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09060024I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10500 N DE ANZA BLVD FLR 2 OWNER'S NAME: APPLE CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 09060024 INC 690 GIBRALTAR DR DATE ISSUED: 06/19/2009 OWNER'S PHONE: 4088629799 1 MILPITAS, CA 95035 1 PHONE NO: (408)942-8200 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Li,. # -�:!!7 9'16 Contractor Date ,' I hereby affirm that I am licensed under the provisions of Chapter9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this ,.e....:.-a.- --A APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point sourc regulations per the Cupertino Municipal Code, Section 9.18. Signatu Date 4//)e?V ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) L, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes, (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION:COM'L TI FULL 2ND FLR TI (EXCLD RSTRMS);BLD OUT NEW OFCS, LABS, TRKRMS, ETC. NO CHANGE IN OCCPCY, NO CHG TO STAIRS OTHER THAN HANDRL UPGRD TO MEET Sq. Ft Floor Area: APN Number: 31622017.172 I Valuation: $6000000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Own tho ' a rat: Date: Cl CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Signature, Date I Licensed Professional 304 yz # W �o ggyggyy iC0 m �FC y�S v7Z Z , 0. Q n Z �U UZ CITY OF CUPERTINO BUILDING PERAW H� 5 ��� DIVISION g..' BUILDING ADDRESS: PERMrr NO. CON CONSTRUCTION INC24 OWNER'S NAME: PERMrr ISSUE DATE PHO 0- CONTROL NO. 408)942-8200 ARCHrrECTIENGiNEER: BUILDING PERMrr INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I are licensed under provisions of Chapter 9 (commencing Job Description p with Section MOD) of Divison 3 of the Business and Professions Coda, and my license Is in full force and effect. COM' L TI FULL 2ND FLR TI (EXCLD RSTRMS) ; BLD OUT o to Cl ense Connaanr EW OFCS, LABS, TRKRMS, ETC. NO CHANGE IN OCCPCY, ARCHrIEC rS DECLARA ON I understand my plans shill be used as public records NO CHG TO STAIRS OTHER THAN HANDRL UPGRD TO MEET Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for We 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 stmewm prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he is exempt therefrom and the basis for the alleged exemption. Any violation or 6 0 0 0 0 0 0 Sectiole n 703I3 by any applicant for a permit subjects the applicant m a Civil penalty of APN Number Occu arc P y 4pe not mothan five hundred dollars (S500)_ 31622017.F2 - ❑ L as owner or the property. or my employes with wages as their soic compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of Required Inspections property who builds or improves thereon. and who does such work himself orthroagh big own employees, provided that such improvements are not intended oroffered 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.). ❑ L as owner of the property, am exclusively contacting with licensed co ovctm to construct the project (Sec 7044, Business and Professions Code:) The Contractor's Li- ccrose Law does not apply to an owner of property who btdids or improves thereon, and , who contracts for such projects with a contractor(s) licensed pursuant to the c unctora License I". ❑ I sm oxempl under Sec . B & P C for this reason Owner Dace WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure fa Workers Compen- sation, as provided for by Section 3700 of the Lobar Code, for the performance of the worn for which Oda permit is issued 0 I have and will maintain Workers Compensation tusunnce, as required by Section 3700 of the Labor Code• for the performance of the work far which this permit is issued. My Workers Compensation ht�sma-n-ce_ and Policy number are: _asri.er Cartier.c ff ,1� Policy No.: ` CEICIFICATE OF D(EMPT70N FROM WO COMPENSATION INSURANCE 0-his section need not be completed if the permit Ls for one hurWred dollars ($100) or kma.) 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 W become subject to the Workers' Compensation Laws of California Date Applicant NOTICE TO APPLiCANr: If, after making this Certificate of Exemption• you should become subject to the Workers Compensation provisions of We Labor Code, you must forthwith comply with such provisions or this permit shall be deemed mvoked CONSTRUCTION LENDING AGENCY 1 hereby affirm that Wee is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097. CN. C-) Lenders Namc Lender's Address 1 certify that I have read this application and state Was the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and beseby authorize representatives of this city to enter upon the abosrmentoned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilitles,jtdgmenta costs and exposes which may in anyway accrue agamstsaid City in consequence of We granting of this permit. APPLIC ERSTANDS AND WILL COMPLY WrrH ALL NON -POINT Issued by: Date l P-l!31 SO ULATION Re -roofs Type of Roof Svatuh of SUS MATERIALS DISCLOSURE Vao applicant or future building occupant stem a handle hazardous material as dcrwog by the Cupertino Murticipal Code, Cbaptar 9.12. sod the Health and Safey Code, seerlan 25532(a)7 All roofs shall be inspected to any being installed. ® [3 Yq No prior roofing material building a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or mtare occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes No I have read theharandaus aterials requirements under Chapter 6.95 ortbe Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand Was if the building does not currently have a tenant. that it is my responsibility to notify We occupant of We requ nts w be met prior to issuance of a Ccnificaic of Occu Signature Of Applicant Date All roof coverings to be Cl`a '' or better g ass - co!-T � Ownerorired agent etc G