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CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT
4C®NTRACT0RINF0RMATI.ON
BUILDING ADDRESS:
SOUTH BAY CONSTRUCTION CO
ffIttMITN®4100099
NE INFINITE LOOP
OWNER'S NAME:
PERMIT ISSUE DATE
APPLE COMPUTER
511 DIVISION STREET
10 14 2004
9 NE:
SANITARY NO. CONTROL NO. .
(408)379-0400
ARCHITECT/ENGINEER:
'
BUILDING PERMIT INFO
BLL ELS PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Mrcby affirm that 1 am licensed under provisions of Chapter 9 (commencing
)nf Division Jof the Business and Professions Code. and my license is
with Section7")elf,
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Lhccmc force dna err at.2 7� Cq I
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License C s -� Lir,, p
Dam Contractor
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ARCHITECTS DECLARATION
I understand my plans shall M used as public records
JAN 3 2005
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby arfrm that 1 am exempt from the Contractor's License Law for the
D
ors
following reason. (section 7031.5. Business and Profession Code: Any city or county
DIF
a peit to convect, alter, improve, demolish, or repair any
which Impulses rm
1 9 5 0 0 0
prior m its i.cal also requires the applicant for such permit re file .,,,.,d otiu men,
Inmt he is licensed pursueaumtne ponvisinm of the Contrecwr's License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Sciumn 7010) of Division J of the Business and Professions Code) or
Oat he is exempt therefrom and the basis for the alleged exemption. Any violation of
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).
❑ L as owner of the property, or my employees with wages as, their.mle compensation,
Required Inspections
will do the work, and he structure is not intended or offered for sale (Sec. 70L , Business
and Pmfessiens Code: The Contractor's Litheness law ams end apply to an owner or
property who builds m, improves thereon, and no divestment work himself or through his
sen empluyccs, provided that such improvements are not intended or offered for sale. IL
however, the building or improvement is sold within one year of completion. the owner.
builder will have lee burden of proving Nat he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am caddevely central with licensed contractors to
construct tM project (Sec. 70U Business and Professions Coall The Conlricmrs U.
cerese 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 Contractor's
Lice me Law.
❑ I am aempr under Sea ,B&PC for his ..on
Owner Dar
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of Perjury one of the fallowing declarations:
1 have and will maintain a Cenifnte of Canunt m selGinsum for Workei sCmmpem
Pro.
as provided for by Section 37M of rite Labor Cndefor the performance of the
work for which this Permit is issued.
I ban and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Cafe, for din performance of the work for which this permit is issued.
My Worker's Compensation Insurance carter and Policy number am:
Carrier:'k. PML Policy Ne.: ili
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becompleted if tM Permit is for mm hundred dollars (SImB
or less]
1 cenlfy that in the Perri mane of the work But which this Permit is imied. I shall not
mploy any person in any manner sen an to Mcome subject to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: if, after making this Cenficam of Emmptlon, you should
become subject to the Worker's Com ponsminn previsions of the labor Code, you must
forthwith comply with such provisions or this Permit hall M deemed mvnked.
CONSTRUCTION LENDING AGENCY
I heathy affirm Nat there is ction lending agency lot the performance of
-
Inc work for which this permit is issued (Sec. 311)7, Civ. C.7
_
Lender's Name
Lender's Address
.
1 1 certify that I have read this appliemion and sate that he shove information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building convection. and hereby authorize representatives of this city to enter upon the
above-mentioned property for inepeemm purposes.
(We) agae I. sae, indemnity and keep harmless the City of Cupertino against
i liabilitieudgments. costsand ex,Pmms which may in any way aacme against said City
in consequence of the graining of this Permit.
i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
REGULATIONS
Type Of ROOF
11414,1Re-roofs
cof Applicant/Contractor Dam
HAZARDOUS MATERIALS DISCLOSURE
Will lee or futurebuilding occupant casae nr handle bzrardous material
u a Cu,am
ni
by the Cupenimi Municipal Code. Chapter 1.11, and the Health and safety
Code.
de. SCC sssJxa'
All roofs shall be inspected to any roofing material being installed.
Dane
Ycs WO
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applkaT ' toure building occupant use equipment or dcvices which
it M1a'rardous air cnnmntinanvs as defined by the Bay Area Air Quality Management
all new materials for inspection.
aricO
Yes Til Nu
ih& than ouns25 rials r5JJanunts under
rChapter
Sage Cod,Sectorsmaterials5533ad255341 udertmei95 iftheGldino-
ma Health&Safdl Oat if the building
Y
dreyllpt cu0 no I have a two it is y espnnshility it entity tM occupant of be
k
�tenya�nt,
re cnauuM„ayf.artoissm eanracenireateefu mpane�
)gnatureofApplicant Date
"B"
All roof coverings to be Class or better
O tbori'r.cJ agent tD—�