03100142 CITY OF CUPERTINO °" 's.v�+sa -"� ,�
BUILDING DIVISION PERMIT �CONTRACTORdNFORMATION ...
BUILDING ADDRESS: PERMIT NO.
DPR CONSTRUCTION INC 03100142
R'S NAME: 1450 VETERANS' BLV PERMITL4UEDATE
NE' .(650) 474-1450 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
CJ E � 0
�00 LICENSED CONTRACTOR'S DECLARATION
i u 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing Job Description
u with Section 7000)of Division 3 of the Business and Narration,Coda,and my license is'
�» ior
leaumCaandarrea � y���j REVISION--IN HOUSE USE ONLY
t ? Licenx Cress Lic.N_,
iF Dam CumrtomNO NEW PERMIT ISSUED/ORIG. #03050160
ARCHITECTS DECLARATION
i 1 understand my plans shall Mused a public records
t6
`0Licenses Professional
OWNER BUILDER DECLARATION
)0 0 I hereby affirm that 11. exempt tram Ne Contractor's o :Any c Low for lbe
o O following arena, ormsun 703 1.3.Business and w,deco"Calc:Any city s county
j$ which its requires a patmio re cnnswcf aixr,ice fors"h Ferran t or repair any tarucmre
pdonn incensed a,a entIntheres the applicant for Cmurermit Licensele a Lw(ned Cha mem
a^ma (trothe is mecing wit pursuant to the of Division(theeBusines iLicenxlawlC Code)
Sq. Ft. Floor Area Valuation C38
I F O (cat he is(commencingwithSection mrd t f Division f r of(M alleged
exempts and Professon,Any
Calle)ser Y
$ Net he is exempt therefrom sod the base for the ailegcd caemplian.Any violation of
Section 7031.5 by any applicant for o pumitsubjects Ne applicant In a civil Fondly of 3M MQlller 00 Occupancy Type
no(more that,flue hundred dollen(9300).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the strucmrt is not intended or offend for ale(Sec.7044,Business
and Pmfamions Code:The Contractor's License Low does not apply w an owner or Required Inspections
property who build,or impmws thereon,and who does such work himself or through his
ownemploycons,provided thauuch improvements arc not intended or offered forsale.IL
however,the avetebding rden or pmenngfluat he
not year of completion,the owner. / \
builder will have the burden of proving Nat he did not build or improve for putque of ( _
sale.). YV]
1,as owner of die property,am exclusively contracting with licensed contractors to
constructLades not (Sec.to an weerBusiof andProfessions who
Code:)TMCs Mercer.ad, \�
acme Law contracts
f not apply a an owner of property who builds or improves Coma,sod, -
who ease Laces for such pmjccta with a comm�artr)liustsed pursuant m the Consnnors
License law.
1 ern exempt under Sea. .B&P C for noon
r Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury,arc of the following dalantian:
1 have and will maintain a Cenifean of Consent o eal6imun for Workers Compere
much,as provided for by Section 3700 of the Labor Code,for the perfomtarm of the
work for which this Permit is issued,
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3".
7M of the labor Cade,for the performance of the work ro r which this pat is issued.
My Work.peI,C�c1m�,.don lnunntt carrier and Polity numbOer° a1
Carver. /wen camas R 7 PolicyN,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This account need not Mcompleted if tM permit Is(mono hundred dollen(9100)
or les.)
I«reify that in Nc performance of the work for which this Permit is issued.l shall not
employ any parson in any manner an u to become subject o the Workeri Compensation
Laws of Ctlirinew Data
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 mus(
�Z forthwith comply with such provision or this permit shall be deemed hawked.
Z O CONSTRUCTION LENDING AGENCY
I herchy alfrm that there is construction lending agency for performance of
X Y the work far which this permit Is Issued(Sec.3097,Civ.C.) .
Y0 Lender's Name
z lender's Address
)Q 1 certify Out I have read Nis opplie alcut end lux Nat the o W.information is
i F correct.I agree to comply with all city and county ordinances and state lava relating to
�U building construction,and hereby atu orinrepresentativesofthiscitytoenteruponthe
G ahnvomcmioned pruriently for inspemion purposes.
(Wen)agree to save,indcmnt fy and keep hum leas the City of Cupertino against
VI liabilities,judgments,costs and expenses which may in any way scene against mid City
)z, in eonuquene crib Ef
mit.
APPLICA NOWILL COMPLiW AONP0INT Issued by: DateOURC R U f(
Re-roofs
Slgnmreaf Apel ofL n nv.cmr Dax
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building ocauf anutore or handle ba/udous material
u tle'"d by she Cupertino Municipal Gods,Chapter 9.12,m0 she Health end Safety
Scoria.25532(al7Na All roofs shall be inspected prior to any roofing material being installed.
Will(hen applicant orYf!NN building occupant use equipment or scale"which If a roof is installed without first obtaining an inspection,I agree to remove
it h"mdous air wnuminanu u scfined by the Bay Area Air Quality M....comma
to,, all new materials for inspection.
❑Yes XNu
1 have mad Ne ha"Na/us materials requirements under Chapxr6.95 of the Califon
riaHealth 6 SafetyCock,Sections 25515,25533 am125534.1understandthenPNe Wilding
dres.mo. mly os arena rO it is my responsibility m notly the axupanarthe
roquircmcn whi nsMlAcl 'ornissuanccofeCcrdf¢amo�Opccg Signature of Applicant Date
Owner or aulhamad agent Dax All roof coverings to be Class "B" or better