05100040 CITY OF CUPERTINO �- r
BUILDING DIVISION PERMIT CO NTRAGTORA NFORMATION
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BUILDING ADDRESS: _ NOVO CONSTRUCTION PERMIT NO.05100040
10431 N DE ANZA RT-17D
illER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER 4TH FL 1042 HAMILTON COURT JQ/21/2005
PHONE: SANITARY N0, CONTROL NO.
(650) 701-1500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION Job Description
u 1 hereby affirm she,I am licensed under provisions of Chapter 9(commencing
W wish Section?")of Division 3 of the Business an a�t euions Code,and my license is
-M, in fanmmeanaarraa. �91pZ2 TI--DEMO (E) OFFICE/BUILD NEW OFFICES
j(N? License Class Li..N
o Dow comraemr J®Yp s INCLUDING ELEC/MECH/NO PLUMBING
ARATION
ARCHITECTS DECL
4s< 1 understand my plans shall bo used as public records
ityU
;off Licensed professional
OWNER-BUILDER DECLARATION
I hereby asirse lhal I am exempt form the Compactor's License Law for the
00 following muan (Sea
do"
Eusineuand Professions Cak:Any city or cotyun
$ which requires a Permit to Construct.alter,improve,demolish.or repair any structure
_Ze
prior o is issuance.also requires the applicant for such permit to file a signed statement
that he is licensed pursuant the previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area valsal-pm 000
xF0 (commencing with Section 7")of Division 3 o tbo Business and Professions Code)in
in
$ that he Is exempt therefrom and the bus for the alleged camphor.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to.'Nil penalty,of APN Number Occupancy Type
not mom Nan five hundred dollars(SSW).
32633114 . 00
Las owner ,0te pmmsmorm myemployeed with wags u th.(wleSite 7044.Eastman uuon,
will doUndlt work,Cdee he Comisnnes tended midmain Law
ed data or
twon of
and erofeuiobu Cade,:The Conwcsofs Liaise law dors rat apply lf an owner of Required Inspections
Own eny whon,procis vided that inch improvements sumsamh work himselfore ed through his
ownemployees,provided prsuchimpromm within one
intendedecorleered for nit.It,
builder Nebuilding orimprommeinissoldwithinone year of improve for the owe of
.it.). will M1am the burden of proving that he did not build or improve for purpose of
❑I.a Owner of the UCC.7(344.
B exclusively contracting with licensed canpaaors to /a
Construct La the project(Sac.70 n Business and Professions Cede:)The Contractor's nd
wholaw data not apply to an owner of traapenysvho builds or improves Neuron,and,
who canmct for stub porjcct with a conpacmrts)licensed pursuant a on,Crnsrxmh
License law.
❑I oro exempt under Sec. .B&P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury nm of on,following declarations:
❑I him and will maintain is Certificate of Cannot to self-insum for Wori Compere
scion,as provided for by Section 37M of Ne labor Code,far Na peffmm.nte of Ne
work for which Nis permit is issued.
1 ham and will maintain Worker's Compensation Insurance,az required by Section
3700 of the Labor Code,for the performance of Ne work for which Nix permit is issued.
My Work Compensation Insurance,Cartier and Policy number are:
Cartier.' fZ. . Poli y No.:I S��9i�,tj
CERTIFICATE OF EXEMPTION FROMORKW ERS'
COMPENSATION INSURANCE
(Thu section need not M ea meted if to tennis is forone hundred dollars(5100)
or lass.)
I certify that in the performance Mitre work for which His permit is issmd.I shall not
employ any permit in any manner m as to become subjecuo de Workori Compcnsadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:if,after making this Cenificale of Exemption,you should
become subject m He Winter's Compensation provisions of Ne,labor Code.you mum
.J Z forNwids Comply with such provisions or His Permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Ihereby Mr.that there if a cor,mrmdnn leadmgagency for the pcifurmantt of
C' the work for which this permit is issued(Sec.3097.Co.C.)
W� Q Lender's Name
z Lcnnri Address
t.)Q 1 certify that I have read this applicator,and mule that flue above information is
ly correct.1 agree to comply with all city and county ordinances and sett laws relating to
Q V building canswction,and hereby authome o:pmxntatives of this City to enter upon ft
above-mentioned property for inspection pumv`.
(We)agree to vee,indemnify and keep harmless He City of CupcNno against
liabilities,judgment.costs and dilettanti which may in any way account against said City
V z AConsequence of the granting Of tremain,
LICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: DateQ—
SOURCEREGULATIONr
rr V�/f•J U Re-roofs
Signature of ApplicanUCon or Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicant or(bsurt building occupant store or handle he mus maand
as defined by Ne Cupertino Municipal ta
Code,Chapter 9.13, d ft Health and Safety
.&Co.755320)? All roofs shall be inspected prior to any roofing material being installed.❑ver P""
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or furore buildingOccupant tax equipment or devices which g
emit hanrsuous air contaminant as Jcfimd by fM1c Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
I have mW Ne hun
arus materials requirement under Chapter 6.95 of the Califor
ria Health&Safety Con,Sections 25505,25533 and 25534.1 unnrsraM Out if Ne,building
docs ratcu fly ham a moan,that it is MY ac iominj iloy m hod fy ft mpan
cus of the
require twpgmhad b4mefpnormrpvamco(x CcmFicaaofacupun .. Signature of Applicant Date
J+rS l tw-t,,J J 16ILl
Owoe ahornadasem Data All roof coverings to be Class "B"or better