06040067 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CONTRACTOR INFORMATION
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMI71-1,10.06040067
10123 N WOLFE RD
lerR'SNAME: PERMIT ISSUE DATE
LANDMARK PROPERTIES MGMT 1450 VETERANS BLV 05/01/2006
PHONE: SANITARY NO. CONTROL NO.
(650) 474-1450
ARCHITEC,ENGINEER: BUILDING PERMITINFO
BLDGELECT PLUMB MECH
0 t 0 l�
±aa LICENSED CONTRACPOWS DECLARATION Job De$CilpllOn
usF 1 humby affirm Nut 1 am licensed under provisions of Chapter 9(commencing
Z. with Section 7000)af Division]oftM Business and Professions Code.and my liceem is
±�N infullforccandctfm STRUCTURAL CLARIFICATIONS RFI — REVISION
7Mz License au, Lk.a
=Fp Dam Conuaztor
s£ ARCHITECTS DECLARATION
1 C 1 ure crwnd my plans shall be used as public record
7iU
.off Licensed Purmimul
OWNER-BUILDER DECLARATION
0 C I hereby alum Nat 11. exempt from the Cssions Cock:
License Law nor the
D O which ng mason.Permit
t 7031.5.BLLaIaUS and Pm.d rinm h.or:Mti Can or county
tuchma
$ which mquims a permit re rnns the alter,improve,demolish,or repair any swmum $Q
�iy prior to is issuacec.alto regains to applieantfor such permit to file,aSignJ statement
< thatM is licensed pursuant to Ne provisions of the Contractor's lJc,uc Law(chapter Sq.Ft.Floor Area y\ Valuation
CFC (Commencing with Section 7000)of Division 3oftheBusiness andProfeuiomCOLIC)or \�
$
that M is eumpt therefrom and the basis for Ne alleged eumpdon.My violation Of
Samos 7031.5 by any applicant for a permit subjects NC applicant to a Civil penalty of 3VRWdI;LI6LrUU Occupancy Type
not mom than five hundred dollars(3500).
I,uowmmcoftliepmpmy,ormymploymawiNwguuNeumlecampen don
will do the,work,and Ne suumum is not intended or offend foraale(Sec.7014,Business
and Pmfessirms Code:The Conuamafs Lieenz law don Last apply to an Owner or Required Inspections
propenywho builds or improve there n,and who doessuch work himselfor through his
tom employees,provided that such imp.rancts art not InmbuW oreffmul for sale.If.
however,Ne building or improvement is sold within ane year of completion.the owner-
holder will have she burden Of proving Nat he did nom build or improve for purpose of
sale.).
1,as Owner of the prepe tl,am excluively Contracting with fcemed contractors to
Co.,.,dm projem(Sec.7044.Business and Profusions Code:)The Conmacwts Li.
,cess Law aura not apply m an owner Of property who Wilds or improve thereon;and
who comes for such projects with a co nctor(s)licensed pursuant to the Commuter's
Lies.Law.
❑I an exempt under Sec. ,B A PC for this wan
I Data
WORKERS COMPENSATION DECLARATION
1 hemby affirm under pevlty of perjury one of the following deClaruims:
I ham aM will for bCenifi7M ofComentrr Cod inaum f performance
of the
bison, r proh thi for mi Section 3700 of dm Labor Code.for dm perfonnarm¢Of the
week far which this permit is issued.
I leave and will maintain Worlds Compensation Insurance,u required by Sanson
37M.f On Labor Cao,for NC peRarmancC of the work,for which this permit is issued. '
My Workers Compensation lommnu umcr and Policy number are:
Carrier. Poli,No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
(This smile need Out W completed if da permit is furan,hundred doiters($100) !
or lav)
1 Cudfy that in the perfOrm.of the work for which Nis Permit is issued.l shall not
employ any person in any mannerso as m become subject o da Workers Compensation
Laws Of Celifomia.Dam
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate of Exemption,you should
beeome subject to the Worker's Cmnpcuadon provisions of the labor Code,you most
,Jz forthwith comply with such provisions or this permit shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
[-+ IMreby affirm ths there u acoumxon lendingagcn,for dm iterforam.of
C tM work for which this permit is issued(Sec.3097.Civ.C.)
aW Landers Name
z Lende`3Addw
V Q I certify Nat 1 Mere mad Nis wlieadan W sale Naz the nose information is
W Hcorrect,1 agme to comply with all city and county ordinances and sum laws minting to
O C.) building construction,and hereby amhurim represenunive of Nis city to cater upon the
yabovcmcmidgra pmpery for inspection purpose.
(We).glee to sale,indemnify and kcal,Mrmless da City of CupCrmm!gains'
c,lL)Z in Coisegenceo the
grmind caperOf
emit. may in anyway scene agaiu'said City ,
C)'� in corsegmmncc of tM eventing of Nia permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature o(AppliaRDam
Re-roofs
HAZARDOUS MATERIALS o Dsuseo hanE i Type of Roof
Willy applicantor mrectum Waidinge.Chaptzom Or handle harardausmatoriel
defined by Oa 32(.)'w Municipal Code.Chapter 9.13.aro tM Health and Safety
.Section 15532(x)?
0y. ���ss__/////,,,tt All roofs shall be inspected prior to any roofing material being installed.
�a
Will thea Bcant orfutum WI ' If a roof is installed without first obtainingan inspection,I agree to remove
emit harardnus mi cansminans ncE by NelBayAnavAir eOualuy Man�igCncm p g
District? all new materials for inspection.
❑Inc. N
Ih a rials-qui..=urulerCMpterti.95ofthcCsifor-
niaHeahhds afc d 505.25533and15534.Iundusund Na.tda WiWing
does rate vc a n L t it 4 my nspomibiliay W notify the occupant ret due
revmnm, ma me'�.rtoiDamaearacrniraamsro,apan,y. ignature of Applicant Dale
Owner, s a ag,m p All roof coverings to be Class "B"or better