07010140 77-
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
C��iTI�GTOR I ��MAT�OI�i.;
PERMIT NO.
BUILDING ADDRESS:
10475 BANDLEY DR NOVO CONSTRUCTION 07010140
PERMIT ISSUE DATE
OWNER'S NAME:
APPLE 1042 HAIV.1LTON COURT 02Z] 4/2007
SANITARY NO. CONTROL NO.
NE:
(650) 701-1500
BUILDING PERMIT INFO
ARCHITECfIENGINEER: BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
ut= I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Cade,and my license is EXPANSION OF EXISTING CAD ROOM AND CONVERSION OF
t=y in full force and effect O2�
izz L;eensccl L�•x PORTION OF MAIN LOBBY FOR STORAGE ROOM. NON
y p Date Contractor
ARCHITECPSDECLAR T STRUCTUFAL
i s< I understand my plans shall he used az public records
)yU
U.In Licensed Professional
H OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
<C ff which requires a permit to construct,alter,improve,demolish,or repair any structure
y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
-?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area
2= (commencing with Section 7000)of Division 3 of the Business and Professions Code)ur $85000
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 the applicant to a civil penalty ofNumber Occupancy Type
not more than five hundred dollars(5500). 3263311-'. .
V V
0 1,as owner of the property,or my employees with wages az their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's u.
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such pmjects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 1 am exempt under See B&P C for this reason
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 Worker's Compen-
'on,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Wo sARRUFIOnA
Insurance carrier and Policy number are:
Cartier. Policy No.:
T OF EX PI ON FROM WORKERS'
COMPENSA NINSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so az to become subject to the Workers'Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCrION LENDING AGENCY
[~- C/) I hereby affirm that there is a construction lending agency for the performance of
ai> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Lender's Address
l certify that 1 have read this application and state that the above information is
U
O correct.I agree to comply with all city and county ordinances and state laws relating to
J building construction,and hereby authorize representatives of this city to enter upon the
Gra above-mentioned property for inspection purposes.
Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permiL Date
►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGJV TI S. f
( !1 Re-roofs
Signature of App tcant/Contractorr T dare
HAZARDOUS MATERIALS DISCLOSURE Type of F.00f
Will the applicant or future building occupant store or handle hazardous material
az defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
fi
0 Yeso
Will the applicant or fut re building occupant use equipment or devices which
If a roof;s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminan az defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
C3 Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs no nlly have a tenant,that it is my responsibility to notify the occupant of the
rcqui encs w ich must met prior to ssuancc of a Certificate of Gc upane. Signature of Applicant Date
/ag ,e�M K r 2. 1 ' c All roof coverings to be Class"B"or better
Owner or authorized agent