09090155 CITY OF CUPERTINO BUILDING PERMIT
D R 1 CONTRACTOR:DEVCON CONSTRUCTION
BUILDING ADDRESS: 10201 N DE ANZA BLVFLPERMIT NO:09090155
INC
690 GIBRALTAR DR DATE ISSUED:09/30/2009
OWNER'S NAME: APPLE PHONE NO:(408)942-8200
MILPITAS,CA 95035
]R'S PHONE: 4089428200
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# 2, MECH RESIDENTIAL COMMERCIAL
Contractor 1 Jf".l /, Date 6�
JOB DESCRIPTION:LIFE SAFETY PLAN FOR OCUPANCY OF 1ST
I hereby affirm that I am licensed under the provisions of Chapter 9 FLOOR DURING
(commencing with Section 7000)of Division 3 of the Business&Professions CONSTRUCTION OF THE 2ND&3RD FLOORS AND I ST FLOOR
Code and that my license is in full force and effect. LOBBY
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 Valuation:$100
Section 3700 of the Labor Code,for the performance of the work for which this Sq,Ft Floor Area:
permit is issued.
APPLICANT CERTIFICATION APN Number:32634070.FLR1 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by-
��- Date: C JAS^
Dat
SignatureY=7e
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044, Date:
Signature of Applicant:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's
I have read the hazardous ma
S
5 of
by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505 requirements25533,and 25534.pter 9
25534. I will
Compensatin,as provided for maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management
District
12 the
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,
not employ any person in any manner so as to become subject to the Worker's
Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I d nt: D
become subject to the Worker's Compensation provisions of the Labor Code,I must Own authorize _Date:_1
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application uand ost to that
ordi the
above
and state laws relating ation is I hereby
which tiu prm ermitat there ssued(Sec 3097,CivdC.)agency for the performance of work s
correct.I agree to comply with all city a county
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
i• ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Date_ Licensed Professional
Signature