05110089 -77- �
CITY OF CUPERTINO % "
BUILDING DIVISION PERMIT 7U7
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMITNO.05110089
10123 N WOLFE RD 4 2010
OWNER'S NAME; PERMIT ISSUE DAM
LANDMARK PROP. 1450 VETERANO BLV 09/0q /2nng
SANITARY NO. CONTROL NO.
(650) 474-1450
BUILDING PERMIT INFO
ARCHITECTfeNGINEER: is PLUMB MECH
IS
0. LICENSED CONTRACTORS DECLARATION Job Description
I hereby affirm that I son licensed under provisions of Chapter 9(commencing
mth Section 7000) fDIW.O 3 of the Bushown and PrOrksawal,Code,and my ilctom Is
mr.11(messand.frect. THEATERS-SUPERSTRUCTURE/ARCHITECTURAL
Licaseclaza, Uc.,
Dow—Contractor ELECTRICAL/MECHANICAL/PLUMBING-CORE/SHELL
ARCHITECTS DECLARATION
I malcusuand my plans shall tic used as public mand, REVISION #06050182, 06060237
iy
M Licensed Professional
OWNFR-BUILDER DECLARATION
I hereby 9MITO that I am owtopt fmm the Crinusawars 1.1anse Law for ft
:nO following reason.(Swedon 7031.5.Business and Professions Code:My city or county
which requires.permit in annime4 A)ta4 houlnews,diromilm-as acrain any structure
prior ki as issuance.also requires;the applicant for such permit to IIIc a signed assistance,
o dist M is licensed punturnal to ft pinvissims at ft Coninswes Lwmaa Law(Chapter,9 Sq.Ft.Floor Area Valuation
i (aurnmencing with Scalon 7000)of Division 3 of the Business and!Profession Codc)or $9999999
151 thal he is remain therefrom and give bids for the alleged— plion,My violadon of
Section 7031.5 by any applicant for a permit libiccu the IPPlicafti 10 3 civil Penalty Of APN Number Occupancy Type
Out cone,those But hundred dollars ISM
[]Lasowner offt prop",ormyemployees Midi wages"theirmiccompensado", q46;P.A R9 AA
�IlMftwrk.odtM�misnolLnWn&dwoffcmdfors�(SW.7044.Busimus ------- - - -- Required Inspections
and Professions Cade'The Ccnuosctmh I wou5se Law dam Out apply W an owner Or
propenywhis builds arimprowas thersom.and who dos ouch work loonswifor through his
Own employees.Provided One such improvements are Out Intended oraffened forsail E.
howeva.the building Or improvement is mid within oro year ofemorkelool.the—
builda will have the haden of provirts Nat he did Out build a Improve,for purpose of
E.1.
asowner tifidution y-mucatt.
'.rwt the Project(Sec.70x4.Basin, ampouicashouscodo,)The conusawesu.
ecruaLawdocasm.,plytem. In-leftYarbaboiltism)meow Hereon,and,
who contracts for such p mormson(i)licensed pursuant an the Corousames
Litems,Law.
❑I. B&P this main.
Dam
iR'Sto,MPENSArION DECLARAMO
I hereby m�under
er penalty of perjury now of the following dielsettions:
Q I have and will maintains CmJfficaw OfComntto self-holum fns Workers COmPcft-
sadom.as provided fou by Section 3700 of the labor Code,for the performansce Of thes,
work for which this pa ntit is issued
0 1 have and will maintain Worimes Compensation Insurance,as oxioned by Section
37(s)a the Labor Code.for the performance of He work for which ibis piamil Is Wood.
My Workers Compensinim,onareara,carrier and Policy number am:
csnriw.�Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section,read not becompicied If Ne permit is rurona hundred dollars(I1010
nr was.)
I comfy that In the performance of ttm wait,foo which this permit is Issued.I shall not
employ any person in my mannam as an become subject to the Work:.'Compensation
LAwSof California.Data
APPII.L
NOTICE TO APPLICANT:It,after making this Certificate Of EUMP110A.You should
become ubjmt a,the Workers Compensation provisions or use Labor Code,you must
Z rearanviih comply all such jamw)da.Or this permit sual M domed ravoked.
z 0 CONSTRUCTION LENDING AGENCY
I thereby affirm that them Is a comemsethm lending agency for the performance,of
Dry r7 He work for which this permit Is issued(See.3(197,Civ.C.)
n2 Q Lenders Name
z Leaders Address
U(3 1 caury that I have most this application soul saw"the above Information Is
LA F conat_I aI=w comply with all city and county ordinances anis to�laws otblitil to
OO building construction,and hereby authorim,0senutives Or th enter upon the
.hove-orwourmcd property(Or i9fpcLu.. r,om. 11
to saw mill(
cp burnican the City of Cupertino against
W=% - hich may in my way memo tZalm said City
LL IN
liabilities. lux�I#.
n cc of 0 It.
am a'
I co rICAIrrill AN A WILL COMPLY WITH ALL NON-POINT
Uw.Z APP Issued by: Date _c—SOURCE ,5e
E o Re-roofs Cl/
Signiame, Ii ImEtur Data
"m H OUS MATERIALS DISCLOSURE Type of Roof
I
V=ft1ppI L fametruildiagoccupontswarcorhantfichaj, ounismonal
=0 u I
as dallms!by L" Municipal Code,Chapter 9.12.and the Heafth and Safety
-6.255 2(.)?
See All roofs shall be inspected prior to any roofing material being installed.
Oyu ONO If a roof is installed without first obtaining an inspection,I agree to remove
Will dic appikstal at riumm building Occupant use equipment or devices which
arit husudoes al,..=I. dic'med by the Bay Area Air Quaky Man-11-tral all new materials for inspection.
"wom"
District?
oy" 0
lhm an alsouptimmusta uniscrChaina6,95oftibeCtlifor.
ai.Hcal"s ly .25533 Lrd 35534,1 understand dolifthc building
0
does_1/ It Isroympainsibililywoutury ft I of de Date
norit too orwi—lauxorscau Signature of Applicant
:Iff�F,loa All roof coverings to be Class"B"or better
Owner�)&oro;i;iIIgem IDau