08080064 CITY OF CUPERTINO + s -, «, a' AN -'x ^°•' �'
BUILDING DIVISION PERMITECOIVT 0WRANFORMATION
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BUILDING ADDRESS: PERMIT NO.
10500 N DE ANZA BLVD FLR 2 & SOUTH BAY CONSTRUCTION CO 08080064
'S NAME: iNu PERMIT ISSUE DATE
APPLE INC. 170 KNOWLES DR 09/23/2008
PHONE: SANITARY NO, CONTROL NO.
(408) 379-5500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EI.ECf PLUMB MECH
0 0 0
upQ LICENSED CONTRACTOR'S DECLARATION Job Description
u I hereby afficm that I am lamoseC provisions provons of Chapr 9(commencing P
xx`v wird Secdon7Qlo)ofItivision 3 oflhe Business and Prolasdorucode.and my Ramis T. I ON 2ND&4TH FLR INCLS (M, E)NON—STRUCTURAL
^•�j h in full f and off '3 7
;q? LiamoC s uc.g 22, 914 -
DECLARATION
2, 914 'DECLARA 10 FIRE DEPT TO APPR FINAL CLEARANCE OF ALL EXITING
Si 7 I..&.ad my place shell M used u public¢cards
J�u
`O� k Lxxxxi Profesdond
OWNER-BUILDER DECLARATION
i il3 I hcmhy M.the I am exempt Imm the Conuantafs License Law for the,
E p O following reason,(Section 7In I.S.Business and Peo(utions Code:Any city at county
$ which requt.a permit m construct,air,improve,damrlkh,or aped,any suuctum
=< prior to its issuance.also requires the applicant!orsuch Permit to Elea signed statement
££ O thatboisliaensedpumunttoNcpmvisiauardseConuxwr'sL"usvcLsw(chapter9 Sq.Ft.Floor Area $ Valuation
y�$ (commencing with Senior 7000)of Division 3ofthe Business and pro0
fessions Code)or 100QQ
—
that he u exempt therefrom and the basis for tan alleged exemption.My violation of
section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of yyumber Occupancy
mol deme main five bundled dollar IISM31622017 Tl' P Y Type
1,m ownm of Jie pmpmy,a m"mployca wio wvgea m reek eek compemdon,
and domewart,andtan suumumis rotintendedoraw dos act apply
an Bud^•••
and prudently
he
Cade:The Conuemost cad License law dam mat apply lf rt owner of Required Inspections
pmpeny wye builds or ed t avec tumor,and who taesueh work himself ulthmugb his
awn em.me tat,proWde i that sohent is sold
wit tie not iemndW mpleered for sale If.
Wilmor,me Wilding m improvement u cold within one year of completion.me ower-
Wildm will have the border of proving mm W did not Wild or improve for purpose of
cola.).
0 1,as ow.of the Property w exclusively nonexcumt wide licensed canusmu to
constmm the pmjem(Sec.7014.Business and Professions Cade:)The Comuanor's U.
cense law does not apply to an owner of property who Wilds or improves dome,and
who contracts Tor such pajama with a ca...mr(a)licensed psucoam to dm Comomm's
Lace.law.
lam aseRpturder Sec ,B&PCrmthlammon
6:
Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pcnity of perjury arc of IW following declarWorhs
❑Ihaveand will mainuina CertiOomo/Canuntmself-insurefaWmkehCampn-
mtion,m provided for by Section 37M of the Labor Code,for to performance of the
works for which this Permit is issued.
❑I have end will maintain Workce.Compensation Iteruana,as required by Section
37M of the Labor Code,for the Performance of the work for which this permit is issued. '
My TWorkefaompematia Inst.career and Polity nm
uber sm:
Carrie. 1'i— N kLrr1 Polity No.: 2�0$- (fT'Y•iy86
CERTIR' TE OF EXEMPTION FROM WORKFRT
COMPENSATION INSURANCE
(That aecta need not W meNcled if the permit is rmane hundred dollar($IW)
m less)
1 wtify that in thus Woussame of the work for which this permit is issued.I shall not
employ any perann in any mamurse,as u become subject a IM WOrkeri Comperuation
Laws of California.Dao:
Apptleant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you mould
become subject on the Warkari Compensation provisions of the Latter Coda,you most
.J,Z forthwith comply with rKh provisions Or this Permit shall W deemed ranked,
z OCONSTRUCTION LENDING AGENCY
rI homey allirn that them if a comction lending agency fm the Performance of
14 tan work for which that Permit is issued(Sec,]09's,Civ.C)
G Q Landers Name
,J z Lander's Address
U Q 1 ratify that I have read this application W sum dead du above information k
D.^ Co 1 ages to comply with all city and county on irtwom and sum laws miring m
-0 t Wilding conswmion.and hereby authorize rpmxnutvvs of this city to cnu4upon du
.hove-mmhtianed pmpeny for i upcctan purposes
(••i P>, (We)agree to cove,indemnify and keep hay In m the City of against s.deicer
r-h h tocoitas,Judgmcnr,costsIs. axpisspe.it. may in any wyanrne.gdnst said City
V z in PLIC a' of me granting of that prmll
^ APPLIC ERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date 27
SOUR RE LATIONS.
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sun itc
HAZARDOUS
Data
Reproofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tan applicant or future Wilding oecupant seem or Rundle Health Romania)
Broad by the 32(id? m Municipal Code.Clupur 9.13.reel the Health and Safety
.Seaton 2ss3z(a)7
❑Yex to All roofs shall be inspected prior to any roofing material being installed.
Will the. Priam car rutu a Wilding era nt um If a roof is installed without first obtainingan inspection,I agree to remove
PP g e equipment Management
D snci menus air canuminsnumIII dcOned by the Bay Are Air Quality Management all new materials for inspection.
❑Ya Sy Po
1 have read the ha»Nous m\ucriaHmquimmcnu unterCbm,o6.95ofthe Uirm.
w Ha1th&Safety Cade,Sections 25505,25533 amd25534.1 urderraM thatilthe Wilding
does of y have.mnanl dealt it Is y raponsihib .notify the meupant of du
require ich mug Wmet pd uana ofa CcZle of Oe panty.
r�JZoo{__ q�iSey • Signature of Applicant Date
Owner m��nr d.ger D,m All roof coverings to be Class'J?"or better