05060075Ddu
50�
00
FFFie
OR
CITY OF CUPERTINO
CONT1tA.CTORINbRMATIUi.
a''.
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
DPR CONSTRUCTION INC
PERMIT NO05060075
OWNER'S NAME:
LANDMARK PROPPRTV MANAGF.MF.TjT14,;n
VETERAN.- MAT
PERMR LSEUEDAT6
E:
SANITARY NO. CONTROL NO.
650 474-145
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am Icnsd under provisions of Chapter 9 (commencing
with Secuan 700*1of Division 3 of the Business am Professions Co&.nd my license is
full force
in full fame and 4 ftu
FOUNDATION FOR AMC THEATER/DOES NOT INCL ANY
License Lk. N
ELECT/MECH/PLBG-REVIEW OF EXTERIOR SHEAR WALL
I underuand my pins Shall W uARCHITEsed u�ublic records
COLLECTOR DESIGN TO BE REVIEWED IN PHASE 2.
'
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affmn that 1 am exempt from tee Contractors License Law for the
following reason. (Section 7031.5, Business and Protections Cade: Any city or county
,
which requires a permit to canauuct. altar, improve, demolish. of repair any enuctum
prior In its issuance, else requires The applicant forsuch remit to file a signed statement
that &is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70001 of Division 3 of the Business and Professions Code) w
Cy 10 0 0 0 0 0
that he Is exempt therefrom and the basis fro the Staged exemption. My violation of
Secure, 703 1,5 by any applicant for a permit subjects the applicant In civil penalty of
ApN Number
Occupancy Type
not mare than five hundred dollars ($500).
❑ 1, As owner orthe property, or my employes with wages as theirmlc compensation,
Required ]Inspections -
(1 p
will &the work. and lac structure is nannmaded mothered foraaa(Sec. 7044, Baaina:,
and Profession$ Cade: The Conuattah Lt.. Law dots not apply in an owner of
property who builds or i mpmwa thereon. and who does Such work himself or through his
Own employees, provided that such improvements are oat intended or offered for sata. IL
however. the building or improvement is sold within am year of completion. the owner
bull&' will have the burden of proving that he did rot build or improve fw purpose of
Side.).
❑ 1, as Owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Profuuans Cade:) The Connector's Lt.
cove law duce not apply in an owner of property who builds or improves thereon, and
who contracts for such pmjects with a contncmr(0 licensed pursuant re the Contnemrs
License Law,
❑ I am exempt under See. .B& P C for this
,Owns' Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
O, ham and will maintain a Certificate of Consent to selbinsure ror Wadrer'sCompel-
sation, as provided for by Section 37M of the Labor Code, for tee performance of the
-
-...
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
37M of the labor Code, for the performance of the work for which this permit Is Issued.
My wor�kcceys gc�oym'�poans�atiis3n Insurance eanjgr and Policy aaamm::`(�s/��' ��
No.:
camler.]�wLVY ATEOF E%EMP ONry _nkuummh�eTr
FFlI WORKERS'
COMPENSATION INSURANCE
ffhissection coed not be completed film permit s fnronehundred dollar Olffl)
or leas.)
1 cenifv that in the performance of the wmk for which this Permit is issued,) shall not
employ any person in my manmrso AS to become subject in the Worker Compensation
Laws of California. Dam —
Applicant
NOTICE TO APPLICANT: If, after making this Can Helm of Exemption, you Should
become subject to the Worker's Compensation proviatwta of tea labor Cade, you meal
foMwirh comply with Such provisions or this Permit Shall be domed revoked.
CONSTRUCTION LENDING AGENCY
I haebyich thi Net there laircommc. agency for lac Performance of
3 7, Ch,
the work fur which this permit Is issued (Sec. 7097, Civ. CJ
Lenders Nstne
"
lender's Address
1 certify that 1 have mad this application and sate last the ahem Information is
a correct. 1 agree m comply with all city and county ordinances and $%is laws relating to
building construction. and hereby autherina Mineanudvu of this city A, enter upon the
abaVe-mentioned pmpeny for iMPCC90n pwpOma
(Wo) agree 10 save, indemnify and keep luumleas the City of Cupertino against
liabilities, judgments. coats and expenses which may In my way acerue against Said City
in consequence of the granting of this permit
i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS
ch,DY LfJ'7(_ -
Re -roofs
Type of Roof
Signature of ApplianuCon Date
HAZA S MA DISCLOSURE
Will lair applicant or future building=open, store or handle havardaus material
ass &flood by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Samena5532(a)' /fyyam�
All roofs shall be inspected prior to any roofing material being installed.
❑Yes MIN'. v7r
.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or &vices which
hasardaus air contaminants AS defined by the Bay Area Air Quality Management
all new materials for inspection.
ls ACO
❑ Yes u
thaw read the baraninus materials oemcnts under Chapter 6.95 of the Califor.
nia Health&Safety Ca&,Scctions25505,25533nd5534.lundemmdthuifdw building
does not currently home tenn4 that It o my msponsibilily m milry the nceupmt of the
Date
mquimmenlawmchmust bemetprianuisnanceofaceruncateorocnpmcy.
Signature of Applicant
All roof coverings to be Class "B" or better
Owner tar $pthorized agent Dam