08030040 CITY OF CUPERTINO
BUILDING DIVISION PERNUTMIT NO.
t G P7'1RAC 'OR�II 'aR'MAxlak�rR
euaplgc43RgRES3 TANTAU AVE #TA02 SOUTH BAY CONSTRUCTION CO 08030040
PER'S NAME: 1Vfile PERMIT ISSUE DATE
APPLE COMPUTER 170' KNOWLES DR 04/09/2008
PHONE: (408) 379-5500 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
woo LICENSED CONTRACTOR'S DECLARATION Job Description
uZI hereby affirm that 1 am licensed under previsions of Chapter 9(commencing
<g with Section 7000)of0ivision3ofthoBuaineasandPrafessiuneCode.and mylicense u REVISION STRUCTURE CALLS. ORIGINAL #07120020 NO
^<�Hin full force and effect
Sol LicenseCla, Llc.x 33617 NEW PERMIT.
F Dam Conuaclar
`p ARCHITECTS DECLAR ION
,22 1 ma ersund my plans Mall M mud aspublic record+
6
liC� Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
i.0 o following mason.(section 7031.5.Business and Professions Cade:My city at county
$
which requires a Permit to consuveL alcor,improve,demolish,or repair any structure
z�O pdorto daissutnce,also inquires flue applicant forsuch pemitmfile asignedsmmment .
gg C
dislike isliecnud pursuanlui previsions ofthe Contractor's License Law(Chapuo9 Sq.Ft.Floor Area 0 Valuation
2€ (commencing with Sidon7000)of Division 3nflhe Burinectod Professions Code)or
egg
this he ts exempt therefrom and me basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fear a permit subjects the,applicant to a civil penalty Of 31618027 .fijPbVUMber Occupancy Type
trot mom than five hundred dollars($500).
0 I,u owns of the pmpoM,Or my employees with wages u dmir vele compensadon,
will da the work and thenumme enol intended oraRered rental.(Sec.7W.Business Required Inspections
and Profusions Cade:The Contractors License Law does nm apply to an mance of q P
property who build,or improves thereon and who does such work himself or through his
ownce ployoes,provided that such improvements art not immMed oralfertd Intrude.If,
however.me building orimprevemant is cold within am year of completion,the owner.
Wilder will base the burden of proving that he did net build or improve for purpose of
make.).
0 1,as Owner of Use property am exclusively contracting with licensed ex niramors to
camwm the pmjem(See.7046.Business and profession Cods:)The Cun rsuchms U.
comes Law doss not pply to an owner of property who builds or improves Norton.and,
who convects for such projects with a contrutor(s)licensed pursuant to the Contractors
License Law.
am exempt undo See .B k PC for this rtuon
u Dam
WORKER'S COMPENSATION DECLARATION
TION
hereby affbm under penalty of perjury one of the following declartdom:
0 I haw and will maintain aCenifiamof Consent to ulNesum forWorkers Compen-
sation,u pmvided for by Section 3700 of the Labor Code,for the performance of Ons
'work for which this permit is issued
0 I have and will maintain Worker's Compensation insurance,as required by section
3700 of me labor Code,for the performance of the work for which this permit is bound.
My Waher^s C1o1mpemNan Imnurxmce carrier d Policy number an:
Cartier:Ilan b..�mti L 2--PlI"fa' FOO No.: CZ t t 7 30 -
CERTIFIGTE OF EXEMP TqN MOM WORKERS'
COMPENSATION INSURANCE
(Thi,rection need natW..plcwd If the permit is fmaoe hundred dn0ass($100)
or W.)
1 unify mm to to liformanc.of the work far which mis permit 1,issued,l shall Out
employ any person in any manner an u to become subject in the Worker'Compeno0an
Laws of California Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you Mould
became subject he the Worker's Compensation provisions of the Labor Code,you most
,J 0 forthwith comply with such provisions or this permit shall W demand revoked.
Z C4 C ONSTRUCTION LENDING AGENCY
[—m I hereby affirm that them is a conservation lending gency for the performance of
CYi > the work for which this Permit Is issued(Sec.309'7,Civ.C.)
aQ Lenders Nune
Z lender,Add.
U O 1 unify that 1 have reed mis application and sum that the above information is
ty F cmmtt 1 agree to comply with all city and county andinanca end cuts laws rtla ins to
-�U Wilding convection,and hereby anthoriae rtpruenmives of this city to enter open de,
LTl above-mendonad property for inspection Pon..,
f�y.I (We)agree to ave,indemnify and keep harmless the City of Cupertino against
jy y liabilities.judgments,emas and expenses which may in any way accrue against old City
U'Z in consequence of me Seaming of this permm Date
► APP UNDERSTANDS No ND WILL COMPLY WITH AL NO -POINT Issued by:• 9
SO C CULA770NS. l/ ,,//
�/✓I, t,=1 p 4/ T 9/°9' Re-roofs
S nuurt .VCanira uW Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or totem building oceupanurert nr handle Mention,material
fined by the Cupertino Municipal Code.Chapter 9.12.and me Health and Safety
Section 25532()7All roofs shall be inspected prior to any roofing material being installed.
C]yes No
Will the applical or fu ne Wilding oavpanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Will the itripficar,or kne Wilding occupol use equipment 0,devices which
emit hmallous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
DisvictT
SYes '%No ^ //
Ihave road myCodc.Seen 255D5,25533 and
binavehapter thin of the Wilding
it.not
So Cade,Sections]]fthis5535anmeNtulylumasmmdmuiTthe Wilding
a-
does not cu a¢rant.that It u m vihilil to no0f the oma t of Ne Swy1.✓r^'_
require whzhm =rmiyu of a Cc am of Oce
�� Signature of Applicant Date
Ownermamharized agent ✓7/ Dam All roof coverings to be Class'W'or better
'CITY OF CUPERTINO
CITY,+OF
C.UPEkTINO REVISION/DEFERRED
PERMIT APPLICATION FORM
�4�6 30LY1
APN# Date:
1( I �-O Z-7. -7 x-0.2
Original Permit#:
Building.Address:
0,Lf00 rA
"
NI'al_ling Address (if different frotri building address):
Owtier's.Naive: Phone
"Contractor: Phone;; 6 —�3 16 Z'Z
eU �v 'cel ani. Fax: 3-7
7
Contractor ticense #: 33�lq-1
Cu erdfio Business License # 5
c
Contact:. Phone:Pay
- Fax: 3-7cf3a5(,o
B-Litding Permit.Info:
Bldg. Elect ❑ Plumb ❑ Mech ❑
Resi" erift1 ❑ Commercial
Job Description:
Type of Construction (Usage Class): * OccupancyType '
n r
I TR;J1FR,❑ 1,`1,il11,, V-1HR ❑ 1.1, 1;11, '1V V-N
Valuation (cost of prof ect):
Project Size: Standard Large ❑ Major ❑ Val'uatiom
CITY OF CUPERTINO
MYOF. REVISION/DEFERRED
CUPEI,TINO
PERMIT APPLICATION FORM
FEE SCHEDULE
Quantity Fee'ID Fee Deseription Fee,Qroup Permit Type
S_q Ft
1'REVCOMNE�IV Revision Cornmercial New -B 1*
1REVCOMTI Revision Tenant'Improvernent B 1* TI
1REVSFDWL Revision SFDWL B IRISFDW
1_REVRESADD Revision Addition B— 1.R3, SFDADD
1REVRESREM Revision Remodel B IRMFD_REM
1DEFINSP Deferred Submittal not R-3 B 1:* ,
Inspection
1.DEFPLNCK Deferred_ Submittal not R-3 Plan B; 1'* OR'
Cheek 1*'TI
1DEFR3P.LNCK Deferred submittal R-3 Plan Chk B 1R3SFDW
1MSFDADD
1R3, SFDRE*M-
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