05090185 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �O,1TRACT•.pRII1VF,ORMATIONII, >
BU
ILDINGADDRESS: DPR CONSTRUCTION INC PERMIT NO.05090185
ER'S NAME: PERMIT ISSUE DATE
LANDMARK PROPERTY EUP 1450
NE SANITARY NO. CONTROL NO.
650) 474-1450
ARCHI'fECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
uo0 LICENSED CONTRACrOR'SDECLARATION Job Description
rd 8F�k 1 hereby affirm tat I am licensed under provisions or Chapter 9(commencing
m zlG wit Sweden 700D)ofDivision 3a(te Business and Profcasioas d Code,mmy license is
.n
llrareedercm
REVISION--COLUMN STUBS @ ROOF
q z "rense class Lm.g
Dam.Contocmr
ARCHITECTS DECLARATION
it I uMcnund my plans Nell he used as public records
G Licensed Pmfic sh nal
OWNER-BUILDER DECLARATION
E 1 hereby affirm tat 1 em awmpt from the Cantacus's License Law far the .
et (allowing turner.(Seed..7011.5,Business and Pr0(esshms Code:Any city ar county
$ which requires a permit to construct,alma Improve,demolish.or minor any nruclum 0
prior to its issuance.alan requires the applicant for such permit to rile a signed statement
pp- Nat he is licensed pursuant to the provisions of to CanuaclaYWcense Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y (commencing with Section 7000)of Division 3 of to Business and Profesdom Cade)or
that he Is esemps tmefrom and site basis for to alleged exemption.My violation of
Section 7031.5 by any applicant for a permit ubjmu to applicant to a civil penally of AAN NWIR-if 0 0 Occupancy Type
not more than five hundred dollars($500).
❑1.as owner oft to property,or my employes with wages as teh sole compensation,
will do to work.and to structure 6 not intended r.farad far sale 7044,Budlmu Required Inspections
and Professions,Code:The Commmes License IJdans am apply m m Ml owof 9 P
pmpeny who builds er i mpeves thereon.andw ha does ouch work himseAf or duough his
awn employees,provided tat such improvements are notinmMed oraffered for sale,If.
however.the building or improvement 6 mid whin one Kar of mmpledon,to owner- �y
builder will have the burden or proving that he did rot build or Improve far purpose of
asteJ.
Co
0 1,as owner of do property.am aclusively contracting wit licensed mmanan so
construct she project(Sec.7044.Business so Professions Code:)The Conuacmfs U.
cense law does not apply to an owner of property who baits or improv tenon,and, / �\
who concocts for such pmjaots wit m
acenctoKU licensed pmmm t
Law. anl o ConuanoYs �/V
License w.
❑Ismexem er Sec _ .B Q P C for tla matron \,
Date
WO C 'N DECLARATION
1 hereby affirm under penally of perjury aro of to following declanlious:
1371of
ave nd will maintain a CenOcxte of Comes,m self-insure for Worker's Compen.
,as provided for by Section 3700 of to labor Code,for to perfome nce of to
for which Nis permit Is lured.
ave and will maintain Worker's Compensation Insurance,as required by Section
the labor Code,for to performance ofto woh forwhich tis permit is issued.
arker's CompenaNm Insurance artier and Policy number am: ,
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Mss section need ant bu completed If Ila perm66 foranehundred dollar($1010
or less)
1 satisfy tot in to performance of to work for which this permit is based.1 shall not
employ any person in my manner an as to became subject to to Workers'Compensedon
Laws of califomis,Dam
Applicant
NOTICE TO APPLICANT,IL of ar making this Ce tifiam of Exemption,you taut
become subject to the Wonkees Compensation provisions of to Labor Cade,yen most
O O forthwith comply wit such provision or this permit mailmed rc
l W deewked.
Z CONSTRUCTION LENDING AGENCY
(ti Ihereby affirm tel tem 6aeonsurcdon teadingagency far to performance.(
Kito wort(or which tis permit 6 issued(Sec.3097,Civ,C.)
W�0 Loader's Name
Q z Lender's Address
fJ Q 1 certify that I have mad this application and tote tat to above information 6
Dr!•' caned.1 agree m comply wit all city and county enhances and sum laws relating m
w
Q SV' building construction,and heresa
by todm representatives of tis city t dm
enter upon
W above-mendoned property for Inspection purp=L
(We)aSme to ave,indemnify and keep harmless to City of Cupertino against
r<V) 11abllidw,judgments,casts and expCruilo which may in any wy accuse against aid City
(� IAnPPLsegAMeo wPr TAN of tr D W t COMPLY WITH ALL NON-POINT Issued by:, Date
SOURCER NS
Re-roofs
Signature (Applicam/C nmclor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will t applicant or forum building mcupom nom or handle harardous metrial
as defined by to Cupertino Municipal Code.Chapmr 9.12.and site Health and Safely
de,Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes I]No
Will to applicant or future building occupant use equipment or dews which If a roof is installed without first obtaining an inspection,I agree to remove
It havanaes aircamminsrm as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes C)No -
Ihawrealyc dWM !W5341uChapanrd.95ofOCCalifonniaffalIhav dtedsunderchisondtuifde Wiling
docs net howMliry mratify No amupanl of six: aleto hmC.,ifexmofOccupacy. Signa. eofApplicant DatA
Owncrmaulhadmd agent pare All roof coverings to be Class"BI'Or better