Loading...
03010135poo of ---'b yF- o U iiCC3yIU1'�� no 66$C W%t-zY<• F O to Op zN WQ �z UO_ O U W 0. Uz CITY OF CUPERTINO ^� s �i:'' _-• s=. BUILDING DIVISION PERMIT ,CON, TRACTOR INFORMATION BWLDING ADDRESS: DPR CONSTRUCTION INC PERM] NO. 10950 N TANTAU WNER'S NAME: 1450 VETERANS BLV APPLICATION SUB DATE KAISER HOSPITALS 01/23/2003 ONE: (650)474-1450 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLUG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Seniors R )111(Dlvidint3of NCBusinese dYA Professions Code, nd my license is �erree Nrea /' �� e( DEMO ROOFTOP HAVC/DUCT/SUSPENDED LLG Lice Lice Class Lic.X Date Contras CIJ A CHITECT'S DECLRFA—TIUN I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that) am exempt fru. the Comunctor's License Law for the following mann. (Section 7131.5, Business and Professions Calc: Any city or county which requires a permit or construct, eller, improve, demnlish, or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement Sq. Ft. Floor Area that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 $69H10ation (commencing with Section 7000) of Division 3 of the Business and Professions Cale) or , Nat W is exempt therefrom and the buts for the alleged exemption. Any violation of Occupancy Type Section ] W 1.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of Ne property, or my employees with wages u their able compensation, N(5 ASSI@NED will do Ne work, and the structure is not intended bnbffered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply m an owner of egmre nspee Ions property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improvements are not intended or offered forsale. If, , however, the building or improvementissold within one yearnfcampmuon, theowmer- builder will have Ne burden of proving Nat he did not build or improve for purpose of ashJ. p, ❑ 1, as owner of the property. em exclusively contracting with licensed contractors to _ construct Ne project (Sec. 7044, Business and Professions Code:) The Contractors Li- ceue law does not apply to an owner of property who Wilds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to she Contractor's IB� License Law. ..-, ❑ 1 am exempt under Sec. . B & P C for this moon woe, Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Cenificale m Consent to self -insure for Worker's Compen- tion, or provided for by Section 3700 of the Lahr Cow. for she performance,of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as, required by Section 37. of the Labor Code, for the performance of Ne work for which this permit is issued. My Worker's Compensation Insurance comer and Policy number ase: s QQ Cartier. N F Policy No. ,]_ CERTIFICATE OF EXEM iiTION FRO ORKERS' COMPENSATIONINSUR CE mussection need not weemplemd if the Permit is forone hundred dollars ($100) j or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner to as in become subject to the Workers' Compensation Laws of C.ff tom.. Data Applicant NOTICE TO APPLICANT: IL after making this Cenificam of Exemption, you should become subject to the Worker's Compensation provisions of the Iaber Cale, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 herchy, affirm Nn there is a cooawetion lending agency for We performance of the work for which this permit is issued (Sec. 3W7, Civ. C.) Lenders Name lender's Address I minty that 1 have mad this application and now that the above information is coned. I agree to comply with all city and county ordinances and sum laws mining to building construction, and hereby auNorim mpresentatives of Nis city to enter upon the ahovo-memtiomed p.peny for iupecuon purposes. (We) agree or sare, indemnify and keep harmless But City of Cupertino against liabilities, judgments. costs and expeuca which may in any way swore against said City in conttyuencc of the Bramin is permit. APPLIC ER IA A WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCER TIO Re -roofs Type of Roof 2 to mount of pprc.00omua or Data HAZARD RIALS DISCLOSURE Will the applicant or future building occupant store or handle haeudous material u defined by she Cupenino Munic' Code, Chapter 9.12. and Ne Health and Safety , Code. Section 255324) All roofs shall he inspected to any roofing material being installed. t]Ycs No prior If a roof is installed without first obtaining an inspection, 1 agree to remove will the applicant or Tum. dingacupaT use equipment or devices which it harandous air com tam nu derived by Ne Bay Arca Air Quality Management all new materials for inspection. istiict7 ❑Yes No 1 haves real the haranusmamrialsreyuiumcnts under Chapmrfi.YS bfNc Califno iia Herith&Safely Cods.Sad..255115, 25533ud 25534.1understand thm tithe Wilding tires not cu ac at it is my responsibility o notify the Occupant of Nc mquist.en is net or I.moaneeor. Cenicw(0,<uprer. Signature of Applicant Date All roof coverings to be Class "B" or better ownernr an gems Dam il aot` OF CUPEkTINO CITY OF CUPERTINC DEMO PERMIT APPLICATION FORM / p D.� l o 12S APN # RI/0 `0 O � O 3 � Date: Building Address: 10 cfSo NtOle-rt+ rtaHTAU I � PR�9-T1 too Owner's Name: �-P-t4w Phone #: kAISOP— yoSP1TaL S� PAY ANA2swS q0o C)-+-S- -+-S-Contractor: BUILIDNG Contractor: License #: BSEISMICRE Seismic Residential Contact: Phone #: Sco-rT �{�-SS X08 SS�1 - SS i� Applicant/Contractor: Plan Check Fee DP -- , Buildi Info: yerrnit Bldg Elect Plumb Mech Job cription: O oc,Ist+ oohr0p yvA _ vGTu'm4VL IN is �A �� �P�AGcsoBn Residential: 5vs ,Jp Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: SS, 000 Architect/Engineer: Valuation ��--•, 9,l� GA N/e-ToN A-e-GF+ITFCfSly , v b Type of Construction: Occupanc Grou - — ly oTc �PtTD f F, Qty. if A v �6 able Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG nOZ O AWP FaZUV] rnaa F -7N OZ`S—, 0 oC of -< XOyU LLOa iyno W � N ~Za iWI-0 a3� Oz Z2 a� �Z UOr- 0 U OU U r. to U U1 Y Ur UUFEKI INU BUILDING DIVISION PERMI', CONTRACTOR INFORMAT."14: BUILDING ADDRESS: DPR CONSTRUCTION INC PERMIT NO. 10950 N TANTAU OWNER'S NAME: 1450 VETERANS BLV APPLICATION SUB DATE KAISER HOSPITALS 01/23/2003 PHONE: (650)474-1450 SANITARY NO. CONTROL NO. ARCH ITECT/ENG I NEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section) of Division 3 of the Business ald Professions Code, and my license is in lull force cffec �� 511`9 ec Lice Class Lic. p i O '( Date Contraslax A CHITECTS D ECLAR AT 110 N I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sccuon 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve. demolish, or repair any structure prior to its issuance. also requires the applicant for such permit i file a signed statement that he is licensed pursuant to the provisions of the Contractors '".nsc Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business ar.. -• -'n,s Code) or that he is exempt therefrom and the basis for the alleged exemptiL r.n- iolation of Section 7031.5 by any applicant for a permit subjects the applicant to a ri. it penalty of 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 and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who doessuch 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.). ❑ 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 Contractor's License Law. ❑ I am exempt under Sec. , 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- 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 Worker's Compensation Insurance carrier and Policy number are: Carrier: N ' F Policy No,. -TOSSA3, CERTIFICATE OF EXEMPTION FRO ORKERS' COMPENSATION INSUR CE (This section need not be completed if the permit is for one hundred dollars (f 100) or less.) 1 certify that in the performance of the work for which this permit is issued, I 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. 1 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 above-mentioned property for inspection purposes. (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 in consequence of the grantin his permit. APPLIC�%ERSTA A WILL COMPLY WITH ALL NON -POINT SOURCE RFAVATIO r f ` nature of App"Eicam/Contra or - '../ Date HAZARDO ERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Mu nic Code, Chapter 9.12, and the Health and Safety Code. Section 25532(a)? ❑ Yes No I'l Will the applicant or future ding occupant use equipment or devices which emit hazardous air contaminanta deli ncd by the Bay Arca Air Quality Management District? ❑ Yes ❑ No [have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code. Secuons 25505, 25533 and 25534. 1 understand that if the building docs not cu tLy�ave a t tit is my responsibility to noufy the occupant of the requirement to ust or to issuance of a Certilicre of Occupancy. Owner or au gent Date' Job Description DEMO ROOFTOP HAVC/DUCT/SUSPENDED LLG q. Ft. Floor Area Issued by: Re -roofs Type of Roof .'erl-i. • Occupancy Type Date 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