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CITE' OF CUPERTINO
BUILDING DIVISION PERMIT
C�11��G7CC3Y2INO�iMA�'�ON
BUILDING ADDRESS:
PERMIT NO.
10435 N TANTAU AVE
NOVO CONSTRUCTION
08080059
OWNER'S NAME:
PERWT ISSUE DATE
APPLE COMPUTERS INC
1042 HAMILTON CT
08/07/2008
PHONE:
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
70b Description
hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
withScction7000)cfDi3ofthcBusinrssapd.Po@ssions Code, andmyliccnscis
(`OMM'L TI, BLDG OFC IN EXTNG OFC SPACE, 120SQ; NO
force d effect.vi'on
nse 0
Licein
Class Lic. # `p
RE -RF &NO STRUCTURE
Dau:__JLJBa, Contractor. Dj&aCi
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's 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 u) its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed to the of the Contractor's License law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$20000
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
.gyp Number
Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than eve hundred dollars (x500).
31606039 : Ct(
f, as owner of the property, or my employees with wages as their sole compensation,
e
Required Inspections
will do the work_ and the structure is not intended or offered for sale (Sec. 7044, Brines:
and. Professions Code: ThConumcior's License Law does not apply to an owner of
nse
Q p
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 Contractor's
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 Worker's Compen-
sation" as provided for by Section 3700 of the Labor Code, for the perfoimance 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 Worker's Compensation Insurance carrier and Policy number are:
^ D
Carrier. 1.6E {�� 101 Policy Nm.:) 5 2 22!401 - 0
CERTiFICAPTION FROM WORKERS' •
COMPENSATION INSURANCE
(rhis section need not be completed if the permit is for one hundmil dollars (SI00)
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 Ccrtiecatc of Exemption, you should
become subject to the Worker's Compensation provisions of the Lithor Code, you must
forthwith comply with such provisions or this permit shall be deemed rooked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them: is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
"
Lender's Address
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,
c) ag to save, indemnify and keep harmless the City of Cupertino against
lia . iti ju gm ms, costs and ex nses which may in any way accmc against said City
i onse ue cc the granting of is permit.
PPLI
Date
HAZARDOUS ALS DISCLOSURE
Type of Roof
Will the applicant er future wilding occupant store or handle hazardous material
as efincd by the Cupertino Muni iyial Code. Chapter 9.12. and the Health and Safety
Code" Section 25532(a)?
❑Yes � Na
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
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
'
❑Yes CINu
c re d e humdous materials mquimmcnLyunar Chapter 6.95 of the Califor-
/ � JTye
Signature of Applicant Date
All roof coverings to be Class In' or better
owne ( Da,� -
or authoricd agent