06040097 CITY OF CUPERTINO / 8
a� +
BUILDING DIVISION PERMIT =CONTRACTOR INk'URMATION .
r'".3 Ni at,t i'P re.
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMITNG.O6040097
10123 N WOLF RD
OWNER'S NAME: FERMPr ISSUE DATE
LANDMARK PROPERTIES MGMT 1450 VETERANS BLV OS/IS/2006
SANITARY NO, CONTROL NO.
(650) 474-1450
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
:Op LICENSED CONIRACIOR'S DECLARATION Job Description
C 1 hereby affirm that I an Itmmxd under provision of Cl aper 9(Commacing
tiOn wiNSaaoon RXgT)of Division30ftheBuimssaM Profc 'per Code.and my license is
in fullfameanderfact. REVISION FOR STRUCTURAL CLARIFICATIONS. NO NEW
:• `1Cw Class, Le'a PERMIT ISSUED. ORIGINAL PERMIT # 05060075
r Dow Contractor
At,h.11 .,a DECLARATION
l¢� 1 undernanJ my plans shell W used u public recmrda
JyV
°0 f, Classed Professional
3 OWNER-exempt R DECLARATION
v{ 1 hereby.(Sere Nat I L exempt from Ne CanuactCoc License Law for the
5 p O following ut.reason.(Sadao RD LS,Business and Profesaluv COJr:Any city Or county
i m which requires n pamso b cnn,wct alms improve,h Permit O ri repair any ttmtturc
prior miu issuanm,also requies the applicant far such Permit On fikasigneJ statement
r< met heulicensed purmant On ma provision of de Commcmrs Liar,taw(Chapter9 Sq.Ft. Floor Area Valuation 0
uyg (commencing with Section PMID)of Division 7 of the Business and Profession Coac)Or
that he is exempt thetefmm and the buss fm Ne alleged csomption.Any violatian of
Section 7031.5 by any applicant for a Permit suhjccts the applicant to a civil penalty of NN 0 U 3 bet Occupancy Type
net mart Nan five hundred dollen ISM 316 2 7 . 00
I,uowmeraftkpmKny.mmyamployemwithwa mtheumlcc K=Uon,
will do the week and Ne structure u not intended ar oRerrA farsale(Sec.7044,Business
and Professions Cade:The Cantrossn',Licuve Law does act apply man owner of Required Inspection
roge
pny who builds orimpaventhereon,and whodoessuchwmk himself ardsm igh his
awn employees,poo,dud Not such improvements are not intended oraRemd fmsale If,
however,the building or improvement is said within ane yearof cwvpletion,the aweas-
buildu will have Ue burden of proving Nat he did not Wild or improve for purpose of
sale.).
❑1.as Owner of the property.am exclusively convecting with licensed mnuacmn to
construct the project(Sea.7044.Business aM Professions Cade:)The Convectors Ll. ,
cents law dean not apply to an owner of property who Wilds or improves themon,and
who contracts fm such projects with a conuactm(s)Raved pursuant to the Conoaasors
License law.
❑1 am exempt under Sec ,B At P C for this reason
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hereby W.under penalty of perjury one of the following dedaratiou:
❑I haw and will maintain aCutifica a of Covenuosel6inure fm Workers Compere
salon,as provided far by Section 3100 of the Labor Cade,far Ne af.romme,of Ne
wools far which this permit is issand.
❑1 have and will maintain Workers Compensation Worst..as required by Section
37W of the la W,Code.far Ncperform.ofdhe wast fm which Nis permit u issued. '
My Workers Compensation Insurance arrom and Policy,number am:
Caner. policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu xcfi...door W cmnpkted if the Permit is farane hundred dollars(SIM) v
or leu)
1 anfy that in Ne perfarmaae of the wart Ire which this Permit u issued.I"I our
employ any person in any muncrm as m become mbjat to tM Wadmrs'Compensation
Laws of Califoroia Data
Applicant
NOTICE TO APPLICANT:If,after making this Cci ifiam of Exemption,you should
Wasson subject in Ne wmsaes Compensation provisions or Ne Labor Cade,you must
.J z forthwith comply with such pmvivau or Nu permit shall W dermad revoked.
Z O CONSTRUCTION LENDING AGENCY
F+ I hereby aD'um NU Nce era ronstrucmor lending agency far the pa for amt.of
I5: me work for which this permit is issued(Sec.3097,Civ.C.)
6W. Landers Nene
7 z Lenders Address
U Q I cvnfy Nat I have read this ap,Iic.i.n arta sum that the above information is
it, cancer.I agree to comply with all city and cou om inanco and sum laws elating in
DU Wilding eonsuuetion,and hereby anmeda rtpr unntiva of Nis eiry eco enter upon Nc
z in consequence
on mantic o the par for inpecti
H LL
(We)agree to save.indemnif lass tW City of Cupertino spinet
fn liabilimo.judgmenls.cosuandespc ave ay in any way,came against said City
U Z APPLL CANTOUN ERM I, AN t L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUU
� Re-roofs
Sigwure of Appl" a Data AZARD 5 MATERIALS DISCLOSURE Type of Roof
Will the applicant orf Wilding occupant nam mhandk haaardau mamrial
u defined by the Cupertino Munici a1 Code.Chapter 9.13.cad tM Health and Safety
aM.Scctias us3zea)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu Na
If a roof is installed without first obtaining an inspection,I agree to remove
W Il the applicanr or fm re building em u equipment or dcvims which g P g
gslhavandau air cunuruman ef� y B Area Air Quality Management all new materials for inspection.
❑Yrs
I have earl the hnaadn and a menu under Chapter 6.95 of the Califo>
nu Haalthh Safctycode, ,3 3553c l urnersund that if ftWilding
docs not,orn ntly have a te t on asap mobility to notify the oaupant Of the
equiemenswhich nation ens n area of aCenci o(OccuPaney. Signature of Applicant Date
Owncr Oraumc lend.a Data All roof coverings to be Class "B"or better