10110044COVER SHEET
10110044-0
20605 LAZANEO OR
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20605 LAZANEO DR
OWNER'S NAME: APPLE INC
OWNER'S PHONE: 4089744876
0 LICENSED CONTRACTOR'S DECLARATION
License Class e-Io Lic. # e:J 7 4f 4, 'i 7 i ._. et..c:<:.-r~/c
Contractor t:--V;P ~,{ I .J() Date / I -l'f -Ze:>.('~
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I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
[ have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. I{ij
APPLICANT CERTIFICATION
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 authorize 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 liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature j'-{ L #t.~£ Date 1/ -/9'-/c)
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0 OWNER-BUILDER DECLARATION
I hereby affirm tbat I am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
[ have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws ofCalifomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 authorize 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 liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
CONTRACTOR: CUPERTINO ELECTRIC INC PERMIT NO: 10110044
1132 N7TH ST DATE ISSUED: 11/19/2010
SAN JOSE, CA 95112 PHONE NO: (408)991-1000
r rBUILDING PERMIT INFO: BLDG r ELECT PLUMB
rMECH RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REAR OF BLDG -INSTALL IK TEMP GENERATOR,
STAND-BY
Sq. Ft Floor Area:
APN Number: 32633096.00
Valuation: $15000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued byL.r-/7~
Date///92 t.:f
RE-ROOFS:
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 "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner~ authorized agent: GJ
~ C-.p2{;:p Date: 1/ -/9'-20 (CJ
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
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CITY OF CUPERTINO
TEMP POWER
CUPERTINO PERMIT APPLICATION FORM
APN#
Contractor:
Date:
l·"2'ID
d.
Phone #:
Phone #:
Phone #:
g. S95·0~~
Fax #: l). d-D ~ L.
Contact:
Contractor License #: _J ';J
Cu ertino Business License #: 0
Residential D Commercial
Valuati0;l/cost of project):
~ I 0 tJ-t(),fJ2,
Type of Construction: N/A
Quantity Fee ID Fee Description Fee Group Permit Type
lERT<200 Res. Temp Power <200
Amps
E lREAP14
lERT2001K Res, Temp Power 200-1K
Amps
E
1EPERMITFE Electric Permit Issuance
IBCBSC Cal Bldg Standards
Commission Fee
B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
ITRAVDOC Travel & Documentation
Fee
B
Revised 06/12/09
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cnvor
CUPERTINO
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CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
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Date:
Phone #: og.}/J r·0:J I ~
Fax #: 40g -'d-75 -ft? 2
Contractor:
Building Address:
:2 S
Owner's Name:
Contact:
APN# 3?.-(p 33
Cu ertino Business License #:
Job Description:
-j V\<;~~U
Residential D Commercial
Type of Construction: N/A
Quantity FeeID Fee Description Fee Group Permit Type
lERT<200 Res. Temp Power <200
Amps
E lREAP14
lERT2001K Res. Temp Power 200-1K
Amps
E
1EPERMITFE Electric Permit Issuance
IBCBSC Cal Bldg Standards
Commission Fee
B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
ITRAVDOC Travel & Documentation
Fee
B
Revised 06/12/09