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CITY OF CUPERTINO77777777=7
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BUILDING
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fWsiNITE LOOP
ICOM MECHANICAL INC
PERMIT NO.
07100159
ER'S NAME:
PERMIT ISSUE DATE
APPLE COMPUTER
477 BURKE ST
10/30/2007
PHONE:
SANITARY NO. CONTROL NO.
(408)792-2292
ARCHITEC UENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
C OMML T.I.- REP LACE HVAC BOILERS
in full force and effeCt. Z
License C ss Lic. #
DateContractor i�
ARCHITECTS DECLA A
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
Sq. Ft. Floor Area
Valuation
prior to its issuance, also requires the applicant for such permit to file a signed statement
Contractor's License Law (Chapter 9
that he is licensed pursuant to the provisions of the
Division 3 Business Professions Code) or
$65000
(commencing with Section 7000) of of the and
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
316 0 210 7 AR Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500)_
, V
❑ I, as owner of the property, or my employees with wages as thein sole compensation,
Required Inspections
q P
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li -
cause Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractors) licensed pursuant to tie Contractor's
r (cense Law.
am exempt under Sec B & P C for this reason
.utter Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ i have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, 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 required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
My Worker's Compensation Insurance carrier and Policy number are:
Carrier 61 PolicyNo.: 33108 I ao
//CERTIFICATE -OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
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 Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code- you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a consuuctinn lending agency for the performance of
y the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
1 certify that I have read this application and state that the above information is
" torten. I agree to comply with all city and county ordinances and state laws relating to
building conswction, and hereby authorize representatives of this city to enter 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 in any way accrue against said City
■ in consequence of the granting of th' rmiL
APPLICA -OND STANDS WILL MPLY WITH ALL NON -POINT
Issued by:CDate 4) �rj7
SOUR EG ONS.
!o �'
Re -roofs
Type Roof
Si ofApplicant/Co D
HAZAR US ATERIALS DISCLOSURE
of
Will the applicant or future building occupant store or handle hazardous material
.cftned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Ac, Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
fir,
❑Yes ( o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Managcmenl
all new m: Lterials for inspection.
District?
❑Yes [�to
1 have read the hazard�/us materials requirements underChapter6.95 of the Califor-
nia Health & Safety Code, 25505.25P3 and 25534.1 understand that if the building
do.s not�rte have a tartan that it ; y responsibility to notify the occupant of
ret(nifcmc ich mus m t prior issuance of a Cartificatc of Occup
Signatureof )f Applicant Date
-
All roof coverings to be Class "B" or better
— oxen ori ag Dare