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10050180CITY OF CUPERTINO 13UILDING PERMIT BUILDING ADDRESS: 10627 BANDLEY DR 11 1ER'S NAME: APPLE INC OWNER'S PHONE: 4089748221 ❑ LIfBNSED CONTRACTOR'S DECLARATION License Class J Lic. # / Contracto �(/ Date G I hereby affirm that I am license under the provisions f Chapte. 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 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. 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;nter 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 -per ce regulations per the Cupertino Municipal Code, Section 9.18. a re Date ❑ OWNER -BUILDER DECLARATION 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). 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 +� building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save _emnify 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. COr TRACTOR: SOUTH BAY CONSTRUCTION CO INC 170 ICNOWLES DR LOS GATOS, CA 95032 PERMIT NO: 10050180 DATE ISSUED: 06/24/2010 PHONE NO: (408)379-5500 BUILDING PERMIT INFO: BLDG I— ELECT F PLUMB r— MECH 7 RESIDENTIAL F COMMERCIAL f— JOE DESCRIPTION: REPLACING 7 HVAC UNITS; REMOVING (E) BUILT-UP ROOF, INSTALL 161 SF OF NEW 4PLY & WHITE CAP SHEET B.U.I LOOFING Sq. I't Floor Area: APN Number: 32410047.00 Valuation: $160000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued bye �� Date: �Z `I—I- RE-ROOFS: All r>ofs shall be inspected prior to any roofing material being installed. If a roof is insta'.led without first obtaining an inspection, I agree to remove all new materials for inspf ction. Sign rtuuW of AppI' an : / ate: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I ha -e read the hazardous materials requirements under Chapter 6.95 of the Cali ornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain com rliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safe.y Code, Section 25532(a) should I store or handle hazardous material. Add tionally, should I use equipment or devices which emit hazardous air cont rminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Code, Sections 25505, 25533, and 25534. i Owrho ' / Date: CONSTRUCTION LENDING AGENCY I herby affirm that there is a construction lending agency for the performance of work's for v hich this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I unc erstand my plans shall be used as public records. Signature Date ' Lice rsed Professional