OF CUPERTINO
C
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # I, j ' G 2 L . O r Date: I ' I
(P 6C)2 -
1 z z� 07
Building Address:
10 300 u _ TRNT 1W i o
Mailing Address (if different from building address):
Owner's Name: Phone#:
),�VP1E q-74 - 2,2- 31
Contractor: Phone:
eiOv-t-N Yj Cpvyj`ZQLMAj Fax:
Contractor License #:
Cupertino Business License#:
Contact: Phone:
CAvtiV,",J �P,�n�H Fax: 3 7q - 3a5-
Residential H Commercial
Job Description:
T— Pe," T_ ,r _ mow,„orcia-Q aFflzE�_
SP�cF .
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of onstruction (Usage Class): Occupancy Type:
1 FR, I IFR ❑ 11, 111, V-lHR ❑ 11, 111, 1V V-N O
Valuation: Square Footage:
Project Size: Standard1h Lar e ❑ Major ❑