08100113 CITY OF CUPERTINO +� .+'n»6'r ' x
BUILDING DIVISION PERNIIT eCON PR�4GTQRINFORMATIONd
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BUILDING ADDRESS: PERMIT NO.
10500 N DE ANZA BLVD SOUTH BAY CONSTRUCTION CO 08100113
NER'S NAME: Itlit— PERMIT SUE DATE
APPLE 170 KNOWLES DR 10/20/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHnF.CffENGINEEA: BUILDING PERMIT INFO
COMM'L TI, TEMP PERMIT GOOD BLDG ELECT PLUMB MECH
THRU 11/201,138
0 0 0 0
wap LICENSED CONURACTORS DECLARATION Job Description
1 herebyNn o
(m
affirm n I am limasm under provisions;of Chapter 9 mmeming
wish Section 7")of Division 3 of to Busircss and Professions Code.ano my license is
^�a In fall face and eR
i Lkense CI Lk.I
n F,q Dau Convenor
7W RCHrtECI'S DECLARATION
I understand my Plans mail bo used as public records
OyU
lto� Limessm Pmfeaionn
''a OWNER-BUILDER DECLARATION
ji F I hcmby tlnrm Dat 1 am vcmpt from the Convacta's License law for to
OO following mown.(Scedon'/031.5.Becomesand Refessiom Code:Any my or ceunry
C
S ff whkh acquires a Permit to cottRrect.atm.im omse.devolih,an,minor MY suunum
yZy prior an its lOWnce,alae acquires to sppliClnt(or such pcmlit to rile aligMd==at
o mat he is licensed pamant to the ymvidons of he Contractors uanse Law(Charter 9 Sq.Ft. Floor Area Valuation
(commencing wit Section 700M of Division 3 of do Business and Pmfessiaa Code)or
$ tat W u exempt Wrefrom and ho bash far the alleged execution.Any violation of
Seerlon 703"by star,applicaog for a Permit subjects he applicant to a civil penalty of APN Number Occupancy Type
fat more tan five hundred dellam(3500).
❑I.aowsa ofth propaty,amy wPlaym wit cagesuUc'v akcompevWm,
will do meword.and heswctucu is not mounded cautioned ferule(Sec.TUss,Business,
and Pmfcvdons Code:The Convvcmrs Limn a Law does ant apply In an owner of Required Inspections
Property who Wilds.,ireproves human,ams vhodoessuch wokhimself.,trough his
ownemployma,provided hat such improvements art not lateral aoRcrm(sale If.
however,to Wilding s improvermnt is mid witin ons year of ancupletiov.he owmu-
Wildu will ham the burdm of proving tV he did not Wild or improve for im"m of
sa c.A
❑1,as mwrcr of he Properly.Liu uelusmvely contracting wit Handed centranrss to
comwn the prejees(Sec.TOsa,Business am Professions Code:)The CoovanoYs Li-
cove law does not apply to in owner of property who Wilds or Improve human.and.
who commeas for such projects with a contractor(s)licensed pursuing In the Contractors
Lmcose Law.
❑I are caunpt undo See .B d P C far his mason
Due
WORKER'S COMPENSATION DECLARATION
I hereby alffn a under pevlty of perjury rn of dm following declamations:
❑I have am will maintain acertirieam of Covent to self-imme fa Workers compen-
smon,as Provided fm by Section 37W of the Labor Code.far he perform.of do
wart for which his permit is issued
❑I have and will maintain Wmase3 Compensation Insurance,as acquired by Section
3900 of the labor Code,for he performance ofte ware for which hid permit is Wsd. '
My Worke/ejlAdlCo/nKraaudoo Wurance carrier and Policy number are:
Cartier. "•�OS'tiZ_ Policy No.:X11 �0311k
CERdflCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(itis sectim need naoW completed if to permit Is fame,hundred dollar,(3100)
or less)
I cenify tat In me performance of he work for which this Permit is located,I shall ria
employ any person in my mamcrw a to become subject m to Worten Compensation
La"of California.Data
Applicants
NOTICE TO APPLICANT.If.after making this Cer iOau of Eatmptim,yon hmld
become subject ta the Woreus Compensation pmvisiov of he Labor Cede,you mail
.,z fool comply wire such prmviaov or tis Permit shall W decreed unaged.
z^ CONSTRUCTION LENDING AGENCY
[—u 1 Weeby affirm than dere is a eovuucdm lending agency ror to performance,of
f3i the work,for which this permit is cams(Sec.300,Civ.C.)
W Q Lede's Name
7 z Imndurd Address -
U Q 1 certify ha I ham read itis application and aur ha to above iNormatiun is
ty correct.I agree to comply wit all city and county ordinances and sum laws minting to
Q building covuucdon,and hereby mmorim communatims or his city m enter upon the
r .hove-mentioned property res inspection purposes
(We)agree m ave,indemnify and lump harmless he City of Cupenka against
y liabilitimlodgments,case arm expemu which may in my way+cerue agai s,read City
U z in mutual ana of he{wing of bar permit
`-' APPLIC RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by[9Date Le a�
SOUR REGUL ONS. �1t n
�'f I�JI1/a..Eu / fJKj6 t� Re-roofs
Sigwur canvOoarc
awr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to appllcem or future Wilding occupant von or handle hmalloW material
as defucd by the Cupertino Mu 'ca cm
ad Code.Chapter 9.13,cab to HVIN and Safety
Section 25532(.)T
❑Yes NAll roofs shall be inspected prior to any roofing material being installed.
Will he apPIb a ere building.,.at tie cgalpment err devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvardna air communists a dcfircd by he Bay Area Air Quality Management all new materials for inspection.
Disumcrt a
❑Yui
I,&Safadtehmaock.\manila.2553iremmuunde ndcomarh.PSofte Califs-
does nolturrent endo,Secdens rid of 3my am1asab I I1unacmund tnifdc building
rectariaen hovel as mt tat ithmy vibilityWant
fy do fat of
rcyuimmen muRbemetpdarm' ofa cof orivef Dae
61'g e All roof coverings to be Class'W'or better
Owner err agcm oat'