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11020065 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20605 LAZANEO DR CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 11020065 INC 0-'-'BR'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED:07/14/2011 Ow,rER'S PHONE: 4089744876 MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT F_ PLUMB r— s9s License Class �( Lie.# MECH� RESIDENTIAL 1— COMMERCIAL Contractvwa: or?k,�i I� \� � � Date JOB DESCRIPTION:INSTALLATION OF 3 NEW TOOLS IN EXISTING ROOM [hereby affirm that I am licensed under the provisions of Chapter 9 WITH (commencing with Section 7000)of Division 3 of the Business&Professions ELECTRICIMECHANICAL&PROCESS PIPING.TOOL Code and that my license is in full force and effect. r INCLUDE-PAINT BOOTH,P2I&BENCH OVEN 117 I hereby affirm under penalty of perjury one of the following two decla 6n - I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$15000 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:32633096.00 Occupancy Type: 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 above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,.the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-podnt source regulations per the Cupertino Municipal Cod ,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. S;- tiire 1': Date Issued by: Date. ❑ OWNER-BUILDEA DECLA TION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain conpliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I health Sal ty Code,Sections 2 05,2553jand255 4.become subject to the Worker's Compensation provisions of the Labor Code,I must Ow r a t riz gent•forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION `CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is ing I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relat to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) V e above mentioned property for inspection purposes.(We)agree to save Lender's Name in .,ify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20605 LAZANEO DR CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 11020065 INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED: 07/14/2011 OWNER'S PHONE: 4089744876 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. 8 Contractor _ Date % I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two de cla n I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 above 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 accrue against said City in consequence of the granting of this permit. Additionalli, the applicant understands and will comply with all non-p sourc regulaticn p the Cupertino Municipal Cod ,Section 9.18. Ci¢nahre n I 1 ❑ 1OWNER-BUILDEW DECLAMATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, wil I do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this, permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 above 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: INSTALLATION OF 3 NEW TOOLS IN EXISTING ROOM WITH ELECTRIC/MECHANICAL & PROCESS PIPING. TOOL INCLUDE -PAINT BOOTH,P2I & BENCH OVEN Sq. Ft Floor Area: I Valuation: $15000 APN Number: 32633096.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ���� �' Date:. X ,,_ L/ RE -ROOFS: 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 "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(s) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will ainta4coli,,,,nce with the Cupertino Municipal Code, Chapter 9.12 and the thode, Sections O5, 25533, and 255 gent: Date: I hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professional