08070144IIX
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CITY OF CUPERTINO
BUILDING 61VISION PERMIT
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BUiLESS:
PE 17 NO.
WST N TANTAU AVE
NOVO CONSTRUCTION
08070144
OWNER'S NAME:
PSUM ISSUE DATE
APPLE COMPUTERS INC
1042 HAMILTON CT
07/30/2008
FHON&
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECT/ENGINEER:
3LMZING PERMIT INFO
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am li cnscd under provisions of Chapter 9 (commencing
with section 7000) of Division 3 of the Business and Ptofcsd m Code, and my license is
REVISION U PGRD (S I S T ER I NG NEW PURL I N S) (E) RF
'mxfull form Wndef, tics-4910U_
STRCTUR TO HNDL ADDT' L CEILNG LOAD ORIG# 08060120
pale Contractor 0110 N9 G bin
ARCHITECTS DECLARATION
I understand my plena shall be used as public retards
Licensed Professional
OW NER-BUILDER DECLARATION
1 hereby affirm Lbat I am exempt from the Contractor's Ucatsc Law for the
following reason. (Section 7031.5. Business and professions Code Any city or county
which requires a permit to Cm1YrocL alter, improve, demolish. or repair any sr' ua re
prior to its issuance, also requires the applicant for such permit to Gk a signed statement
is licensed to the of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he pursuant provision
Section 7000) of Division 3 of the Business and Professions Code) or
$ 1 10 0 0
(commencing with
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
31606039.W Number
Occupancy Type
Section 7031-5 by ury appliant for a permit subjects the applicant to a civil penalty of
nor more than five hundred dollars (Ss00).
❑ L as owner of the popery, or my employees with wages as their sole compensation,
Required Inspections
will do the work and Lbe structure is not intended or offered for sale (Sec. 7044, Business
and Professions Coda: Tire Contraaces L.icease Law does Dot apply to an owner of
property who builds or improves thereon, and who does such wort himself or through but
awn employees. provided that such Improvements are not intended or offered for sak if.
however. the building or improvement is sold within one year of completion. the owner -
builder will have the burden of proving that be did not build or improve for purpose of
sale.).
❑ L as owner of the property, am exclusively conuacting with licensed contractors to
construct the project (Sec. 7044, Buairnds and Professions Coda:) The Contractor's U.
roue Law don not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a conuwtor(s) Iken ed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec , B & P C for this reason
Owner Date771��tce,1
W Cora
WORKER'S COMPENSATION DBqXARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Certificate of Consent to self-imwe for Worker's Compem-
sadon, as provided for by Section 3700 of LM Labor Code, far the performance or the
wait for which this permit is issued.
❑ 1 have and will maintain Worker's ComprnaLlon lamuance, as required by Section
3700 of the Labor Code, for the performance of the wort for which this permit h issued.
My Workces Compensation insurance carrier and policy number ate: Q
Carrier F+=-��1.1 C I ^s1X: Mr icy No.: �5 i. d Li C1 ' �% TI
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hurwked dollars ($ 100)
or lest)
i certify that in the performance of the work for which this permit Is issued. I shall nor
employ arty person in any maamr so as to become subject to the Workers' Compe radon
Laws of California. Date
AppLiamL
NOTICE TO APPLICANT: If. after making UUa 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 drum that there is a construction lending agency for the performance of
the work for which this permit it iturcd (Sec. 3097, Civ. C.)
hander's Name
L=de's Address
I certify that I have rod this applicui°n and state that the above information is
torten. I agree to comply with all city and county ordinances and sate Ism relating to
building construction, and hereby mthoriae representatives of this city to enter upon the
above-numdoned property for inspection purposes.
12
to save, indemnify and keep harmlest the City of Cupertino against
a casts and expenses which may In airy way acenne against said City
li ntifA�LJ*E
in granting of permlL
PLI RSTANDS WILL C,0�1PLY WiTH ALL NON- TNT
Issued by:S_4vDateOURONS.
/ - 2 o
LAI7
Re -roofs
Signtim of Ali " Da
US TERIALSDISCLOSURE
Type of Roof
Will the applicant or rut= bui ding occupant stare or handle hawdous material
as used by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code. Section 25732(.)7
All roofs shall be inspected prior to an roofing material being installed.
P P Y g g-
C] Yes ❑ Nm
If a roof is installed without first obtaining an inspection, I agree- to remove
VtnII the applicant or future building occupant use equipment or devices which
emit hvardous sir conaminana as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes ❑No
read hanrdaus materiats mquhcnrncrua under Chapter 6.95 of the Cal I for-
rtia & err Cade. Seetians 15505, 25533 and 25534.1 undestud sal d the building
does t U vc a tenarnL that 1 y respmtsfbUily In. natif the occupant of the
'mg nts must be reel pia sire Ccrtilkagp
Signature of Applicant Date
i� o
. All roof coverings to be Class'W' or better
owner nth aeenl Dart