07090045CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ALLCO PARKWAY
OWNER'S NAME:
APPLE COMPUTER
PHONE:
ARCHITECT/ENGINEER:
j LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect '7 611 o l Z
n{�
-
License Class f� Lic. ff
Date q l� � Contractor A30L) 0
ARCHITECTS DECLARATION
I unduswnd my plans shall be used as public records
Licensed Prolessional
< OWNER -BUILDER DECLARATION
5 1 hereby affirm that 1 am exempt from the Contractors Liccnsc Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
Z which requires a permit to construct, alter, improve, demolish, or repair any structure
n 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 Conuaemr's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
A 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 ftvc hundred dollars (5500).
❑ L as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the swcture is not intended or offered for sale (Sec. 7044, Business
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 proffered 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.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's Li-
cense Caw 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 Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 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.
p 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 Worker's Compensation Insurance carrier and Policy number arc:
6ltw:1 fS?c 1
Carrier.. �rlrkPtw�-ai-a �o `PolicyNo.:
CERTIFICATE O EM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one 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 Workcrs 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
O forthwith comply with such provisions or this permit shall he 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.)
c. Lender's Name
Lender's Address
Q 1 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
Ubuilding eonstructioo, and hereby authorise representatives of this city to enter upon the
ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Le) liabilities, judgments, costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
—
Signature of Agglicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hacardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Codc,tSection 25532(a)7
❑Yes [[ Nu
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District]
Dyes I -A -No
I have read the hajardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 255D5.25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant or the
rcquiremen�{ ,
Date
NOVO CONSTRUCTION
1042 HAMILTON CT
(650)701-1500
PERMIT NO.
07090045
PERMIT ISSUE DATE
09/28/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
TENANT IMPROVEMENT -PLUMBING ONLY.
Sq. Ft. Floor Area
31620074 AEF
Issued by:
$200000
Required Inspections
Valuation
Occupancy
7
Date
Re -roofs
Type of Roof
All roofs 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.
Signature of Applicant Date
All roof coverings to be Class "B" or better