10090260 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7919 AUGUST LN CONTRACTOR:WESTSHORE ROOFING PERMIT NO: 10090260
[JC
OWNER'S NAME: JEN LEE
2245-A FORTUNE DR DATE ISSUED:09/28/2010
OWNER'S PHONE: 4084469620
AN JOSE'CA 95131 PHONE NO:(408)694-0060
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class Lic.# MECH r— RESIDENTIAL r COMMERCIAL
Contractor Date
JOB DESCRIPTION:REMOVE EXISTING WOOD SHAKE&INSTALL STONE
I hereby affirm that I am licensed under the provisions of Chapter 9 COATED
(commencing with Section 7000)of Division 3 of the Business&Professions ;TEEL ROOF SYSTEM
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Valuation:$17300
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area:0
permit is issued.
APPLICANT CERTIFICATION APN Number:36212014.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signature Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the stricture is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the
California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I Owner or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Signature
Date Licensed Professional
REV1510N 4
CITY OF CUPERTINO BUILDING PERMIT DATE ` � O
BUILDING ADDRESS: 10460 BANDLEY DR CONTRACTOR:XL CONSTRUCTION PERMIT NO: 10080103
OWNER'S NAME: APPLE INC 851 BUCKEYE CT DATE ISSUED:09/09/2010
OWNER'S PHONE: 4089745951 MILPITAS,CA 95035 PHONE NO:(408)271-2425
LICENSED CONTRACTOR'S E LARATI N
(�i BUILDING PERMIT INFO: BLDG r ELECT PLUMB r
License Class Lic.#
Contractor_2'd- (_Q N u ( On) Date / MECH RESIDENTIAL r COMMERCIAL r
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COMM'L TI ONE STORY 2,286SQ OFC SPACE,PROJECT
(commencing with Section 7000)of Division 3 of the Business&Professions INCLUDES DEMO OF EXISTING OPEN/CLOSED OFFICE SPACE
Code and that my license is in full force and effect. &CONSTRUCTION OF NEW 21 OFFICES.RECONFIGURATION
9/13/2010-REV#]-SMALL LAB/OFFICE
I hereby affirm under penalty of perjury one of the following two declarations: CtIANGES(HARDWALL),STRUCTURAL(ROOF),MECHANICAL(ROOF),
LIGHTING MODIFICATIONS.9/28/10 REV#1 ISSD
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.
I have and will maintain Worker's Compensation Insurance,as pro Y-ZP
vided[To'r by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. .t 3� 1
U'�
APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$800000
1 certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating APN Number:32633105.00 Occupancy Type:
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,aApenses may accru against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED
grantindditionally the applicant understands and will comply
with allregulation per the Cupertino Municipal Code,Section WITHIN 180 DAYS OF PERMIT ISSUANCE OR
9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatu Date � Jv
Issued by: Date:/ '2-,S
❑ -BUI� ER DECLARATION
1 herebexempt from the Contractor's License Law for one of
the following two reasons: RE-ROOFS:
1,as owner of the property,or my employees with wages as their sole compensation, All roofs shall be inspected prior to any roofing material being installed.If a roof is
will do the work,and the structure is not intended or offered for sale(Sec.7044, installed without first obtaining an inspection,1 agree to remove all new materials for
Business&Professions Code) inspection.
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date:
1 hereby affirm under penalty of perjury one of the following three
declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
1 certify that in the performance of the work for which this permit is issued,1 shall Additionally,should 1 use equipment or devices which emit hazardous air
not employ any person in any manner so as to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District 1 will
Compensation laws of California. If,after making this certificate of exemption,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
become subject to the Worker's Compensation provisions of the Labor Code,I must Health&Safety Code,Sections 25505,25533,and 25534.
forthwith comply with such provisions or this permit shall be deemed revoked.
Ownedor author' a t:�
Date:�P p o
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.1 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 I hereby affirm that there is a construction lending agency for the performance of work's
upon the above mentioned property for inspection purposes.(We)agree to save for which this permit is issued(Sec.3097,Civ C.)
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Name
;osts,and expenses which may accrue against said City in consequence of the
;ranting of this permit.Additionally,the applicant understands and will comply Lender's Address
vith all non-point source regulations per the Cupertino Municipal Code,Section
).18.
ARCHITECT'S DECLARATION
signature Date I understand my plans shall be used as public records.
Licensed Professional