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CITY OF CUPESION
BUILDING DIVISION PERNIIT
BUII- T416TTARIANI AVE
rrr
9
*008
OWNER'S NAME:
ATE
APPLE COMPUTERS
PHONE:
SANITARY NO. CONTROL NO.
(408)271-2425
ARCHrrECT/ENGINEER:
BUILDING PERMir INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Divison 3 of the Business and Profcadmis Code, and my license is
in full fora an effect 047a4 SD
License Class LIC s
Date Coniraaar S
ARCHITECTS DECLARATION
I u my plans Mall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following mason. (Section 7031.5. Business and Professions Cade: Any city or county
which requires a permit to construct. after. improve, demolish, or repair any structure
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
(commencing with Section 70D0) of Division 3 of the Business and Professions Cade) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects ox applicant to s civil penalty of
not more thin five hundred dollars (5500).
O 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
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
oven employes, provided dal such improvements am not intended or offered for ask It.
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 Contracmrs 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 am exempt under Sec B A P C for this mason
Owner Date _
WORKER'S 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 for Workers Compen-
sation, as provided for by Section 3700 of the Labor Cade, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the wart for which this permit is issued
My Wo Compensation Insurance artier and Policy number am:
Carier.'/A-��liey No.: � t (O
CFRTPFICATE OF EXEMPnON FROMWORKERS'
COMPENSATION INSURANCE
(This section need rot be completed Lithe permit is for one hundred dollars ($I00)
or less)
1 certify that in die 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. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
became subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed rooked
CONSTRUCTION LENDING AGENCY
1 hereby d TLrm that them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. Q
Lenders Name
Lenders Address
I certify that 1 have read this application and state that the above information is
correct. 1 agree to comply with all city slid county ordinances and state laves relating to
building construction, and hereby authoria 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, toss and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLI
DISCLOSURE
Will the appy building occupant store or handle hazardous material
at defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
❑Yes ONO
Will the applicant or future building Occupant use equipment Or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
O Yes ❑ Nu
1 have read the hvantous materials requirements under Chapter 6.95 of the Califor.
niaHealth &Safct,Seeuons25505,25533and23534.1undcratandthu' outbuilding
does not 9 y ere a tenant, that it is my responsibility to notify the ant of the
mq ie must a 'fical: ofA
Job Description
SET TEMP OFC TRLR FOR APPLCE;SPC WL BE OCCPD
WHILE
INTER MODFCTS MADE TO CRRNT BLDG
Sq. Ft. Floor Area
31622018.46N Number
Issued by:
Re -roofs
Type of Roof
$25000
Required Inspections
Date ?,
Type
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
Date
All roof coverings to be Class 'A" or better