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05110009 CITY OF CUPERTINOT °M;;;; `� r.7 '� `� BUILDING DIVISION PERNIIT - ©N ,"9T,0R1NFURMAT�' dpi BUILOrNG ADDRESS: NOVO CONSTRUCTION P�'MITND'05110009 10431 N DE ANZA BLVD Its NAME: PERMIT ISSUE DATE APPLE COMPUTER (4TH FL. ) 1042 HMILIQN COURT 11 '/ig, 2nnc; E: SANITARY NO. CONTROL NO. (650) 701-1500 ARCHITECTIENGINEER: BLDG BUILDING PERMIT INFO ELECT' PLUMB MECH 0 1� 11:1 zo LICENSED CONTRACTORS DECLARATION Job Description du C 1 bereby,0lrm that 1 at licensed under provisions of Couple,9(commercial L1Nwith Section 70=of Division 3 offt Business and Pmfeduw Cade,and my lkenmU +� m1rollfineeudeffact. � 0L2 REVISION--REVISE OFFICE LAYOUT, jz Licemm Clue Lic.3 — LOBBY DOORS/ MECH. /ELECT. D,e AI S Gti Camralar,�i �a• ARCHITECI'SDECLAtAION ORIG. #05100040 —� 1 undecstanJ my plow atoll he used as public record, 7q<u abs, Licensed Professional OWNER-BUILDER DECLARA71ON 1 hcmlly AMM that 1 am exempt from the CanLawaan s License w far the Q o following Oman.(Section 7031.5.Business ad Profusions Code:Any city or county 9 Which mquirw a Permit W enrmrwt,alter.emprove,demulbh,or repair my swclum prlarm its luwnm.alaequires the applicant ftrach permit w Ole,signed zuemcta < that hebnaatedpurmamtomeprowaionsofthe eomraemr,uccneLaw(Charter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division Sof the Business ad Profusion.Code)or $94 4 Nat he I,wempt themfmm ad the bub His the alleged examption.Any violation of Section 7031A by my appllemt far,permit objects the applicant in a civil penalty of APN Number Occupancy Type set mom dun On huMud dollsea(5300). 0 1,u mmr of the pmpmy,m my employm with wM u Nair mlc compemdon, Wmda thCWPllemats,enwrtamlenummndeawartetm car„lecsea.7Du.euQaw, Required Inspections ad PlareaalOw CadKns Cade:The Con4met I Icemor LAW dam,apply N m.Mller of q p propmy who builds orimpro e,dramen,and whodoessuchwork himuelfwthrough his aw s cemploym.provided Jut each improvements aro at untended aro@rril for 1111 H. haWwnr.the building Or Improvement is mid Within om year Ncompladm,the awner- builder will hen the burden of proving that lis did not build or Improve fa purpose of MIC.). ❑1.uawemar the property., sinconnecting ing With Heatedom W construct Neproject(Sec.704Business ad Pratessions Common',U. aLaw does Out ahWaownerof PaOPenYswbutdsorimprov doormat,Md. weeconuaN Her soh projects With amvalr(s)licensed Prrswnl W the,CommuYof, Loewe Law. [11.uempt antler See .Bl PC(ar Nb recon Dam WORKER'S COMPENSATION DECLARATION 1 heebr,corm under penalty or pedury uee ofthe following deduRlamr. 1 haw and will maintain a CeNOwtaof Consentle self-iwum fns WarkelaCmpen- suim.u provided for by Section 3700 of the label Cade.fm the perforson.of the Work for which this permit is Wood. 0 1 ban and will maintain Workces Compensation Innrnnco,as required by Section 3700 of tie Labor Code,for the perfosmm¢of the work far which this permit it intend. My Workers Compensation lnsunnco carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Clbb atom name mtbo complead Hthe permit t.foranchurroaddo0ata(3100) or IoM) 1 ratify that in LW performance of the work for which this permit Is lamed.I shall set employ any person In my mmnera at W become object W tin Workeri Compensation Laws of CalifQ.IL Data Appllcnt NOTICE TO APPLICANT:If.after making this CerdOwm of Exemption•you should become subject W ate Worker's Compcmdon provision of Ne labor Cadc.you mute .+O forthwith comply with such Provisions Or this permit Nall be deemed re camd. CONSTRUCTION LENDING AGENCY f E� Ihereby affirm Jus Nem is a conauuction ending agency for the Mrfornlacec of gf:> the Work for which this Permit is issued(Sea.3097•Or.C.) 4�!E Landers Name C2 z Lender's Address �)Q 1 cmtify that 1 haw rad this application ad sum Jut the abort Information is ;^ cortCcL L agree W empty with all City ad county oMnanm and sea law.relating W SU^ building construction.ad hereby soNadec upreunraJns of Nu city Wcerupon the ,w W above-mentioned property for Impaction purposes !{y G (We)mime to an,Indemnify ad keep harmine the City of Cupertino against jy U Z in of the grating of Nb Permit. In liabilities,Jingmenta,cm ad expenses which may W my Way aeemC agalwl amid City cmtagmnco ^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUC -r r^T ^1 Re-roofs Signature of Applica amraW, Due HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will No applicum or future building occupant Rom or hande havrdaw mamdal Med by the Cupertino Municipal Code.Chapter 9.12.ad the Health ad Safety Section 25532(41 L All roofs shall be inspected prior to any roofing material being installed. 0Yw yNo WIII the applicasat future building ocupanl tea equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove colt hvardnes air emumiwnu or defined by the Bay Ama Air Quality Management all new materials for inspection. District? 13 Yat, kNo I ham mad the bsurdmamaerials requirements under Chopmr6.95 of the Cullo- omHealth k Safety Code,Sections 255M.25533 and 25534.1 understood the,tram Wilding duet m Oy Mn a mnm.Nu It u my mmoromiiity W costly Nc accupa,of the .qukih,mmwichmwbemet ' ismaceofacemimaeoroopmq.. Signature ofApplicanf Date Owner or authorized agent Dam All roof coverings to be Class"B"or better