09090005 REV1 TINO BUILDING CITY OF CUPER PERCO�� 000s
AU AVE FLR 1 CONTRACTOR:DEVCON
BUILDING ADDRESS' 10300 N TANT INC
DATE ISSUED:09/23/2009
690 GIBRALTAR DR
PHONE NO:(408)942-8200
OWNER'S NAME: APPLE MILPITAS,CA 95035
4ER'S PHONE: 4088629799 CT PLUMB
BUILDING PERMIT INFO: BLDG ELECT
LICENSED CONTRACTOR'S DECLARATION COMMERCIAL
Lic.#
MECH RESIDENTIAL
License Class
Date B DESCRIPTION:COMM'L TI TO PORTION ON THE 1 ST FLOOR OF
ions of Chapter JO
apter 9 EXISTING
I hereby affirm that I am license rovis
of Division 3 of the Business&Professions BUILDING;NEW INTERIOR WALLS,CEILING
commencing with Section 7000) MODIFICATIONS,NEW ELECTRICAL/DATA
Code and that my license is in full force and effect. _ i t r
let
� ...-- a (
of perjury one of the following two declarations: y'C �{ 4 lam/ Y1 .til -���.
I hereby affirm under penalty p J Y r t' ` 6 SY
I have and will maintain a certificate of consent to self-insure for Worker's i)�- /
Compensation,as provided for by Section 3700 of the Labor Code,for the c�k
performance of the work for which this pe�ation Insurance,as provided for by
1 have and will maintain Worker's Comp Valuation:$85000
ork for which this
Section 3700 of the Labor Code,for the performance of the wSq.Ft Floor Area:
permit is issued. Occupancy Type:
APPLICANT CERTIFICATION ation is APN Number:31618025.FLR1
certify that I have read this application and state tordinances
rdhat inan es and state laws relating
info
I ce fy with all city and county ord
correct.I agree to complyof
to building construction,and hereby authorize representatives(We)
re to aveto r IF WORK IS NOT STARTED
for inspection purposes. (We)ag IT EXPIRES
upon the above mentioned property of Cupertino against liabilities,judgments, PERM IT ISSUANCE OR
indemnify and keep harmless the cru
against said City in consequence of the WITHIN 180 DAYS OF PERM INSPECTION
costs,and expenses which may ac g licant understands and will comply
it. dditionally,the app Section 0 DAYS FROM LAST CALLED INS
granting of this perm :.� 1 g
with all no splfrce regulations per the Cupertino Municipal Code, /
Date;1
9.18.
Date Issued by.
Signature u
OWNER-BUILDER DECLARATION RE-ROOFS:
roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any g agree to remove all new materials for
the following two reasons: h wages as their sole compensation, installed without first obtaining an inspection,
or my employees wit g inspection.
I,as owner of the property, Date:
do the work,.and the structure is not intended or offered for sale(Sec.7044, licant:
will Signature of App
Business&Professions Code) with licensed contractors to
1,as owner of the property,am exclusively contracting
project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the p J
I hereby affirm under penalty of perjury one of the following three
declaConsentrations: -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE .95 of the
I have and will maintain a Certificate of n 3700 of the Labor Code,for the 05 25533,and 25534. I will maintain
Sectio I have read the hazardous materials requirements
255 nts under Chapter
Compensation,as provided for by Code,Sectio
California Health&Safety Chapter 9.12 and the Health&
performance of the work for which this permit is issued. provide for by Cupertino Municipal Code,
Compensation Insurance,asp compliance with the Cuphazardo
will maintain Worker's Comp which this Code,Section 25532(a)should I store or handlemit hazardous air
us material.
I have and performance of the work for Safety
Section 3700 of the Labor Code,for the p Additionally,should I use equipment or devices which
by the Bay Area Air Quality Management District I will
permit is issued. Cupertino Municipal Code,Chapter 9.12 and the
of the work for which this permit is issued,I,shall con main complian a with h the Cup 25534.
I certify that in the performance ma
erson in any manner so as to become subject to the Worker's
I Health&Safe ode,Sections 25505,25533,and
not employ any p i l
Compensation laws of California. If,after making ths of the Labor Code,I must Owner or or' a age ! l
become subject to the Worker's Compensation provisionDate:
I be deemed revoked.
forthwith comply with such provisions or this permit shal ,-
CONSTRUCTION LENDING AGENCY performance of work's
APPLICANT CERTIFICATION for the pe
read this application and state that the above info rmlaws relating I hereby affirm tation ishat there is a construction lending agency
I certify that I have 1 `,kith all city and county ordinances and stat for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply authorize representatives of this city to enter Lender's Name
to building construction,and hereby purposes.(We)agree to save
upon the above mentioned property for inspection pure judgments,
of Cupertino against liabilities, Lender's Address
nify and keep harmless the City p �n consequence of the
and expenses which may accrue against said City
g: nting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section fans shall be used as public records.
�'�' a I understand my p
9..18. LJ /0
Date Licensed Professional
Signature