08070203TION�e:
BUILDING DIVISION PERMIT
� x
CC11�iTI2AiGTQR�IIa`O x.
v, f!, E N,�.ti`=° °fib 4:re•�a, .�:. aif€
BUIL TNG ADDRESS:
80650 VALLEY GREEN DR
NOVO CONSTRUCTION
PERMIT NO.
08070203MIT
NER'S NAME:
PERISSUE DATE
DAPPLE COMPUTERS
1042 HAMILTON CT
08/01/2008
PHONE:
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BILDOO PLUMB MECHO
O
LICENSED CONTRACTOR'S DECLARATION
- Job Description
Mmb9 affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 70(10)OfOividon3of tho Buainwutl Profcasions Code antlmylicemcis
REV HNDICP STLS TO BE REGRAD TO CODE; INSPCTR FND
ic^Isecl.deffect, ft LicN �9 10�
INFRCTN DRNG FINL INSPCTN ORIG#08010091
DamContractor 1—t2/CJ GeYns..d'Ya
–I–LW ARCHITECTS DECLARATION
I uMemand my plana Mall W used as public record,
Licensed Pmfcuim tl
OWNER-BUILDER DECLARATION
I hereby 411111111 that I am exempt from the COmbactors License law for the
fallowing mason. (Section 703 U. Business and Profesatuns Code: Any city or county
which me fires a permit to construct, alter. improve. demolish, or repair any structure
prior to its issuance, also requires; the applicant for such permit to Jilt a signed statement
to the Of the Contractor; Lica ed Law (Chapter 9
Sq. Ft. Floor Areap
Valuation
ROIL he is licensed pursuant provislone
$ 0
ss
(commencing with Section 7000) of Division 3 of the 8usineuand Profession Code) or
that be is exempt therefrom and the basis for the alleged exemption. Any violation of
32601053 Number
Occupancy Type
Section 7031.5 by any applicant far a permit subjects the applicant be a civil penalty of
tat mom then Ove hundred dolims (5500).
.
❑ I, u owner of the property, m with theb role cempemutiess
Required Inspections
is otimencus
will d Newark, and the is ted ora amdfu
snot a (Sac.
w dr to an Owner
he Com License law alms not apply lf an owner of
ad Code: The tees Li
m tthermora
property who daessechwarth his
forsab
Own amywhahuilds roviid thatuch improvWwho
mattor ered
own a uiprovided that such improvements arc not Todd ad If.
groat.
opted
build= Ne buildingorimprovement uhalt within one year of completion,thsower-
however, to
wiB have tM burden of proving that k dm trot build or improve for purpose of
sok.).
ale.).
❑ 1, u owner of the property- am exclusively contracting with licensed contractors m
construct the pmjecl (See. 7044. Business and Professions Cade:) The Comnesoes U-
ccua law doe not apply man owam of property who builds or improve theman, and
who conatus for such projects MN a contracmr(s) licensed Comment to the COntnemrs
License Law.
❑ I sm exempt under Sae , B & P C for this moon
nv Dam
• WORKER'S COMPENSATION DECLARATION
I hereby salon under penalty of perjury one of the following declarations:
❑ I haw and will maintain a CeNOnmof Couentta self-iuum fur Worlrars Compen-
sation, u provided for by Section 3700 of the labor Code. Ivor the performance of the
work for which this permit is issued.
❑ I haw and will maintain Workers Compensation Insurance, u required by Section
3700 of the labor Code. for the perfmmuce of the work for which this permit is Issued.
'
My Workers Compensation lmurance artier and Policy mortagr am:
Cartier. Policy Nm: ,V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nolbecomplemd ir0r permit is foranc hundred dollars ($100)
or less.)
1 arG(v, that In Ne performance of the work for which this permit is issued, l shall not
employ any person in any manner set as in became subject to the Workeri Compensation
taws of Ceifamia. Dam
Applicant
NOTICE TO APPLICANT: If, spot making this Certificate of Exemption, you should
become subject at the Worker's Compenaidon provisions of tlr IAWr Code, you most
forthwith comply with such provisions or this permit shall d seemed reeked.
CONSTRUCTION LENDINGAGENCY
thatlending agoney for Uvo perfurrnuceof
Ir
1 herbyich
mit
me work for which this permit is issued (Sec. J097, Civ. C.)
Oda
Lenders Name
,
,
Lenders Address
j I certify that I have and this application sal sass that me, above information Is
' correct, I agms to comply with all city and county ordinances and sum laws relating m
Wilding construction• and hereby authoded mpmxntativea aides city to enter upon the
1
above-mentioned property for Inspection puryomL
i
(We) agree to save, indemnify and taxi, harmless, the City of Cupertino against
j liabilities, judgments, cord sod expenw which may in any way aceta against said City
in consequence of the granting of this permit.
-
i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Type of Roof
//I^�1 acv.._ (P6A, . ^ T-1—O`6
Sawa df ApplicmdU onuacmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicent or future building occupentnom or handle hazardous material
as dennd by tit Cupertino Municipal Code, Chapter 9.12, and the Imalth and Safety
Section T5532(a?
-. ❑Ya �No
All roofs shall be inspected nor to an roofing material being installed.
P P Y 8 g
If a roof is installed without first obtaining an inspection, I agree to remove
Will thx applicant or forum building acuWnt use equipment or dormant which
emit hazardous art conlvnimets as dcrined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes �Nu
.
I have mad the buardmtem ued.isnequiremxnts under Chapmr6.95ofthe Califor.
nis Health &SefetyCude, 3ee6mts25505, 25533 am125534.1 undconad thaiftic building
does not currently have a extent, that It is my mspouibility to notify the Occupant of the
requirements which most be met Print. to issuance an Certificate of Occupancy.
06
Signature of Applicant Date
�l I � -
JA,.�Nvv SeZ"m
All roof coverings to be Class '1?" or better
nem or authonmd ager Dam '