05060221 CITY OF CUPERTINO
BUILDING DIVISION PERMIT € CONTRACTOR�INFORMATION ;
BUILDING ADDRESS: NOVO CONSTRUCTION PERMIT NO 05060221
10381 BAND
OWNER'S NAME: PEILM1T1551JEDATE
APPLE COMPUTER 1042 HAMILTON OURT 08/11 /200r,
SANITARY NO. CONTROL NO.
(650) 701-1500
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
v00 LICENSED CONTRACTOR'S DECLARATION JbDescription
C I hereby affirm mmo
Nat I am licensed area,provisions of Chapter 9(co
encing
b wiilSection 7MBof Division Sof NC Business and Professions Code.e,W my license is 7ss s^ P 9 fs /�
mumr„and,fect ��Z TI--OFFICE/ACCR. CEILzING/RESTROOMS�&
-py to LJJ
Z Lteensc C Lk.p
t�' Dam COntoator PAINT/CARPET 0 d� '+ ! '���
FF ARCHITECTS DECLARATION
Sc Nca
I understood my plans shall M used as public records O/int _
k a0� Licensed Professional
` �(� 2005
7 3 OWNER-RUILDER DECLARATION
2<0 1 hereby.(Star ore I ore exempt from dm Contractor's o e:enseAny city
Law for the p „
<p O fallowing mason. omm,..7031.5,Business and Professions Cod,: ,air stcounty faq;
m which requires.pmmit re com th a site,impose,h Permit.Or repair any awment
0aprions is issuana�.also rcquira^caPPlicam for such Permit to Ek aSignal(su�mcm q ---- —_ $8068,7,7
<
that he is licensed rauanttolhe revisions of theConwctorsLicense law Cha ter9 S Ft. Floor Area - Val
YFp (commencing wit Section ID0()of Division 3 of the Business and Professions Cade)of
i p3 that k u,tempt therefrom and the Esso far the alleged csompuan.My violation or
Section 7031.5 by any eppiicautfor a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
ao,mar,tan RK hundred delta.(BSoo). 32633079 . 00
❑1,"owner of the proNny,ar my cmployco with wages as their sole comply eation,
will do the work and to awctum is notimmMed oroQemd forsalc(Sm.]066,Business
and professions Code:The Contracm/s ucerda,law dace nor appy On in owner of - Required Inspections
property who buildsorimproves thereon,and who doessuch workhimulf or through his
Own employers,provided that Such improvements arc not intended or offerctl(or We.If.
however,the Wilding or improvement is sold within one year of completion,the Own,P
builder will have the Wrden of proving that he did not Wild or improve fes purpose of
sale.).
❑1,as Owner of the pra,cny,am exclusively contracting with lianud contractors to
emotional the project(Sec.7064,Business and Professions Code:)The Contractor's Li.
cense Law dors not apply us an Owner of property who Wilds of troMm thereon.Nd
who contracts for such prejects with a contraaor(s)Iiarued pursuant to the Canmcmr's
Lima.Law.
1 am,vamp,undo,Stt. .B&P C for tis moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Family of perjury one of the following declarations:
svc and will maintain a Ccnificate of Consent to self-insure for Worker'sCompcn-
a,u provided for by Section 3700 of the labor Code.for Ne Foramina,of the
work for which this permit is issued.
<1w and will maintain Worker's Compensation Insurance,as required by Section
11of the labor Code,res the peRarmaree of the ooh far which this Perm,is issued.
My War Com nsationlnsunnmcaniaudPolicynumkr=:
Cartier. Policy No.:k 5o*_;4
CERTIFICATE ue ETEMPrlON FROM WORKERS'
COMPENSATION INSURANCE
(chis section need not k completed iftk permit is Intone hundred dollars(SIM)
of less.)
1 unify Nat in to performanec of the ork hmh tie permit a issued,I shell rat
employ any perms in anymannc,a s Mow a jut to lk Workc,i C aadon
Laws of California.DData¢ NN f vim_
Applicata—
NOTICE TO APPLICANT:If.after making this Ccrifcae,of Exemption.you should
kcome subject to the Workers Comperw,ion provisions of etc Labor Code,you mum
.J O roMwith comply with such provisions or this Permit shall be dced m
m, vaked.
Pn CONSTRUCTION LENDING AGENCY
Ihereb Rom that than is a asoutrvctum lending c
F" a B aB roY for the Performance of
FL the work fur whhich this permit is issued(Sec.3097.Civ.C.)
z lanmrs Name
=z lanmr's Address
U O I carry that I have rod this application and sum Nat the above information is
COMCL I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby autorio,representatives of this city to enter upon she
r W above-mentioned property for inspeeuan purposes.
(We)agree to save,indemnify and keep humless the City of Cupertino against
r fa/y liabilities,judgmcnu.ensu and cxpesues which may in any way accrue agamau said City
U z his rmit.
APPcNTUNDERSTANDScof the gouning Of onsequence
LICAWILL COMPLY WITH ALL NON-POINT Issued by: Date �- I(-0_rSOURC CATION'.
/II(2
Srgnatur FVIm Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 7Dam Type of Roof
Will the applicant or future Wilding occupant stem orhandle hazardous material
as darned by the Cupertino MOuripal Code.Chapter 9.11,and the Health and Safety
Code,Section No All roofs shall be inspected prior to any roofing material being installed.
Will She applicam orfu um Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants�as mfncd by the Bay Area Air Quality Management all new materials for inspection.
❑Yes Pv
1 have read the hazardous materials requiremcnu under Chapter6.95 of the Cahro-
niaHealth aSafcty Com,Sodom 15505,15533 and 35534.1 understand tut ifthc Wilding
doer not currently hoe a tenant that it is my responsibility to noufy the occupant of lie
regrimmcnu which must IS,met prior Of issuance ofa CcrdOcamof Occupancy. Signature of Applicant Date
Owner or autorizad agent Data All roof coverings to be Class"13"or better
C,