10070005 REV CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR:SOUTH BAY PERMIT NO: 10070005
CONSTRUCTION CO INC -- -
OWNER'S NAME: APPLE INC 170 KNOWLES DR DATE ISSUED:08/26/2010
OWNER'S PHONE: 4089743506 LOS GATOS, CA 95032 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION F- F-
1 BUILDING PERMIT INFO: BLDG ELECT PLUntB
License Class Lic.# �� —1 I— F- fT
MECH RESIDENTIAL COMMERCIAL"
Contractor )0" 5. � ( �-�
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: LOW SLOPE ROOF REPAIR&IMPROVEMENTS ONLY
I A'rCI I&
(commencing with Section 7000)of Division 3 of the Business&Professions REPLACE ROOFING,RMV&REPLC MECHANICAL UNITS&
Code and that my license is in full force and effect. SUPPORTS,RFCO NS"ERUCT ROOF SCREEN TO MA'rCI I EXISTNG
hereby affirm under penalty of perjury one of the following two declaratio is: 9/24/10- RFV#I-ADDITION OF NON-STRUCTURAL SKYLIGHTS
I have and will maintain a certificate of consent to self-insure for Worker's (45)-ISSD 10/28/10
Compensation,as provided for by Section 3700 orthe Labor Code,for the
performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation:$390000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work forc i APN Number:35720020.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws rely in-
to building construction,and hereby authorize representatives of this city to ente
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments
costs,and expenses which may accrue against said City in consequence of the JZ
granting of this permit. Addtionally,the applicant understands and will comply Issued by'�' Date:
with all non-point ou e r ula o per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed. Ira roof is
_ installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑
OWNER-BUILDER DECLARATION
Signature of Applicant:_ Date:
I hereby affirm that 1 am exempt from the Contractor's License Law for on of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"Oil BETTER
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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupe tin N icipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti n 5 5 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date: /O 10
1 certify that in the performance of the work for which this permit is issued,I shl 11
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 certify that 1 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 ARCHITE CT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgment,
costs,and expenses which may accrue against said City in consequence of the I understand niv plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Sectior Licensed Professional
9.1&
Signature Date