05100008 CITY OF CUPERTINO "tea•« s4�Yk
BUILDING DIVISION PERMIT CO tR 'ORANF , RMATION = �
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMIT NO 05100008
10123 N WOLFE RD
NER'S NAME: PERMIT ISSUE DATE
LANDMARK PROPERTY MANGEMENr 1450 VETERANS BLV 01/30/2006
NE: SANITARY NO. CONTROL NO.
(650) 474-1450
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
20o LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby affirm that 1 am licensed eed under provisions of Chapter 9(commencing p
<b with Section 7")of Division 3 of the Business"Professions Conic.and my licensee
inmONmeandeffeet. REVISION--POS BEAM MODIFICTATION
qZ License Class Lk.N
O F o Dam.Contactor
',' ARCHITECTS DECLARATION
j U
IC I understand my plans shall W used as public records
o�, Licensed Professional \_\
5 OWNER-BUILDERDECLARATION C.J
f 1 hemby affirm dust 1 am eaempt from the Committees Listen law for the S
p O following mason.(Section 7031.5.Business and PromWons Code:Any city or county
K g V which requires a permit m cmnsmucL slier,improve.demolish,or repair any somehow 0
°iy prior to its issuance.also require the applicant for such Permit to file a signed statement
that he is licensed pursuant o the provisions of the Contractor's License law(Chapwr 9 Sq.Ft. Floor Area Valuation
x�$ (commencing with Section 7")of Division 3 Or NC Business and Pry@unions Consul or
Q et dust W e eumpt therefrom W The base for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a 1 civil penalty of APR
not more than raw hundred dntlan(ssoB3 P Occupancy Type
0 I,as owner of the pmpeny,or my employee with wages as their sole compensation,
will de Ne workend th .mmum is not intended moRered lutanist(Sec.7044.Business
and Prefessions Code:The Committers License Law doe rot apply in an owner of Required Inspections
properly who build.orimprove the eon,endwho doessuch work himselftarthrough he
own employee,provided drat such improvements are out mommd aroRered for We.IL
however,the Wilding or improvement is sold within am year of completion,the Owner-
builder will have the burden of proving Net he did not Wild or improve for purpose of
Me.).
1,as Owner of me property,am eaelusocly cmuacting with licensed contractors to
conswcl the project(Sec.7044,Business and Promotional Code:)The Contractor's Li.
come law Most not apply in an owner of propenywW Wilds or improve thereon,and
who contracts for such prejeca with a cemrv:mr(q licensed pursuant in the Cenwcsorn
License Law.
❑1 am exempt under Sce. .B&P C for this won
Date
WORKER'S COMPENSATION DECLARATION
I hereby alRrm under penalty of perjury one of the following declarations:
❑I have.nd will maimain aCehdOam of Covent msel6ivore for Workers cion't-
aation,as,provided for by Section 3700 of The Labor Code.for the performance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Ivurana,as required by Section
3700 of Ne labor Code.for the performance of Ne work for which this permit is Wood.
My Worker.Compensation Ivunna artier and Policy number taw:
Carrier. Policy No.: - -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed!film permit is potato hundred dollars(3100)
or mars.)
I certify Nat in he performance of me work for which this permit is issucd.l shall not
employ any person in any Mannar set as m become subject In she Workeri Cempcnsadon
Laws of California.Dat
Applicant
NOTICE TO APPLICANT:If.after making the C.mr.'sw of Esemptien,you should
become subject m the Workers Compensation provisions of the Labor Code,you most
.,O forthwith comply with such provisions or this permit shall W doomed revoked.
z
ti" CONSTRUCTION LENDING AGENCY
F IhewbycRrtn Pemcrt its consSec.3M,nding agency lar the performance of
!Yi me work for which this permit u issued(Sec.309'i,Civ.C.)
GA Lenders Name
ZD z Lenders Addw
U Q 1 certify that I have wad the applicuien and sine that the above information is
W f" COMCL I Agree to comply with all city and county ordinances and sum laws mlating to
0UWilding construction.and hereby authorize represcmatiout of this city to cnwr upon the
r W show textortion Property t for CxInnoon purposes
(—'a' (We)sgreemtaw,indemnify and keep hornless he City of Cupertino against
to liabilitie,Judgmcnts,cvtsand es penseawhich may in anyway acerae against aid City
of the grouting of
s pormit.
U Z APPL CANToUNDERSTANDS ArND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of Applican Daw Re-roofs
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Willy t m Cupertino
furore Wildinga,Chapter
tnow or handle Realm anmaterial
v defim0 by dw Cupertino MuniciW 1 Coda,Chapter 9.13,and the Hoath and Safery
c.Scrim 25532(0)? All roofs shall be inspected prior to any roofing material being installed.
�Yv ON.
Will the applicant or future building acupam tau cquipmet at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardous air conuminanu u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yea ONO
1 have mad the Wsardmo materials wquiwmenu underCWPmr R95 of me Califor-
nia Health&Safely COm,Sections 25505.25533 and 25534.1 undersand Coal iflhe Wilding
dos rot currently have a wnm%that it it my responsibility m nudly the aeupont of the
requommm,which most W met prior to issuanm ora Cerdficew of Occupancy. Signature Of Applicant Date
Owner or authorind agent Dam All roof coverings to be Class "B"or better