05120085 CITY OF CUPERTINO M
BUILDING DIVISION PERMIT xaCONTRACTQR TNF RMATIkQW'
BUILDING ADDRESS: RELIABLE CONCEPTS CORP PERMITND.05120085
10101 BUBB RD
ER'S NAME: PERMIT SUE DATE
APPLE COMPUTER 954 CHESTNUT' ST 12/15/2005
PHONE: SANITARY NO. CONTROL NO.
(408) 271-6655
ARCHITECrfENCINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONIRACTORSDEmataof hV JobDescr tion
r�u 1bembY affmm hat Iam ONTRdunderS DECLARATION
A ION 9(mmmmWing p
i with n7")ofDivision 3 ofNc Budnesa W Pdcaalns Code.mA my k.is NNALED
'<n NfWce
ifaranaelrem, /j TI_ _
iJ Doo C Al CHrIF.(.'ISDECLVtATION �t rt
Tun rvdmyplanaehOlbeu aapulJienrnr" P�'1�ff 7n!fg
laxncI PmfevlotW ��I��k(fa�
OWNER-BUILDER DECLARATION BUILDINP
a�i 5 I hmeby uRnn that 1 am exempt from Ibe Cmi.m's Lkrro Law for live
O fWI.voing won.(Seeliun 7MI3,Bualnaa and Pmreasiom Co&:Any chy m county
Ko which rec oiu a pcm4 W vemrtct,ahu,impo.c,d .Kook,m repair any structure $14 5 8 7
for^
thao he
theappikaof fm such lor'W fleaslmtNauWmeru
£ < (.rornianMffi nl loth)of Disinlu fir lwte urinvata dPrtwl:w(Oupm9 Sq. FI:Floor Area Valuation
i (cot beiaCgwithaeref ]00)1 of aria for
the
isetmrcascnd Profcvy vi Codd or
Uul he 4 essmp Nertlmv arW Ne d.,4 fa t&alleges eaemplorr.Any violation of
Semim 7031.5 by st,applicant for a permit avbjeeu the appikml W a 6"lstralty or r Occupancy TI pe
not more Bun five hundred dal Wa(5500),
❑k,uowrta of de WoP'cq,amY ernPloyaa with tvgnv Netr wlc ampertvtlm,
wBl&fe work,mW W she Cme 4 std s Li0ena m aw'Io Tamale(Sec.W"Busirca
mN Pmreasimu cox:The eanuacWYa Llama Law em,nor"Ply W�owm of Required Inspections
property who wit"aimprawv tbercon.W wiaxuautit wok himself or thnrogh h4
awn emPby�,pmvMed Nuatehimprmemenu are rWtinundrd maRrrtdfm sale 11. ,
bowrerr the have
the o impmvemun 4 that
within am yea of c prom,for
the owmr-
bulkier win Nve the wNm of proving Wt K did saner build a improve far Purpose of
sale.).
❑1,u owmr of W property,am excluu tlr cmvaning with 1' n M mnuaa®s W
mmvom Ne project(Sec.7014.B..and Pmfevorms Cox:)The Contras ,Li-
arae I-aw doe,ea apply to.m nano a(property.wha buil"or impmw theneon.and
who comourta for each pojccu with a mnuaeWr(s)Bcenad poranam W the Comra m s
Llan&law.
❑Iamexmoptmuo Set ,B6PCfor Wareuam
Dm
WORICER'S COMPENSATION DECLARATION
I hereby afllrm un&r peoaky of perjury rate of the,following dae4r.tktu -
❑1 have and HII mahnun aCW 0cau of canam to sats-mavae
worforwwkcY.Cornprn-
m,r pvvWcd(or mSwim 7]00 of W I�bor Code.fa the puformure of Ne
wok for which W a permit 4 Luvcl
I have mrd will minim.;.Workrla Cmr,emmlan Imarmee,u reyvired by Socdm
3] ofthe Labor Code,for Nc pmfmmme of the war for w1kich Nu permit 4Iw t
My Workr—�lr>C/oom�ppeherom / carrier mil Policy moods me:
Carrier: iry No.: ..
CERTIFICAT'EOFEXEMPDONFRO WO (ERS'
COMPENSATION INSURANCE
(This seetion rrsi motbe cmnple"Vote pfmil is farone huMN iW Wer(Skaa)
orca )
I anify Net in the performance of the work for which W s permit 4 ime4 1 shall not
employ any person in any maorer an as W become wbjcct W the Workart'Cortren ation
Ire or cilirtmo a.Dara
Applicant .
NOTICE TO APPLICANT:If,alto,mrting Wer CW rkme of Esempxn,you a bouW
wmme mubjat W the Workers compe.u..provini.or Ito Labor Code,yon muu
.UO forthwith mmpky with such pmvlabm On th4 pcmtit a 11 be tlomaa mokcd.
z"-' CONSTRUCDON LENDING AGENCY
[—tom Ibmebyaffirm Wt here 4.mnwtetkm lvWingagenc,for live perfamunc of
Ix 7 the wank cur whkh d"permit it area(Sa.3091,Co.C.)
AIsndrYs Name
:7 Z IuWris Addw .
U O 1 Certify that 1 have read thi.grpfvtion W rete Nm the Wore Nfmmaim 4
W(: mxr¢I.l agree to comply with all city and county ordimmea uW aute last mixing W
Wilding comtrumim,and booby amhorire rcpreacnwiva of thio city W amor upon the
G above-memloned property for 4erv.i.fo. o
(We)agra to save,lnxmnl(y and tap bumleat de City or CupcnitW apiml
wVJ liabilities,judgmmu,coua and expenses which may Nasty way acme apical atoo City
UZ, In cane .of the turtling o"' pcm 11. IS
'-' APPLICANT UNDERSTANDS AND P ILL COMPLY WITH ALL NON-POINT Issued by: Dale 2-
Sg9UuggF REGO ONS"
S( k b 6" / 1 /21Z V! ' Re-roofs Ua*W -C u
of Applr H ZARDOUS MATERIALS DISCLOSURE win Type of Roof
Will rive aPpinarr or Nuedtlldinp occupant store or haodic lomtr mmaterial
u xfirad by the Cupertino Mumaiptal Co,le.CbaWr 9.12 arta the HcaIN.std Safety
.Seodm 25532(0] All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will Oe mpnrant or Nome wilding o pant a.Q wnipmeru or M1.whiO If a roof is installed without first obtaining an inspection,I agree to remove
emit h 000a it cmumimmu as&fiord by the Bay Area Air Quably Mamgemer, all new materials for inspection.
Disbicla
❑y"
1 bavo read W hvarri.muerWs rtyuirenevt unxrClupta6.95 of doe Califm-
n4 Hmldt&SaINyCo&.Somlom25505,25533 and 25531.1 to ictvvd Nmif the wilding
dm m1 vteray 11 myrapomthillly tomdry NC aupontof Ne
tro
Signature of Applicant Date
All roof coverings to be Class"B" or better
wthmi .gent Date