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BLD-2020-1899BUILDING PERMIT CUPERTINO CITY HALL 10300 Torre Avenue • Cupertino, CA 95014-3255 PHONE 408-777-3228 WWW.CUPERTINO.ORG BUILDING ADDRESS: 19333 VALLCO PKWY Cupertino APN: 316 20 075 PERMIT NO: BLD-2020-1899 OWNER'S NAME: APPLE INC OWNER'S PHONE: Not Provided JOB DESCRIPTION - REMOVAL OF NON -BEARING WALLS, LIGHT FIXTURES AND FINISHES BUILDING A - T.I. PREP (2,336 SF) LICENSED CONTRACTOR DECLARATION 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full CONTRACTOR: LICENSED A GENERAL LICENSED EXP 11/30/2022 I hereby force I hereby HATHAWAY DINWIDDIE CONSTRUCTION CLASS: ENGINEERING CONTRACTOR, NO: 729664 DATE: affirm that I am licensed under and effect. affirm under penatiy of perjury I have and will maintain a certificate for which this permit is issued. I have and will maintain Worker's I certify that in the performance laws of California. If, with such provisions or this permit COMPANY B GENERAL BUILDING CONTRACTOR the provisions of Chapter one of the following of consent to self -insure Compensation Insurance, of the work for which this after making this certificate shall be deemed revoked. three declarations: for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith V issued. Compensation comply HAZARDOUS MATERIALS DISCLOSURE Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance I have read the hazardous materials requirements under the Cupertino Municipal Code, Chapter 9.12 and the Health V with equipment Municipal & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Sections 25505, 25533, and 25534. or devices which emit hazardous air contaminants Code, Chapter 9.12 and the Health & Safety Code, EPA LEAD -SAFE DISCLOSURE Renovator will be responsible for this project. Firm Certification No: Firm is required for this project. An EPA Lead -Safe Certified Firm Name: No EPA Lead -Safe Certified Certified V CONSTRUCTION LENDING AGENCY that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code). Lender's Address: I hereby Yes affirm under penalty of perjury No V Lender's Name: APPLICATION CERTIFICATION against will and state that the above representatives of this city liabilities, judgements, comply with all non -point information is correct. I agree to comply with all city and county ordinances and state laws relating to building to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, source regulations per the Cupertino Municipal Code, Section 9.18. I certify that I have read this application construction, and hereby authorize harmless the City of Cupertino the applicant understands and Signature: .