07050291 CITY OF CUPERTINO �
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDJNG/aI�D.� h" UBB RD SOUTH BAY CCNSTRUCTION CO 07050291
iN l U L O 1i PERMIT ISSUE DATE
OWNER'S NAME: 05/31/2007
APPLE COMPUTER 170 KNOWLES DR
SANITARY NO. CONTROL NO.
jNE: (408) 379-55C0
BUILDING PERMIT INFO
ARCH I['ECTIENGINEER: BLDG ELECT PLUMB MECH
:z LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business roI io/gs_Code,and my,license is DEMO INTERIOR WALLS AND CEILINGS
y in full force and effect
z License Class Contractor Il
•p Datc Contractor
w ARCHITECTS DECLARATION
-� 1 understand my plans shall be used as public records
�a
v Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law far thej O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation
prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft. Floor Area
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q' $30000
— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of �p Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofF35720 0 0 8.t1 f�Number P y yp
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
(:1 1 am exempt B&P C fo is an
er arc
Owner / Date
S C MPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insurc for Worker's Compen-
sation,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 required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation{Ins nce carrier and Policy nu rr arc:
Cartier. N +� Poliry No.: J
CE TIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z. CONSTRUCTION LENDING AGENCY
(�CA I hereby affirm that there is a construction lending agency for the performance of
fx> the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
az Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
(L ~ correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
F'vj liabilities,judgments,costs and expenses which may in any way accrue against said City 1r j
U Z in consequence of the grailding of this permit. Date
�. APPLICANT UN T ND L CO PLY WITH ALL N N- INT Issued by:
SOURCE REG
Re-roofs
signature Sf Applicanvcontractor Dare 'I of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Mun�iciCodc apter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
E]Yes If a roof is inst�llled without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as de d by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes n
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 75534.1 understand that if the building
docs not currently a tc at it is my sponsihilily to notify Ute upant tote Date
requirements h st i coCaCcrtificatcof��M
Signature of Applicant
All roof coverings to be Class"B"or better
Owncrbr authorircd agent