10070028CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10431 N DE ANZA BLVD FLR4 CONTRACTOR: SOUTH BAY
CONSTRUCTION CO INC
PERMIT NO: 10070028
OWNER'S NAME: APPLE INC 170 KNOWLES DR DATE ISSUED: 07/21/2010
OWNER'S PHONE: 4085938579 LOS GATOS, CA 95032 PHONE NO: (408)379-5500
License Class~ Lic. # ~s:; (,C{ -, ~
Contractor C;; t?J't\o\ by c...rrr. Date ..., ... l..1 ~ I (;)
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.
o LICENSED CONTRACTOR'S DECLARATION
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 ofthe Labor Code, for the
perfonnance of the work for which this pennit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the perfonnance of the work for which this
pennit is issued. ~lL
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infonnation 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 hannless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting ofthis pennit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18. ~
Signature ~;:::::= Date (-2..,-/0
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: INSTALL (2)NEW PAIR OF DOOR WITH SECURITY CARD
READERS,.RELOCATE (1) PAIR OF EXISTING WINEW (3)
NEW PAIRS
Sq. Ft Floor Area: Valuation: $30000
APN Number: 32633114.FLR4 Occupancy Type:
Issued by: __~_'""2__-. __
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
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,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
o OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury one ofthe 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
perfonnance of the work for which this pennit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the perfonnance of the work for which this
pennit is issued.
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(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
I certify that in the perfonnance of the work for which this pennit 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 pennit shall be deemed revoked.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
_rau~ent: """' ~-----I' -Date: J.. ~ 2..1 - , '0
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infonnation 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 hannless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this pennit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
ONSTRUCTION LENDING AGENCY
I hereby affinn that there is a construction lending agency for the perfonnance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name ~
Lender's Address, _
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional