07090110 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT INtRMTT�N�
PERMIT NO.
BUILQ,I1�j�it150 RIDGEVIEW CT 2ND FLR SOUTH BPY CONSTRUCTION CO 07090110
l(UJ L� PERMIT ISSUE DATE
SR'S NAME:
APPLE 170 KNONLES DR 09/18/2007
SANITARY NO. CONTROL NO.
PHONE:
(408) 37 -5500
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
a 0 0 a
p LICENSED CONTRACTOR'S DECLARATION Job Description
W P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
i tad with Section 7000)of Div' on 3 of the Business and Professions Code,and my license is INTER I OF. T. I . COMMERCIAL; NEW WALLS AND BASE.
1`40- in full force and effecL r
`4z in full f force
ClaLic.S PATCH & REPAIR WALLS AND PAINT.
p Datc Contractor
F r • ARCHITECTS DECLARA '
i W< I understand my plans shall be used as public records
)A.0
U.H Licensed Professional
O a OWNER-BUILDER DECLARATION
}.�
I hereby affirm that 1 am exempt from the Contractors License Lawar the
p00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
0i 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 t' -Ft.Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 `'9 $97953
1,_ (commencing with Section 7000)of Division 3 of the Business and Profession Code)or
i 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 of3160604f, ' Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as 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
awn 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
sate.).
❑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 Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec. B&P C for this reason
,er 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-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑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 Workci Compee'nsai on Inas nce c ier and Policy number are:
Carrier: t' ��olicy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for rine hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(~ 1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
az Lender's Address
U C I certify that I have read this application and state that the above information is
Ct, corrccL I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
f1. (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z
in cone of the granting of this permit. Date 27
►+ APPL ANT DERSTANDS AND LL/�MPLY WI HALL NON- DINT Issued by
SOU E REG ONS. �//
T � � Re roofs
Signature of Applicant/Contractor ate T of R oof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
�s defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
de,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes I°
\tet If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or Tutu ilding occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new IT aterials for inspection.
District?
❑Yes No
I have read the hazardous ma rials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Section 25505,25533 and 25534.1 understand that if the building
docs not urrently have a tenant,that it IS 111YANPOnSibilily to notify the occ ant n dhc
rcqu' mcn hich must be met pri to i an rir a eerti rite of Occ�Di.tc
Signature of Applicant Date
All roof coverings to be Class"B or better
Owner or authorized agent