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CITE' OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILD N(��D� FSS:
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PERMIT NO.
N TANTAU AVE SHOOT
NOVO CONSTRUCTION
07120067
ow314w.
FERMPT ISSUE DATE
APPLE INC.
1042 HAMILTON CT
12/10/2007
PHONE:
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACPOR'S DECLARATION
licensed Chapter 9
Job Description
I hereby affirm that I am under provisions of (commencing
with Section7000)ofDiv"on3oftheBusinessandProfessionsCode,andmylicenseis
COMM' L INTER LIGHT DEMOLTN, RMV UNDRGRD & FH
in full force and effect.
v�'�--
License Clans, Lic.N
WALLS, DOORS & FRMS, R/R FIXTRS, TILE
Date %.I(.7 (5a Contractor LC
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors 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
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 (Chapmr9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$15000
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
j1j�}bar
3 16 0 5 0 Ayfl'1-1
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).
5 6 G _J
❑ 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
Required Inspections
and Professions Code: The Contractor's License Law docs 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-
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-
❑ I am exempt under Sec , B & P C for this reason
Owner Dare
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Conscnt 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 Worke`i''af ompensation Insurance eerier and Policy n bet.�m
Carigr: 1�'1�+b4Z lu��lA�:i`�PorcyNo.:°�LOt-1�7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA77ON INSURANCE
(This section need not be completed if the permit is for one hundred dollars (SIOO)
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 construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
'
Lenders Address
1 certify that I have read this application and state that the above information is
-
corecL I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
atime-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 this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE RnTIONS,
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lnr�
Re -roofs
Signature of canVContractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined bythe Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, SElYes 25on 532(a)? r1io
All roofs shall be inspected prior to any roofing material being installed.
Will
If a roof is installed without first obtaining an inspection,agree to remove
the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
.1
all new materials for inspection.
District?
❑ Yes Q�o
1 have mad the hazardous materials requirements undcrChap er 6.95 of the Califor-
nia Health & SafctyCode, S=dons 75505, 25533 and 25534. f understand that if the building
docs not currently have a bream. That it is my responsibility to notify the occupant of the
mil"�`''en��wWch beOct prior to issuance ofaCertificate0(Occupancy
Signature of Applicant Date