03020072 CITY OF CUPERTINO =a'R rxrr �"4 74FT7_17 a2=' =
BUILDING DIVISION PERMIT C,ONTRATUR I�NF.O
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMIT"D03020072
10950 N TANTA6 AVE
OWNER'S NAME: 1450 VETERANS BLV PERM"L'nn0/2003
1ISER PERMANENTE
"E' (650) 474-1450 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIF.Cf. PLUMB MECH
app
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LICENSED CONTRACTORS DECLARATION O O O
U I bereey air,.Nat I am I...ituMeyypprovluoos of Chapter 9(cnmmencing - Job Description
with Section t ) Division 3 of Ne Busineihhd Rofcaaions GoM,said my license is
inGl fu11rorcean s V TENANT IMPROVEMENT BLDG 1 2 j�
ng: o:rnmo
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It TEMP PERMIT #03040044 lY"'HNAQ'jEg3
=ARCH A S TION
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un y le • use panne TION (PHASE I) I1'p
�Q Licensed al JUN 2 0 2003
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OWNER-BUILDER DECLARATION
9 I hereby affirm that I am exempt from the CanlractaYs License Law for the
i 0 0 fallowing reason.(section 703 LS,Business and Professions Code:Any city or county
which requirm•Permit to construct,alk,.W prove,damalkh,or repair any mucare ulrIf pp
I:r, i a
—zrr
Oat
Niskmance,alm requires lW anion of due
nmhperme.Liam
file• Law(Cha ter9
ppmm< (comms lkcnsedpursuanuoN)ofDivision3oftheBuanmhndImicsw(Chodur9 Sq.FL Floor Area Valuation
Y k's that he
(commencing ftmimmon and of Division3 of theBusinessessand Prof Any vi Code)or
Nu be k exempt Nere(mm and as bss4 for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number 123b y Type
not more than five hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as their mlc compere•don,
will do the work,and site structures Is not Intended or offered for sale(Sec.7044.Business 51:609037 . ou
and Profession•Code:The Conummes License Law docs net apply a an owner of Required Inspections
properly who bur I IN m i m provesHereon,end who daeuuch work himmlf or through his
own employees.provided 0141SOO Improvements tie not Intended osoffered restate.If. 101 — FOUNDATION
however,the building or improvement is mid within one year of completion.the owner.
W ildcr will have the WNcn of proving that he did not build or improve for purpose of 102 — PIERS
111 103 - UFER
D I.as owner of the property,am exclusively contracting with licensed conuacan in 104 — REBAR
mummer IN prejaca(See.7044,Business and Proksaom Code:)The Conuacmra Li.
ceme law does nos apply W an owner of property who Wilds or improves Neeson,and, 105 — ANCHOR BOLTS
Who lswts for such pecjeeu rwpurpose,m N
with a commr(s)licensed puuant e Conum
acrs
Lkena106 - SEWER & WATER'
0 l am exempt undo Sec. ,B k P C for Nis resson 202 - UNDERFLOOR PLUMBING
Owner Dna 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME
10 Ihereby•from under penalty of perjury one of the following chcl•rnkns: 205 — UNDERFLOOR INSULATION
C]I have and will munuin a CW ilcea ofConscnt m al6lmum for Warker•Compere
anon,as provided for by Section 3700 of the Labor Code,for the performance of the 301 - ROUGH PLUMBING
werkmrwhichthisPermitI.ismad. 302 - TUB & OR SHOWER
❑1 have and will maintain Workers Compensation Insurance,u required by Section 303 — ROUGH MECHANICAL
1700 ofN I�Wr Coale.for Ne performance of ave forwhich Nis permit lslssued.
My coo res Compensation insurance ceniman lick number ail: 304 — ROUGH ELECTRICAL
C. iJdiL Uadlea FLR.E icy Na.: 7�45'3Y3 305 - FRAME
COMPENSATION INSURANCE 306 — HOLDOWNS
(This seedon wed notbecomplcad lfthe Permit is forone hundred dollars(SIM) 307 - INSULATION
""`aa') 308 - SHEETROCK
1«nify Nat In the performance of 1W work for which this permit it issued.10.11 not 309 - EXTERIOR LATH
employ any permn in my manwr an as to become subject to ftWorkers' mdan
Compea
Laws or California.Data 310 - INTERIOR LATH
Applicant
NOTICE TO APPLICANT Ir.after real,this Centrals of Exemption,you should 311 - SCRATCH COAT
become subject in Ne Worker's Compensation provisions or she labor Code,you most 313 - ROOF NAIL
zO forthwith comply N
mPlywiswhprovium
provisions met] 501 — FINAL ELECTRICAL ENERGY
y CONSTRUCTION LENDING AGENCY
[-t
1 hereby affirm Oat them is a construction lending agency far do ferfornewc of 502 - FINAL PLUMBING ENERGY
a�
to wua for which this permit is issued(Sec.3M.Civ.C.I 503 - FINAL MECHANICAL ENERGY
LUQ Landers Nunc
�7z LanderaAdd.. 504 - FINAL BUILDING ENERGY
U O I ceni(y that I have read this application and some Oat the above inrormadun is 505 - FINAL ELECTRICAL
t.3.Fcorrect.I agree to comply with ail city and county ordinances and aux Iowa renting to
pU Wilding construction,and Wreby authorise representatives of this city to char upon ftGAS TEST
WaWve-mentioned property for impecdon purposes O FIN
F 4, (We)agree u save,indemnify and keep numerous the City of Cupertino gains
t..,y liabilities,judgments.cost andexpem.which may In any way amus against suit City I C ICAL
U 7 in consequence of IM Nndng of this Permit.
�7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
SOIIRCT S.
�fWu��" mit/ 30.03 Re-roofs 514 INAL PUBLIC WORKS
esofA carDataH DOUS Debuilding
ops DISCLOSURE or URE Type of Roof
Will due Cupertino
future buildings.Chapter
mom or handles Health and
v dented io are Cupertino Municipal Code.ChaPar 9.13,and We Health and Safely
!d—
Section 35533(•)? pppp All roofs shall be inspected prior to any roofing material being installed.
❑Yes (gryuWill the applicant or future Wilding occupant use equipment or devices whichIf a roof is installed without first obtaining an inspection,I agree to remove
harsrdnm air contaminants at defined by ate Bay Area Air Quality Management all new materials for inspection.
cB❑Yes NuI have mW Ne hvudnusmeariab mquiremcnu under ChaPar695 ofNe Glifo•
&Safety Cade,Sections 35505,35533 and 35534.1 understand Naz if Ne Wilding
not curren0y N amens On111 is my remmindbllit a notify Nc occupant of Nc
'h normismanceara Cana eco cupancy' Signature of Applicant Date
�4.kQLAudW.d.g Dace All roof coverings to be Class"B"or better