07060231BUILDING DIVISION PEi RAUT
BUILDING ADDRESS:
10400 RIDGE VIEW CT
PERMIT NO.
SOUTH BAY CONSTRUCTION CO 07060231
OWNER'S NAME: 11V C: PERMIT ISSUE DATE
APPLE COMPUTER 170 KNOWLES DR 7
PHONE: SANITARY NO. CONTROL NO,
(408)379-5500
ARCHITEC ItNGINEER: BUILDING PERMIT INFO
BLDG ELECT PI.UMR MFC'A
o C LICENSED CON'TRACTOR'S DECLARATION
U;: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z m with Section 70(10) of Division 3 of the Business and Professions Code, and my license is
in full force and effect. 2> / 2'7 (�
Liccnsc Cl is Lic. p J 7 v
�, ❑ Date Contractor
ARCHITECTS DECLARATION
a1 understand my plans shall be used as public records
a0
C, y Licensed Professional
ur OWNER -BUILDER DECLARATION
a g 1 hereby affirm that I am exempt from the Contractor's License Law for the
❑ O following reason. (Section 7031.5. Business and Professions Code: Any city or county
m which requires a permit m construct, altar, improve, demolish, or repair any structure
.Z 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
H m (commencing with Section 7000) of Division 3 of rhe Business and Professions Code) or
_ 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 moo).
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0 1, as owner of the property, or my employees with wages as their sole compensation, '
will do Clic work, and the structure is not intended or offered forsale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds orimproves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered forsale. 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-
cense Law docs not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License law.
C]1 am exempt under Sec. , B & P C for this reason
Owner 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 n22er ate:
- Pots y No.: k
Carrier. L I B trf U S Policy No.: b3i t ZZZ^ '3
CERTI CATS O EXEMP7TON FROM WORKERS'
COMPENSATION 114SURANCE
(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' Compeasatfon
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 construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ, C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby autheriTe 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
Imbilities, judgments, costs and expenses which may in any way accrue against said City
in conPANT
f the granung of this permit.
APPLNDERSTANDS ANJW�LMPLY ALL NO -POINT
SOU
Date
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)?
El Yes ']No
Will the applicant or future bui [ding, occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes �No
1 have mad the haTardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505,25533 and 25534:1understandthatifthe building
docs n cjjTrendy have a tenant that't i y responsibility to noufy the oeeu, ant of the
reyui cruficarc of Ocean
Owncr-or authorized apent C4J� Date " O
Job Description
INSTALL NEW CHAMBER "K"
Sq. Ft.
31606046 qS1 Number
$5000
Required Inspections
Occupancy Type
Re -roofs C
Type of Roof
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.
9_/1 ha7
ign reofAppli ant Date
All roof coverings to be Class "B" or better