06080063CITY OF CUPERTINO
BUILDING DIVISION PERMIT -
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BUILDING ADDRESS:
SOUTH BAY CONSTRUCTION CO
11NO'06080063
2 INFINITE LP
0 NER'S NAME:
PERMIT ISSUE DAM
APPLE COMPUTER
170 KNOWLES DRIVE,
E:
SANITARY NO. CONTROL NO.
(408)379-5500
ARCHITECT/ENGINEER:BUILDING
PERMIT INFO
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ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
p
1 hereby arfim Nat I are licensed under PmviYana of Chapter 9 (commencing
with Section 701)11) of INAA.n 3,uthe Butin. fgsiuns CoMia of ylicoms; is
in full tome and Arrau/SIV—/a1
TI OFFICE - 3820' NEW OFFICES INTERIOR DEMISING
Liven I s, Lm.N
Dale / German- '
WALLS NEW CONFERENCE ROOM AND BREAK AREA ARE BE
ARCHITECTS DECLARATION
CONSTRUCTED.
I unbuttoned my plans shall W used As public records
Licensed Ptleaskmal
OWNER-BUILDER DECLARATION
1 hereby affirm that I am mo mpt (rum the Conbactor's License IoW for me
following mason. (Section 703 1.5, Business and Pmfessmu Cade: My city m county
which requires A perms Mu connrwl slur, hnprow. demolish• or repair any structure
prior An its outcome. Alsomquires Ne applicant for such permit In Me A signed Moment
Conuacmr's Uccnw Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he b licensed pursuantlo the provision, of the
(commencing with Smion 7000) of Division 3 or use Business and Professions Code) or
$125000
that he s exempt therefrom and the Was for the alleged ca unptlon. Any A.I.6 A of
APN Number Occupancy Type
Satinn 7031b by Any Applicant for a permit subjem Ibo appumnl he a civil penalty of
not mom than fin hundred dollars (5300).
❑ I, As owner cruise property. amyeroploym with wages As Meek Able eompenudon,
will dodo work and thesteclum s Out letended oroRered Awashe (See. 7044, Badness
and Pmfesa am Cade: The Conmcmrs License Law dol not Apply In an wtur of
Req c Ons
wkWilds dee awhwarkbimselfwmmu{hits
cpropertyowcon proridmpmwlhumgandwk
such impmwmwtsone offered torula
InNe.,lMee,Pmgai prowneost I-
however, Ne building m impmwmrnt cold within mm year or me owwr-
?Pj(!�/�/g/�//>j♦j
i.p. for
buima will love the buten of pmrin{ that k did cot build m improv for purpose of
g
talc.).
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ronexnaA u
❑ h As owntt of ct property, , B exclusively contracting with ) The
coutroct u¢ project (lea. 7014. Business and Proresdan code:) The Cwuacmr's e lau•
ccuw does not m thereon, apply an moor of property who builds or improve then, and ,
.
b fe
®� a g�
who contracts for such pmjects with a conmamos(G licensed pummml m Ise Comoomora
(V// 'C'{rvyej gg
License Law.
❑ Ions exempt under Sec , B & P C for this mason
�....yy
yr,
er DAM
WORKER'S COMPENSATION DECLARATION
1 knby &Mm under penalty of perjury arc of the following dalasWanc
❑ I haw and wlil mdnuin 1CeniBm a o(C...t Moself-inurefor Warks's Compcn-
satim, u provided for by Section 3700 of the Labor Cade, for the perfomanm of the
work for which this permit is basted.
❑ 1 have and will maintain Worth Compensation Insurance, As mqulrod by Scedon
3700 of Ne Labor Code• far Me po romance or me work for which mos permit is Issued
'
My Workmel CompenutiIn lnsu%j � mn�ic(rof Polity number are:
Carrier.G'A'fJNA�O�Polley
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
OTs section wed not k completed Vona Permit s foranc hundred dollars(51001
or leas.)
1 certify Nos in the perfurmawe of um wart for which this permit is issuce, I shell not
employ any person in any manner an u m become subject in use, Wortess' Compensabon
Laws of Califomia. Dau
Applicant
NOTICE TO APPLICANT: If. no, making this Ccnifiem of Esempdon, you should
become subject to the Worker's Compcuadon prevision of the Labor Code• you meet
forthwith comply with such provisions or this Permit Mall k demand revoked.
CONSTRUCTION LENDING AGENCY
I hereby iBm the mem Is a c lending agency for the performanco of
' esu work for which oa permit is issued (Sec. 30". Civ.CJ
'
Lender's Name
Lender's Address
j I Comfy that 1 haw read this application and some that the show information Is
' comm. I agree to comply with all city and county aNim noes and state lam relating to
building coneouction, and hereby authorize mprmcnutives of this city to enter upon the
I Above-memiuned property for Inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
i Iiabilitics,judgmenMs. casts and espensea which may In any way Accrue aSAWL said City
I n ca9yywnec of th {moan{ of this permit.
' APyLjC►NI UNDERSTANDS /djD WILL MPLY WITH ALL ON-POINT
Issued by: Date
S U REGULATIONS /Y/
Re-roofs
Type of ROOF
9�°y
Si{nae re of nppecan anmclo Dam
HAZARDOUS MATERIALS DISCLOSURE
Will she Applicant or Anum building occupant nom or handle hamNnu malmid
As defined by Ne Cupen)m Mun' Pal Cock. Chapter 9.11, And do Health And Safety
dc, Secuon 1553X4)?
All roofs shall be inspected prior to any roofing material being installed.
Ym e
If a roof is installed without first obtaining an inspection, I agree to remove
Will Met Applicant w future Wilding occupant use equipment or dcvicm which
emits hnvordnw air contaminants u deawd by the Bay Amo Air Quality Management
all new materials for inspection.
Distinct?
❑Yes NO
I haw mad the haarmms materials mquimmenm under Chapter 6.95 of k CA111m.
me Health& SafmyCode. Sttvia x15505.35533 w175534.1 understand owir arc building
d it, haw A te m u it is Apt ulhllky te nodl'y Me OCIUMOt of the
which mum rAn afacettirjpa ra
Signature of Applicant Date
Icreme
gA/ �q o 6
All roof coverings to be Class "B" or better
Owner or mthorivcd fgcnt Dam'