10080205CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 5 INFINITE LOOP FLR 2 CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 10080205
OWNER'S NAME: APPLE INC 1042 HAMILTON CT DATE ISSUED: 10/15/2010
OWNER'S PHONE: 4089744876 MENLO PARK, CA 94025 PHONE NO: (650)701-1500
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALD
License Class B Lic. # '":1Cf 16~;;t
Contractor l\)OJ0 L.O~lX.;:t)C:XV Date 10/ sj I0
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.
COMM'L DEMO -NON-STRUCTURAL-PARTITIONS,
CEILINGS, FINISHES(7352)
I hereby affirm under penalty of perjury one of the following two 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
perfol1l1ance 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 perfol1l1ance of the work for which this
pel1l1it is issued. ~
Sq. Ft Floor Area:
APN Number: 31602109.FLR2
Valuation: $35000
Occupancy Type:
Issuedb=
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infol1l1ation 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 hal1l1less the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this pel1l1it. Additionally, the applicant understands and will comply
with all non-po~ltsourc regulati ns per the Cupertino Municipal Code, Section
9.18. (' • \ i /. RE-ROOFS:
Signature T:n. V __ Date {O ~ /0 All roofs shall be inspected prior to any roofing material being installed. If a roof is '-"'" J1-----------------------------1 installed without first obtaining an inspection, I agree to remove all new materials for
inspection. o OWNER-BUILDER DECLARATION
CONSTRUCTION LENDING AGENCY
HAZARDOUS MATERIALS DISCLOSURE
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affil1l1 that there is a construction lending agency for the perfol1l1ance of
work's for which this pel1l1it is issued (Sec. 3097, Civ C.)
Lender's Name, _
Signature of Applicant Date: _
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(a) 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 maintain compliance with the Cupertino ~unicipal Code, Chapter 9.12 and
the Health & Safety Code, Section: :5S~ 2~ 33, and 25534.
Owner or authorized agent: t;= ....IN.~ Date: J~JJS'/IO
" I
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
perfol1l1ance of the work for which this pel1l1it is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the perfol1l1ance of the work for which this
pel1l1it is issued.
I certify that in the perfol1l1ance of the work for which this pel1l1it is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws ofCalifomia. 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 pel1l1it shall be deemed revoked.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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, 1------------------------------1
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infol1l1ation 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 hal1l1less 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.
Lender's Address _
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional _
Signature Date