06030144 CITY OF CUPERTINO %
BUILDING DIVISION PERMITt_0NTRA6"TQRTNkORMATIONNN
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMT"00.06030144
10123 N WOLFE RD
RSNAME: PERM"ISSUE DATE
LANDMARK PROPERTIES 1450 VETERANS BLY 04 /11 /2006
ifMNE' '
SANITARY NO, CONTROL N0.
(650) 474-1450
ARCHITEC,'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+aa LICENSED CONTRACTOR'S DECLARATION
mC I hereby affirm that I am licenwd under previsions o(Chapmr 9(commencing Job Description
fZW with Section 70(kO of Divivon]of dm Business and Pr-feuiu Code.and my licemt¢is
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in full and ercs/ • - EDECLARATION
�h REVISION-RFI ' S STRUCTURAL
x Z Liccnsc Step Lk.N�-
Da¢ Contractor
V RCHf1EC`rS DECLAR 01
m< I understand my plans shall he used u public records
5yU
s C Lkenscd Pm(csvonal
OWNER-BUILDER DECLARATION
I I hereby[(Leen Nm I em exempt(win the Cssions o License taw for Ne
p o following mown.Permit
t IIh lot Business And!Pm(enl ms Cods:My city or county r
<S which its usu a permit to ennswct applicant
Improve,demrmittish,fie asig any tamwure (]
a
prior to its issuance,also ,quirts the applicant far such Permit m e s signed statement
t
4
< teat me cing wit pursuant 7 7000)of
Disiam-f tiro,Buazwr alxenmlaw(C odc)or Sq.FL. Floor Area Valuation
YFC (commencing with section]000)of Division 3 o Ne Business and Professions Codc)or
y Nat he u exempt therefrom and she basis for she alleged exemption.My violation of
Section 7031.5 by any appliant for a permit subjects;Ne applicant to a civil penalty of M 99ATer Occupancy Type
not more than fixe hundred dollars(5500). P Y YP
❑I,uawnw of die pmprny,wmy employees with wagesastivv sole c-mpeasadon,
willdotheworkand Nesswctumunosintendedorofferedfarsa (Se=.70u,Business
and Profession Code:The Contractors License Law does act apply to an owner of Required Inspections
property who builds a impmves dureon,and wMdwasuchworkhimselfor through his
ownemployar,provided himprosemcnuartnot intcndWm-leered for sale IL
however.Ne building or improveprowment Is sold within one year of completion,the oom
builder will haw loshe burden of proving Nat he did not Wild w improve[w purposee of of
wic.l.
0 1.as owner of she property,am exclusively contracting with licensed contractors to
commonest the pmjem(See.7W.Business and Pmresuons Code:)The Contractors U.
cove law docs not apply to an owner of pmpwy who builds or improves daemon.and
who contracts for such projects with a commetor(a)licensed pu ream to Ne Convectors
Lim.Law.
0 l me eaempt undm Sec. ,B A P C for this mason
4� Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑i ham aM will maintain a Cerdficem of Comm mwlf-invert fw Workers Compan-
.non,as pmvidvd for by Section 3700 of the labor Cade,for he peR-rmm.of use
work for which this permit is issued.
0 I have and will maintain Workers Compensation Insurance,as required by Section
37W.f the lobar Code,for Ne 11immanee of Ne w-h for which Nis permit is issued.
My workers Compensation hawsmnce can ice and polity,number am.
Cartier. p�
artier. NC-/CUnes-) Vrsy/�I+aliryNo.: f__Z / 6
A�3 �
CERTIFICATE OFEXEMPION FROM WO ERS'
S'
COMPENSATION INSURANCE
rDru at.reed natbc completed Ifthe permit Is foronc hundred dollars($100)
or less)
I cmti(v Nvt in to perfunnancc.10.work for which this permit is issued.I shall not
employ any person in any mmmrw as to become subject m she Workers'Cwnpensation
U.of California.Date
M,lians
NOTICE TO APPLICANT:IL after making Nis Ccniftcem of Exemption.you should
beembe wbjem to the Workers Compcnsadon provisions of Ne lather Code,you mutt
.J z forthwith comply with wen provisions or this permit shall he deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
L•, I hereby affirm dust there is a commwcdon lending agency for the poforromm of
CL the work for which this permit B issued(See.3097,Cih,C.)
W�Q lenders Name
D z Lenders Address
V Q I certify that 1 hale read this appI cam o send We the the aboae information as
II,f+ corrin 1 agree tocomply withall day d ty uminmuces and state laws mlating to
0 V building construction,and here by autrartstoulves of this city to color upon on,
F 4 above-mentioned property for ins p s
(We)agree to save,inti f` yup barmleas the City of Cvpcmno against
ti fA Iiabilides,judgmcnu.cosis e n s which may in any way seems gainst wid City
IJ z ins-uryuehe.of ds ng permit
^ APPLICANT U A S NO WILL COMPLY WITH LL POINT Issued by: Date �
SOURCE REG fS �J / ��
7
Re-roofs
sienaurt Ap b=an nuacmr Da
W ARDOUSMATERIALSDISCLCSUR Type of Roof
I dmappli rat w future building occupant elm wbandlc hmeadmet maerial
as defined by the C coin-Municipal Code.LTapwr 9.",sed Ne Health and safety
de,
Section zss3z(a)' All roofs shall be inspected prior to any roofing material being installed.
YG
Will the applicant- factum building / pant sew cyvipment w devices which If a roof is installed without first obtaining an inspection,I agree to remove
crit hmaNnus air contamim ns u dell= y she Bry Area Air Quality Mmagmnmt all new materials for inspection.
District'
0 Yes
v '
I hu.read,Wbrhm wvm nalsmcluirememsunder Chei ofthe ifw-
oixHcalth@Sof ctions 505,25533md25534.lumicrs thetifthe mlding
does not tune ly v moan shat It u my responsibility to!o Necas oct of Ne
regoiremtn wh h dtx tpri-rtoiswance.f,cedEca roefmPan o Signature of Applicant Date
Owner 2UX0ri7zdag2KL ir Date All roof coverings to be Class "B"or better