07120249CITY OF CUPERTINO'-�.
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BUILDING DIIISION PEIRMT
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BUILG DO FSS:
1TUS"�
PERMIT NO.
RIDGEVIEW CT 1ST FLR
SOUTH BAY CONSTRUCTION CO'
07120249
OWNER'S NAME:
PERA TIS9UE DATE
APPLE
170 KNOWLES DR
01/15/2008
NE:
SANITARY NO. CONTROL NO.
(408)379-5500
ARCHITECfa:NGINEER:
BUILDING PERMIT INFO
BLDGO ELECTO PLUMBO MECHO
LICENSED CONTRACTOR'S DECLARATION
I hermy afRrm that I am limmu d under provisions of Chapter 9 (commencing
.lob Description
with Section 70011) of Division 3 of the Bueinum and Professions Code,aM my Hmam is
REVISE LAB AREA TO ADD NEW CHAMBER
I"
immuclfall ad Affect. o
License Cissa Lie. N In ` 7
W/STRUCTURL; ORIG #07090110 NO NEW PERMIT
Date — — Contractor
ARCHnECTS DECLARATION
I understand my plans shall be used As public records
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am ucmpt from the Canaano/s Lianas Law far Ne
rollowing mssen. (Secuun 7031.5, Beat.. and Pre as toms Cock: Any city M county
which requlms a permit to comtrict, alter. improve, demolish. car ¢pair Any structure
prior it, its iasuanoe, alw requires die applicant forsuch Permit to file a signed sutemcm
that he is licensed pursuant to the paviuona of the Conliacmra Uu mm Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Business and limitations Cade) or
$10000
that he u aacept therefrom and the basis for the alleged emmptiot Any violation of
Section 7071.5 by any applicant fora permit isujects the applicant to a civil penalty of
Number
Occupancy Type
more dun
not mafive dN
hundred mm 5500
31606046 :
❑ I. As owner ofthe property,Amy employees with wages Ali Manacle compensation,
waldothework,AndtheswciumbnorimmndedaraRemd(mule(Sec.T .Busiaw
asM Professions Code: The Communes License Law does not apply to an awner of
Required Inspections
property who builds ser im prom thereon, end wha does such work himselr m through his
own emplayees, provided Wet such improvements are not intended aro@rod for salt If.
however, We building or Improvement is sold within ane yens of completion, the owner-
builder will have Me burden of leaving that he did Amt build or improve for purpose or
Agile.).
❑ 1. AA owner of We property, am exclusively convecting with licensed contratms in
construct the project (SAO. 7044. Business and P olessians Code:) Tim Comtrsetor's U.
come law data not Apply W an owner of property who builds or improm Damon, and
who contracts forauak project, with a comractoKs) licensed pursuant in Me ContrAcmr's
LYeme Law.
_
❑lomesemptunder Sec. ,B A PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aaIrm under penalty of perjury ane Af the fallowing declamvans:
have and will maintain aCen ficam ofCommnt re self.lasum fm Wurkee,Compen-
on, As provided for by Section 3700 of die labor Cade, for the performance of Me
work for which this permit is issued.
❑ i have and will Maintain Warier'. Compensation I... As required by Section
3700 Arum lobar one, fm We performance of We work focwhich this permit la haoed.
'
My Worker's Compensation Insurance carer and Policy number me:
—r3
carer. ReoOpolicy No.: 031LZZo
TAPTION FROM WORKERS'
COMPENSATION INSURANCE
„
(This section ..door ha minplemd little permit 1A for ant hundred dollars (5100)
or less)
1 terry Wet in the performance of the work for which this permit is mated,l shall not
employ any person in any m merman a to become subject in the Wormer Compensation
LAMSMF California. Data
Applicant
NOTICE TO APPUCAND If, Afar making this Certificate of Exemption, you should
bacteria subject to die Worker'( Compensation provisions of die labor Cade. you mute
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forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby aRno that them is a construction lending agency for the performaoee or
the work for which this permit IA issued (Sec. 7097, Cih, C)
1<Imer's Name
Lenders Adda m
1 madly that 1 have read this application and Aum Wet the Above infmmWan is
conmL I agree to comply with all city and county oldmaoea and Bute laws relating to
building construction, and hereby Audience mpaseemutim of this city to enter upon the
ahwe- puryose,
property for cm
(Wtian re
(We) Agree to taw, indemnify and keep haamlev the City of Cupertino against
Wr Ad
Ilabilides,judgmenu,cosu and expenua which may in Anyway Accrue against mid City
in can a of the granting of this permit
APPL A UNDERSTANDS AN ILL COMPLY WITH ALL NO
P
Issued by: Date
AOU CE REGULATIONS.
yC /L/I/ r /
Re-roofs
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Signmu All fAppirun�• tear Fwd
Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or fugue building mcupamstow in handle hamrdoas materia
As deRncd by the Cupertino Municipal Code. Chapter 9. 12. and We Health and Safety
Cal, Schon 25531(a)?
❑ Ya Na
All roofs shall be inspected prior to any roofing material being installed.
an ns
If a roof is installed without first obtaininginspection, I agree to
Will the applicant foto ilding Occupant um equipment a devices whichP
g remove
hnasdnus all conuminanm u defined by the Bay Area Air Quality Management
all new materials for inspection.
trice?
❑Yes,
Ihawmadthe hamAdausm5M5.
95afWe Glding
553racilli 255M.lents
nit HrslWd: SefmyCad, Sectimu 75503, 15577 am125514.1unMrsand Wulfum building
underhand
ams not euAmndy hew a ¢nen, Wet my mapoeibfity to notify the oecupmt or We
myu which mum be issuareeaf Cerntficamaf cupmry
Signa e of Applicant Date
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All roof coverings to be Class "B" or better
D oro Modred assn,°
am