03100036CITY OF CUPERTINO4�
'U
nun.n)ncmvlslon PERMIT
CQNTRACT0R'INFORMACIQN,.;I,
BUILDING ADDRESS:
DPR CONSTRUCTION INC
PERMIT No 03100036
OWNER'S NAME:
KAISER FOUNDATION
1450 VETERANS BLV
PERMI7155UEDATE
NE:
(650) 474-1450
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 E o t�
LICENSED CONrRACMR'S DECLARATION
pDSCTIp
]b Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Sectio 7IXIU)uf Division Sof the Business and Ptnfesainm Code, and my license is
Lrml mare erten. S9`��"/G
REVISION-IN
HOUSE USE ONLY
License x Lk. g
Data Contractor DPR'
ti NO NEW PERMIT/ORIG.
403050160
ARCHITECTS DECLA TI g
1 undersutBynY penspha her�J as puM' r Js
La.enseI
OWNER-BUILDER DECLARATION
1 hereby affirm that 1
hereby exempt from the Donl.elCo License Law for the
following mmnn. (Erection 1. Business and Professions Cole: Any tiny or county
which a permit m consumer. altea improve, demolish, or sig any
ensu
ea
statement prior m its censed e, also rcquimnhe applicant for such permit m files signed stateroom
its isos
he oscine wit parrumul h) the Comment's (Chapter
Sq. Ft. Floor Area
Valu 'on
of Diaonenf
Com) or
(co ad PooelAuns,Co
(commencing with Section7(100) of Division3 oftheBusiness
ae pion. Any
Nn he is exemptturtfrom and the bsais for the alleged exemption. Any violation of
3IkEYS Mflftr 00
Occupancy Type
Section ?031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than Gro hundred doll.. (S500).
❑ 1, as owner of the properly, or my employees with wages as their sole compensation,
e wrens
Rid Inspections
p
will do the work, and me structure is not intended or offered for sale 7W. Busiws
and Professions Code: The Con racmr's License Law does not apply to in owner of
proton who buildsor improves themon,and who doessuch work himself or through his
101 -
FOUNDATION
awnemploycrs, provided that such improvements are not intended oroRtted for sale. If.
102 —
PIERS
however, the building or improvement is sold within ane year of completion, the owncr.
builder will have the burden of proving that he did not wild or improve for purpose of
103 —
OF ER
01.
104 -
REBAR
❑ 1, a owner of the properly, , Business s and contracting with licensed movement to
cause a (Sec. agannroandProfessionsdsorimpromthemor'sLi
10 —
ANCHOR BOLTS.
doesnotapplytoect
whowildsimp to rhemacand,
come hwcarsnaupplymts
106 —
SEWER & WATER
ithaofprotons
the
who contracts for such projects with a conuactort0lioemed pursuant m the Conmctoh
License law.
202 -
UNDERFLOOR PLUMBING
1 am exempt under Sec B & P C for meson
203 -
UNDERFLOOR MECHANICAL
DW ata
ner
-
UNDERFLOOR FRAME
WORKER'S COMPENSATIONDECLARATION204
I hereby of➢nn under penalty of Pettey 0. of the following declarations:
205 —
UNDERFLOOR INSULATION
Ihave and will mainou a Ccnificateaf Conserv m self-imum for WorkaisCompen•
301 —
ROUGH PLUMBING
aalion, sa pounded far by Section 3700 of the Lat or Cade, far the performencc of the
302 -
TUB & OR SHOWER
work for which this permit is issued.
3 03 -
ROUGH MECHANICAL
❑ 1 have and will maintain Worker's Compensation Insurance, sa required by Section
3700 ofthe lswr Cale. for the parformocc ofthe work far which thispermnis issued.
304 -
ROUGH ELECTRICAL
ply Yorker's Compered.. In,... canner end Policy uumbena:
(�j/n/ler.
3O5 —
FRAME
NA7/sn/A t— ,(��*_�bfic, No.: 708534
CERTIFICATE OF EXEMPTION FROM WORKERS'
306 —
HOLDOWNS
COMPENSATION INSURANCE
307 -
INSULATION
Croix section need not he completed if the permit Is for one hundred dollars ($1BE
308 —
SHEETROCK
nr tread
1 calory that in me purmmmnce of the work for which this Permit is iuucd, I shall not
309 -
EXTERIOR LATH
employ any person in any manner an as to become sabjatto the Workeri Compemalion
310 —
INTERIOR LATH
California. Data
^te
Applicant
311 -
313 -
SCRATCH COAT
ROOF NAIL
NOTICE TO APPLICANT: IL after making this Certificate of Eaemldion, you should
became Subject to the Worker's Compensation provisions of IN Labor Code, you must
forthwith comply with such Provisions or this permit ahaii be deamed invoked.
501 —
FINAL ELECTRICAL ENERGY
CONSfRUCfION LENDING AGENCY
502 -
FINAL PLUMBING ENERGY
I hereby affirm thal0mre is a construction lending agency for the Performance of
503 -
FINAL MECHANICAL ENERG
the work far which this permit is inued (Sec. 3097, Civ. C.)
Lender's Name
504 -
505' -
FINAL BUILDING ENERGY
FINAL ELECTRICAL
Lcndei1 Address
1 ccnee that I banply rod This application and soar that sure information is
condin l agree to comply with all city and county oNinarmm and sum Iowa
and l0
506 -
GAS TEST
buildingcomtrvniocand hereby euthon r upon t
rpoeunutiw of this rely reenter upon the
FIN PLUMB G
ahovcmee)agreproperty for Impaction p
keepha.
(We) agree to rove, indemnity and keep humless the City of Cupertino against
0 8
FI L
Iiobililinsjudgmenu, eons and expenses which may in any way accmc against said Ci ly
5
in conseyuenec of me granting of this permit.
APPLICANT ON ERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: 5
ING Date
SOURCE REG L I
Re-roofs 514
Type of Roof
NAL PUBLIC WORKS
onset LApplicanUCom c
HAZARDOUS M ERIALS DISCLOSURE
Will the applicant err fuwrc bu' Ing oecupenumrc or handle haruJous mammal
as def and by the Cupenino Moni ` el Code. Charter 9.12, and the Healthand Safely.
Cole, section 255320)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yat No
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant or fw buildi occupamux cyvipmenl err Jcviccs which
iI hasardnaa air contaminants<umed by the Bay Arca Air Quality Managcmcm
all ❑eW materlalS COC IHSPCChpn.
DYca
I have mal me hamr ss mquimmcnts under Chapter 6.95 ofthe Califor.
ni Ire&SafctyCadc, cion25533do125534, 1 ,d todlhatifthcuilding
J tcurtc lyh vc. mo an, thatitumy mrpansihility 0 nilly Iw oecup.t or but
immeu �h at me dor lnisamnccarec.ru". QaPsnay.
SignalurcofApplicant
Dale
06 o
All roof coverings to be Class "B" or better
Ow
ner or amhorireJ ergate