07100026CITY OF CUPERTINO
BUILDING DIVISION PERNUT
BUILDING ADDRESS:
19191 VALLCO PKWAY CAC-04
OWNER'S NAME:
APPLE COMPUTER
PHONE:
A RC HI-f ECT/EN G iNE ER:
Qzp
LICENSED CONTRACTOR'S DECLARATION
U r: 1 hereby affrm that I am licensed under provisions of Chapter 9 (commencing
aa with Section 7000) of Division 3 of the Business and Profrasions Code, and my license is
in full force and effect, 102, Z. z License Class LJc. N
f- O Dam ContractorM y'-) (D
ARCHITECTS DECLARATION
CA < 1 understand my plans shall be used m public records
�U
a
O H Licensed Professional
y g OWNER -BUILDER DECLARATION
>. I hereby affirm that 1 am exempt from the Contractors License Law for the
. p O following reason. (Section 7031.5, Business and Professions Code: Any city or county
m Pi which requires a permit to concoct, alter. improve, demolish, or repair any structure
_ prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9
i o (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
! 14 that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ 1, 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
and Professions Code: The Contractors 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 notjNe)tted or offered far 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 -
cerise Law does not apply to an owner of property who builds qr improves thereon, and
who contracts for such projects with a contractor(s) licensed puustiant to the Contractor's
i.ieense Law.
❑ 1 am exempt under Sec. . B k P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Libor Code, for the performance of the work for which this permit Is issued
My Worker's Compensation insurance carrier and Policy number are::
Carrier. fit(?- knFla n i F., r � Policy.
olicy No.:
CER-17PICATE IXEMPf70N FROM WORKERS'
COMPENSATION INSURANCE
010s section need not be completed if the permit is for one hur&c!d QoOara (3100)
or less)
1 certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Worbars' 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
�Z forthwith comply with such provisions or this permit shag be deemed revolrrA.
7—O CONSTRUCTION LENDING AGENCY
-r
=-t V) 1 hereby affirm that there is a concoction lending agency for the performance of
]: > the work for which this permit is issued (Sec. 3097, Civ. C.)
3a Q L.endces Name
Z Lender's Address
J 0 1 certify that I have read ibis application and state rho the above information is
'-' correct. 1 agree to comply with all city and county ordinances and stare laws relating to
U(wilding construction, and hereby authorirt representatives of this city to enter upon the
a above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
v) liabiLities, Judgments, costs and expenses which may in any way accrue against said City
(„) Z to consequence of the granting of this permit,
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
i d'z --- I C)le- / o -1
Signal ofA icant/Contractor fate
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
❑ Yes jNo
Will the applicant or future building occupant use equipment or devices which
emit haiardous air contaminants as dcfncd by the Bay Area Air Quality Management
District7
❑ Yes lh No
I have read the hazardo`^uss materials requirements under Chapter 6.95 of the Califor-
nia Health k Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
requiremerip which must be met prior to issuance of a Certificate of Occupancy.
�— zLe___ `viz fc,-7
Owner or auiliajtrA agent Date '
NOVO CONSTRUCTION
1042 HAMI
(650)701-1500
PERMIT NO.
07100026
PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ELECT PLUMB MECH
Job Description
COMML'S TI --TEMP PERMIIT
NO INSPECTIONS AFTER 11/2/07
Sq. Ft. Floor Area Valuation
$350000000
3 102 0074 q&1 Number
Required Inspections
Issued by:
Re -roofs
Type of Roof
Type
Date 1�-Z -L,-?
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 "B" or better