05100195 CITY OF CUPERTINO �a'
BUILDING DIVISION PERMIT r•�bN"CRYII01 %OR NFORMAUON '
3�,. r ,^F. ,• 1, 9,
BUILDING ADDRESS: PERMIT NO,
DPR CONSTRUCTION INC05100195
OgQIW24IE:N WOLFE RD # 2030 PERMIT ISSUE DATE
LANDMARK PROPERTIES MGMT 1450 VETERANS BLV SANITARY N93 15/20OLN0.
ARCHITECT/ENGINEER: (bbU) 4 /4-14bU BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
50 LICENSED CONTRACTOR'S DECLARATION Job Description
i I hereby affum that 1 am licensed under provisions of Chapter 9(commencing p
with Sudan 7IX0)ofD10.1me 3 of Me Bard.and Professions Codo.and my license is
I.full farm and effect.
j z Lism.Class-contractor SUPERSTRUCTURE-16 SCREEN THEATRE
SW ARCHITECT'S DECLARATION
<7< I understand my plans shall M used as public meet&
U
Licensed Professional
r5 OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Cuntrecmes License law for Mm
i o following mason.(Section Wn I.S.Budncu and Pmfauinm Cade:Any city or county
K which requires•perach la cam met,alter,improve.derralish.Or mpWr any Immune
:v, prim W its issuance.also r of=the aMliam fm each permit to file a signed summenl
r< that he is licensed pursuant to the providam of Man Con=ioel Ucense Law(Charm 9 Sq.Ft.Floor Area Valuation
a (commencing with Section 7000)of Division 3 of the Business and Profcadnns Code)or
. Mut he is eumpt steamboat and the bum fm the Alleged esempMco.My violation of
Section 7031.5 by any appliaat for a permit objects the appliunl M a civil penalty of APN Number OCcu
nm more Nan five hundred dolma(S300),
❑I,M owner of the properly,or my employe,with mgrs As Mb role compensation,
will do the work.end the =turn meat intended m offered fm Ne(Sm.70,,Business Re uired Inspections
Bad Professions Code:The Coruscates License law done not apply m an mann of 31620037 . 0 0 q P
property wo W116 or im proven Mwmon,and who dues amh work himself or through his
own employees,provided Met each improvement me not Intended orortued fmsale.if.
However,the building or improvement is old within one you of completion,the awaer-
Wilderwill have the burden of proving Mut he did nm Wild or improve for purpose of
talc.).
L'
owncr of Mte pro:y..m eoluaively contracting with licensed mntrmlora at
d the project(Sec.70N,Business and Professions Code:)The COATIMMel U-
conse Law does not apply at m owner of property who builds or impmms thereon.And,
who contract,for such projecu with a contractor(s)Burned pursuant at Med conuaeloes
LicenseLaw.
❑I we exempt under Sec. B k PSC ffor this reason
Owner,
W 5COMPENSATION DECLARATION
I hereby affirm under penalty of perjury aro of the fallowing declarations:
eve and will maintain.Certificate ficate ofConseno self-lnaum for WorkeemCompen-
Bellon,As provided for by Section 37M of Mie labm Cade.for the performance of the
wank for which this permit I.issued.
❑1 have and will maintain Wmkerh Compensation Insurance,As sequined by Section
37W of Ne labor Code.for the performance of the work for which this permit m Issued.
My Worker's Compensation Insurance carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thmsocion need not he completed If Ih permit is froom hundred dollus($10111
air mu.)
I certify that in the performance of the work for which this permit is Issued,I Mall not
employ any peron in any manner an 1�rust at the Works"'Compensation
Laws of California.Dam _
Applican
t7N077E0 APPUNI rrmaking NS� 6icau ra Exemption,you should
become subject m the Workeri Compensation provisions of the Labor Cede,you must
Z forthwith comply with such provisions or this Permit mall o deemed re riled.
0
y CONSTRUCTION LENDING AGENCY
I hereby affnm Mut them ma eonstoction lending agency for the performe,aaof
7 Mm wish for which this permit ts issued(Sec.3097,Civ.C.)
QLendeea Nurse
Z Landers Addn,s
0 I unify Mut 1 have mad this application and tum Nat We above information is
F
correct.1 agree to comply with All city and county ominaem and state IBM refining to
U building construction,and hemby authudm repreromalim of this city to enter upon Me ,
W move-mentioned property fm impaction purpose,
(Wo)agree to save.indemnify and trap harmless the City of Cupertino against
rrA liabilities.judgments,tutu And expensrs which may in my My acnm against Mid City
Z in consequence of the panting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
,^ l _ 1 /S-�t� Re-roofs
Signature o pplim ` re Dam
HAZARDOUS MATERIALS DISCLOSURE / Type of Roof'
Will the applicant or fumm building Occupant tom m handle haramous mamdai
As deflect!by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Calc,Ston 25532001 W j All roofs shall be inspected prior to any roofing material being installed.
Oyu
Ud^u
PctWill the applicant or future building Occupant aupOccupantum m equipment devises which
If a roof is installed without first obtaining an inspection,I agree to remove
aM rims,in contaminants u darned by the Bay Arca Air Quality Management all new materials for inspection.
?
❑Yes M4.
1 have mad the huamnue materials requirements under Chapter 6.95 of the Califor.
ale Hui"SafetyCade.Sections 25505.25533 rod 23534.1 undeutand that If the building
dans not annually have a tenant that It is my m.pmulhlllly m noMl'y the nccupanl of Ne
requirements whip muni he mel prior to ismanco or a Ccranute of Occup ay. / Signature of Applicant Date
�S o(� All roof coverings to be Class "B"or better
Ow ror au d1r agent Do