07070073CITY OF CUPEKHNO
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
19191 VALLCO PARKWAY
OWNER'S NAME:
APPLE COMPUTER
PHONE:
ARCHITECUENGINEER:
3 p LICENSED CONTRACTOR'S DECLARATION
'V P I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z U with Section 7000) of Division 3 of the Business and Professions Code, and my license is
a in full force and effect:' 7M
2? License Clas Lic. p 1
F, ❑ Date Contractor l%fir-' �hti
W ARCHITECTS DECLARATION
i�
rG < 1 understand my plans shall be used as public records
�U
4
Lt Licensed Professional
A J
OWNER -BUILDER DECLARATION
a g 1 hereby affirm that 1 em exempt from the Contractors License Law for the
p Ofollowing reason. (Section 7031.5, Business and Professions Code: Any city or county
0
m which requires a permit to construct, alter, improve, demolish, or repair any structure
Z aprior 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 Contactors License Law (Chapter 9
lS- $ (commencing with Section 7000) of Division 3 of the 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 (E500).
❑ I, 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 Contactors License Law docs not apply to an owner of
property who builds or improves thereon, and who doessuch 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.).
❑ f, 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 contacts for such projects with a contactor(s) licensed pursuant to the Contractors
License Law.
❑ I 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 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.
I have and will maintain Worker's Compensation Insurance, as required by Section
00 of the Labor Code, for the performance of the work for which this permit is issued.
My Worke'
___Policy No.:
CERTIFICATE OF Extmi TION FROM WORKERS'
COMPENSATION INSURANCE
(chis section need not be completed if the permit is for one hundred dollars (S Io0)
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 Ccnificatc 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 shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
r-+ I hereby affirm that there is a construction lending agency for the performance of
Y 7 the work for which this permit is issued (Sec. 3097, Civ. C.)
t-1 Q L.endcr's Name
DZ Lender Address
Q 1 certify that I have read this application and state that the above information is
correcL 1 agree to comply with all city and county ordinances and state laws relating to
D U building concoction, and hereby authome representatives of this city to enter upon the
t. W above-mentioned property rot inspection purpose&
y t7r (We) agree to save, indemnify and keep harmless the City or Cupertino against
fn Iiabilities,judgmenLs, costs and expenses which may in any way accrue against said City
J Z, in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SO
Signature of Applicant/Conlractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as damned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely
Code, Section 25532(a)?
❑Yes qNo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District?
Cl Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
docs cu(rrently have a tenant- that it is my responsibility to notify the occupant of the
rc JmM4 issuance or a Certificate of Occupancy.
authorized agent Date
NOVO CONSTRUCTION
1042 HAMILTON
(650)701-1500
IOl�:
PERMIT NO.
07070073
PERMIT ISSUE DATE
07/10/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
TEMPORARY PERMIT -NO FINALS ON THIS PERMIT GOOD
FOR
30 DAYS -EXPIRES 8/10/07. ORIG PERMIT #07060094.
Ft. Floor Area
31620074('
Re-roofs
Type of Roof
$0
Required Inspections
Ipm o—rary Permit
Valuation
Occupancy Type
lss,-.2d prior to. plan cheep completion
CCntractor _^r accept complete
respc�s additions,
omissio
C07-
Frar-o�_. I U6�-
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