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10050209CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20605 LAZANEO DR CONTRACTOR: DEVCON CONSTRUCTION INC PERMIT NO: 10050209 OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED: 06/30/20 I0 OWNER'S PHONE: 4088624397 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATIONeI' uc=,C'", 'S ud 3]91 (~ ~ Contractor 1LJ co~ G.o~\IDate C/6 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 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 ofthe Labor Code, for the perfonnance of the work for which this pennit is issued. () a APPLICANT CERTIFICATION '-j{'­ I certify that I have read this application and state that the above infonnatlOn is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ofthis 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. Additi }IIally, the applicant understands and will comply ;'i:~. all no~nt sou ce regt tions P?rtin~MuniciP~I_COdJ Section signatur~ 1); ~ -,1 ~ Date~ I ""--JIV ~ " o 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 ofthe 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 perfonnance ofthe work for which this pennit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 ofthe Labor Code, for the perfonnance of the work for which this pennit is issued. 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. 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 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: COMM DEMO INTERIOR REMOVE (E) NON STRUCTURAL FLOOR SUB & REPLACE W/ NEW THICKEND SLAB Valuation: $98750 Sq. Ft Floor Area: APN Number: 32633096.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issuedby:~"" Date:C;:J O/c:-C5 .r 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 BEITER 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 conta~nantsas defined brthe Bay Area Air Quality Management District I will maintain;compliance wit1t~ Cupertino Municipal Code, Chapter 9.12 and the ea & Sa ety Coil ,S let 'bns 25505, 25533, and 25534. ~ ~~Ow \. a A hqrizedlal!VA~l.--' itA I / ... Datel ---v..., J "" \ C( NSTRU~)NLENDING 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