07030287BUILDING DIVISION
BUILDING ADDRESS:
1 INFINITE LOOP
'ER'S NAME:
,PPLE COMPUTER
FHONE:
ARCHITECT/ENGINEER:
PERMIT
p Q LICENSED CONTRACTOR'S DECLARATION
toI hereby affirm that I am licensed under provisions of Chapter 9 (commencing
U with Section 7000) of Division 3 of the Business and Professions Code, and my license is
y in full force and effect —L 7
v� Z License Clas LM M
p
Date Contractor
m ARCHITECTS DECLARATION
j a < I understand my plans shall be used as public records
)yU
U. H Licensed Professional
OWNER -BUILDER DECLARATION
eI hereby affirm that 1 am exempt Gum the Contractors License Law far the
p O following reason. (Section 7031.5, Business and Professions Calc: Any city or county
which requires a permit to construct,
improve, demolish, or repair any structure
14 prior to its issuance, also requires the applicant for such permit to file a signed statement
- ? < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
r (commencing with Section 7000) of Division 3 of the Business and Professions Coit) 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 of
not more than five hundred dollars (5500).
0 I, 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
and Professions Code: The Contractors 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.).
❑ I• 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-
ccnse Law docs 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 Contractor's
License Law.
Q 1 am exempt under Sec B & P C for this reason
,r Date
WORKER'S COMPENSATION DECLARATION
0 Q
Z
W `~
az
UC
V. F
�a
v
U�2
I hereby affirm under penalty of perjury one of the following declarations:
PERMrr NO.
SOUTH BA`_' CONSTRUCTION CO 07030287
INC PERMIT ISSUE DATE
170 KNOWLES DRIVE STE 120 03/27/2007
SANITARY NO. CONTROL NO.
(408)379--5500
BUILDING PERMIT INFO
ELECT PLUMB MECH
Job Description
10 NEW O:FICES WITH DOORS.
PAINT,MEt-'HANICAL,ELECTRICAL,CARPET,T-BAR REPAIRS.
Sq. Ft. Floor Area
31602106.
] 1 have and will maintain a Certificate of Consent to self -insure Cor Worker's Compen-
ation, as provided for by Section 3700 of the Labor Code, for the performance of the
cork for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as required by Section
700 of the Labor Code, for the performance of the work for which this permit is issued.
4y Worker's Compensation Insurance qrrier andpolicy number aare:Z2� _t
:arrier.�'�
C RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
)r less.)
f certify that in the performance of the work for which this permit is issued. I shall not
:mploy 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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I 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.)
Lenders Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby authorize representatives of this city to enter upon the
ahuve-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, ' d encs, costs and expenses which may in any way accrue against said City
in cone nee thc granting of this permit.
APPLIC NT DER' 'ANDS AND IL MPLY W TH ALL NO -POI/NT
SOUR RE( IONS. N0, Z'Tl
12
Signature pplicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
1. Section25532(a)? ,,��
(] Yes Op No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District?
E] Yes 4N.
'ha
read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Codc, Scction 25505, 25533 and 25534.1 understand that if the building
docs not 0y have a tenan�that qui crus hush must be mce of a Ccrtificatc of panty
tiJ � a3
Owner o orircd agent Datc
Issued b;
Re -roofs
Type of ?Zoof
vaivatlon
$110000
Occupancy Type
"Required Inspections
All roof, shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signaturz- of Applicant Date
All roof coverings to be Class "B" or better