04100162 CITY OF CUP ERTINO - - ,"'• M;*au:s',t 'mt^ 6 '<' ;[�e+^a• a'?.s�`^'"'r `' _ _ _ _..
BUILDING DtvlsloN PERMIT - ,CONTRACTQR'INFORMATIOO N
BUILDINGADURESS: "" NOVO CONSTRUCTION PERMITN1b4100162 '
I"' 2431 N DE
ER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 1042 HAMILTON COURT 12 /n7/2on4
ONE: SANITARY NO, CONTROL NO.
(650) 701-1500
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
a O o LICENSED CONTRACTOR'S DECLARATION Job Description
C wl I Mm vffirm Nat 1 am limlucd dMcr of Chaprtr 9(commencing p - -+
IJ iso O(XI)of Division]of NC Bus rrc ofevium Code,and my license is
o` iaml andaffcd lO2Z TI--INFILL OF (E) OPENING FOR NEW SPACE '
5 Lice. lass Lie.k .. . /
.�-
Dam Contractor
ARCHITECI'S DECLARATION//
m I 1 sande nd myplarp-Cell he yud a;
0.in L¢cnsca�P fessional// �I }"16•
OWNER-BUILDER IER DECLARATION
1 hereby alio diel 1 am exempt from the Cormanors License Law for the
0f� '- - - ----
0 following reason. 70]1.5.Business and Professions Codc:Any city or county
k ru n_nA C'!/\'
s which reyvia permit m construct,elm,,improve,demolish,ser mpuir any struchro L[�f//
Z y poor m its issmnce:aiw regulons the applicant for such pcnnit m file a signcJ seemmem
lhatMincin withSnstion7 m)ofDiviansn oftheBusinesandProevonsCode)tar9 Sq.Ft. Floor Area l�/�¢' , ✓Uj Valuation -
- '� 2 (see,he
(commencing Section the
basis-fit,
theBusinessand Professions car
� that W u eaunpt thertfrorn and Ne buil far the alleged eaempuan.Any violation of nn `r!! �•l i
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ON 0 -G//t,�;�;:- Occupancy Type
not more Nan five hundred doll..(3500). ty
❑1,m ownm of the pmpeny,m my employcu with wages m IWir mle compensation,
will do thaw,kmd lheswclore is not intended oroRemd forsale(Sec.7l ,Business Re sired Inspections
r-• -
and Pmfessiov Code:The COncense uaclors LiLaw does not apply to an owner of _ - _ -_-_ _ q p - -"
property who builds arimpmms hereon.and who doensuchwmk himselforthrough his
own employees,provided Nat such improvements art not intended oro@red for We.If.
however.Ne building or improvement is mid within ane year of complation.the owner.
builder will have the burden of proving that he did oat build or improve for purpose of '
sale.).
❑L as Owner of the pmpeny,am aselterively contracting with licensed contractors to -
construct dm pmjca(Sao 7014.Business and professions Code:)The Contractor's Li- .. -
co se law does not apply On an owner of property who Wilds or improv overarm,and
who concocts for such projects with a comntor(s)licensed pursuant to the Contractors _- - -- " -
License Law. ..
I am eumpt under Sec. .8 k P C for this reason "- -
u Data -
WORKERSCOMPENSATIONDECLARATION
1 hereby affirm under perml y of perjury arse of dm following daelaradans:
C „ I ham and will maintain a Certificate.f Conscni to selGinsum for Worker's Competi.
salion,as provided for by Section 3700 of doe Utter Cedc,for the performance of the -
workforwhiehthispermitisissued. -
1 have and will maintain Worker's Compensation Insurance,as mPined by Section
3700 Labor Code,for the perform.nmof the work for wilt this permit is issued.
nkam.��pa1rslIaurn Insurance carrier and Pali
a errs NllYlt. ItL tllla - Policy 0..: 1! (_Dq J ..
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mit metinn..dnot becompleted ifIW pcien is froom,hundred dailars(SIM)
or less.)
1 Certify Nat in the performance of the work for which this permit is issued,I shall not - -
employ any person in any manner m as to become subject to lW Workers'Compensation ,
Laws of Califomia.Dam
Appi!mam
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you most
�Z faMwith comply with such prmisions or Nis permit shairbe deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
[-. I hereby affirm that there is consuuclinn lending agency for the performarmc of
C the work for which this permit is issued(Sec.3119'1,Civ,C.)
U4 lenders Name
Z) z2. lenders Address
V O 1 ccnify that 1 have read this application and seem that the above information is
4G f" correct I agree to comply with all city and county ordimmeas and suite laws misting to
O V building construction,and hereby authada repmmnlativ of this city to enter upon the
} above-memioned property for inspection purposes.
92. (We)agree to save,indemnify and keep harmless the City of Cupertino Against
fq Iiabilidu,judgmems,costs and espences which may in any ways..against said City
V Z in consequence of the graming of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL jjj•••IIIDN-POINTIssued by: Date /Y
SOURCE REG ONS.
117.1 U Re-roofs
Si ort of AppiicanVCrnlnnor am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant store or handle hvardous material
cfineit by the Cupertino Municipal Code,Chapmr 9.12,antl the Hcahh and Safety
c,Section 255320)? All roofs shall be inspected prior to an roofing material bei.
[3y. All
p p y g g installed.
Will ova applicant or furore building aceupam use equipment or devisers which If a roof is installed without first obtaining an inspection,I agree to remove
7Dishiet?
havmdouc air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
dna
❑Yet
I have mad the Wandous materials requirements under Chapter 6.95 of IW Calif,.
Health h Safety Code,Sections 255115.25533 am125534.1 undersmM that ifthc Wilding
s ret tly hoc a tenant.that its my nesp asuf ility to nosey IM occupant of me
to 'wsbc�unnpnormissaanaof.certifmamofaea arscy. Signature of Applicant Date
a ��T1� All roof coverings to be Class "B"or better
ner car authorized agent Dam