05090129 CI TY OFCUPERTINO 'IMT
BUILDING DIVISION PERMIT iCONT12ACT.,0WTN7N'O' RMAPONe
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BUILDING ADDRESS: DPR CONSTRUCTION INC pa"MRNo'05090129
10123 N WOLFE RD
ER'S NAME: PERMIT ISSUE DATE
LANDMARK PROPERTY MANAGEMEITT1450 VETERANS BLV 09/26/2005
NE: SANITARY NO. CONTROL NO.
(650) 474-1450
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
TIE ELECT PLUMB MECH
I�
Sop LICENSED CONTRACTORS vda,PDECLARATION Job Description
rd I+j F I ionIsomeb,70 affirm that I am IlaeBd under prevision of s Coda. 9(wmmense Is p
Z1`orf with Sectian]gIU)Of Division 3ofthe Business and Professions CMC.and mylicenset,
?� in full form and effect. REVISION--BULLETIN 3 FOUNDATION
�Ljj� Lk,nse Glu, Utalf
ri Dam Contractor NO NEW PERMIT ISSUED/ORIG. #05060075
ARCHITECTS DECLARATION
I undersand my plan shall he used u public records
5 Licensed Pro(eumnal
OWNER-BUILDER DECLARATION
gi 1 hereby affirm that I em exempt from also Commences License Law far the
00 following moon.(Section 703 1-5,Business and Profession Cade:Any Chy or County
$f which inquires a Permit in contract,altar.Improve,demolish,or repair try sraclum
�y prior to it,issuance.size acquires also applicam fn such permit to Ble a signed mekmcm
C that hebliccnscdposition othe prevision ofave ConnamesLiccancLaw(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division Sof the Business and Professions Code)at $0
5 — that M b raempt therefrom and One bub for W alleged mo mptioa My violation of
Secdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy T
not mom than fin hundred dollars(5500). p y ype
0 1,u owner of the property.m my mployeu with wags u Noir mk compcmtion,
will da the warpmd the aramuw b noammaded reoriented for We(Sec.70th.Business Required Inspections
and prediction Code The Cantrumr,Limme law done ret apply m an swot,of q p
pmWny wM bullda orimpmma duereon,andwM duesaueb work himeelfor Wough his
ownemployeas,pmvided dual each Improvement,are not Intended Or offered for sale.if. �l
however,the building orimprovement taxed within naso year of completion.she owe,-
builder will Mw the burden of proving that be did ant build or improve for pursue of �,r
sale)
[:]1.1,as ower of also Save.7property..B anus and Professions
ns with limned conmerors It.
construct the project(Sec.o an Business cadxii,who
Cade:)TheContractorsthenmre and.acne ntr dint not apply m an owner of property rand bud present
improve Norton.and,
who contracts for each pmJeeu with a camrxmr(s)licensed punum m alae Commixoes V
LiFenee law.
I am exempt under Sec .B k PC fa Nb
fes, Dam O
—WAR FIT'S COMPENSATION DECLARA710N '
1 hereby&Man under penally of padury can of the following declaration:
Ihaw and will maintain a Certificate of Consent noself-Wort fur wmkee,Campea.
ssln.u Provided for by Section 7700 of W Labor Code,for the performance Of the
or which this permit is issued.
were
and will maintain Worker's Compensation Insurance,as required by Section
3]oDof uso ItborCoda for des performma of the work for which dub pemsit is luued.
My Wurkera Compensatimt Insarsnca carrier and Policy number,son:
Cartier. Policy No.:
CERTIFICATE OF FXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Thisaamlon need net Wournpleati ifalc permit brormc hundreddollen(SIM)
lir less.)
I certify that in the perfnlmanca of the work for which this Permit is issued.l shall not
employ any peon in ally mMnf an as m Meome,subject to DIc Worker'Camperamon
Lowe of california.Demi
Applicant j, '; / —
NOTICE TO APPLICANT{after looking this CcNRcate or Exemption,you ehouW
become subject as the Workers Compensation provision of use LAW Code,you mum
O forthwith comply with each provision or this Permit Nog be deemed ranked.
r rr CONS IRUCDON LENDING AGENCY
[r vim.. I hereby affirm that siert h a Conmmnimn lendingageey far due perfolmonmuf
�i W work far which this permit is Issued(Sec.7(197.Civ.C.)
W Lenders Name
z Lander,Add.
U0 ee I ceNry that I haw mnd ad this application asat¢Chu also ebow Information Is
V.E correct.I ogto comply with all city and county ordinantts and,uws m lominting to
O building convection,and hereby authodm terminations ofthis city to color upon the
t71 aMve-menti ursd property for Inspection purpura.
LL (We)agree to caw.indemnify and keep hormkss the City of Cupertino against
,A lkbilitin.judgmCnu,cOxxx and corcoua which may to my way came ogalnl Wd City
U 7 in eauequenec of the griming of this Pertik
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dater-7GJ'
SOURCE REGULATIONS, r
si rA VCamm�icCm1� 9 u 16 Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII"d aPPlica a or'umre building occupant mom or handle hasaNuu mamrial
defined by the Cupeealno Munici 4 Cade.Chapter 9.17,and ft Health and Safely
Scetiae zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yec u
Will the applicant or future building Occupant pC equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hmArdow air conuminana u sand by due Bay Area Air Quality Management all new materials for inspection.
Oiurict7
❑Yrs u
It,aw aced the MsarGvs materialunquimmenuunderchap urd.95 ortM coirae.
lila HmtLh&SarctyCodc.Sccam 25505.75533 and 25534.1 undcntwd dwtifthc building
done not...fly ben a consul.thin It b my reapoW hinny m aulify the Occupant of the
acquirement,which mot be pdarmiuuus[cafe Ccnifca afacnpmcy Signature of Applicant Date
owner or.uthorie agem am All roof coverings to be Class"B"or better