06050028 CITY OF CUPERTINO
BUILDING DIVISION PERMIT '',�ONTR?;CTQR�INIi'ORMATION ":�
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMIT NO.06050028
10123 N WOLFE RD
R'S NAME: PERMIT ISSUE DATE
LANDMARK PROPERTIES MANAGM NT1450 VETERAN
PHONE:
SANITARY NO. CONTROL NO.
(650) 474-1450
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C= 0 0
Oj LICENSED CONTRACTOR'S DECLARATION Job DCSCrIpt100
Us CC 1 barcby affirm Nat 1 am lican ed under provisions of Chapter 9(cammcncing
�ZW with Satian]OpU)of DiviionJof the Butlnev and afetyvml ea mylicc.0
=„ in funrnrtaanitaffet. KK C TEMPO) qqqJqUE
tIq? LicenuC s �Lic.N I},.. rl
;Fa Dal es (-(1 tr [On4Ybf tL�l— Itk11�
I ARCHITECTS DECLARATION
i < 1 understand my plans shall Inc used as public records
tyUa.
N Licensed Profcssionsl JUL c
'y� OWNER-BUILDER DECLARATION ��ooU
1<I hereby affirm Nm I am sempt from the ConmnCo Jecns Law for the
Z20 fallowing¢aaoa permit
E 703 M.Buainess and Prome,do fol Code:My airy at county
tura
r En which requirEx a wtmis on construct.the aper,improve,demobh,or repair any structure $20000
.xi priorbiu issuance.also rcquirs Um applicant far with permit wfilc asigneJ sntemcm
dsm he is liccnxd pursmnt tolk provisioM of me Cenvecmrs Lions Law(Chapmr9 """NS .fB.. o '� Valuation
��� (commencing with Schon]000)of Divhuion7nf the Businessmd Professions Cadc)ur u -
$ Nat he is eumpt tiemfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by asry applicant for
me m a permit subjects Na applicant to a civil penalty of ei OCCU T
nfuman BK hundred dollars(S500). Occupancy Type
❑I.as,owner of the propene,in my employees wire wages as thea sole compenution,
will dis ft work,and ft struerm,6 not intended.1 offered RE salk,(Sca.7044.Busi. Required Inspections
and Prefessiaos Code:The Committees License Law does not apply w an awncr of q p
property who bui Ids m impsen.tlu:reon,and who does such wark himself or through his
awn employees,provided mal such improsemeu art netimmmded aroffcred for sale If.
however,the building or improvement humid within one year of completion.Ne owner-
builder will here the burden of proving mat he did ret build or improse far pulp=of
talc).
❑I,as owner of the property,am Exclusively convening with licensed contractors b
comoon the project(See.7000,Business and Professions Code:)The Caotrm:mes U.
cense taw does not apply m an owner of propeny who Niids or improves thereon,and
who concocts for such pmjcm wit a contracter(s)licensed pursuant w IM Convenors
Llcewe taw.
❑I am Exempt under Sca ,B&P C for this reason
Dao
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pmulty of perjury One of the following declare lams:
❑1 hsve arW will meinuin a Cenificete of Cement wself-insure fm Workers Compen-
notion,u provided for by Section 3700 of the labor Code,for the performance of to
work for which this permit is hushed.
Q 1 have and will maintain Workers Compcnamon In....as required by Schon
3700 of Nit labor Cade,fee to performance,orate work for which this permit is issued. '
My Worker LCommpenndon Insunn¢amier wd Policy n bite art:
Carrico '7�- Policy No.: 5a 70 O
CERIIFlGT OF E%E41ON FROM WORKERS'
COMPENSATION INSURANCE
(Thi section wed not be completed if th<permit huferow hundred dollars(SIW)
or less)
1 cenify mal in me Performance of the work for which this permit is issued,l shall net
employ any permr,in my madoer se as to became subject w this Worked Comprssvtion .
Laws of California.Dam
Applicant
NorICE TO APPLICANT.If.arm,making this Certificate of Exemption.you should
bceome subject w the Worker's Compensation provisions of the labor Code,you mass
.J z retwith comply with such provisions in this Permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
(-+ 1 hereby affirm that Vert is a coMtructin t lending agency for me Performance of
D: the work fur which this permit Is issued(S..3097,Civ.C)
G 0
Lookers;Now
o z Lcoders Addlona
V 0 1 cenify mat 1 Aare mad Otis application and state mm the above information is
IL. co em I agree in comply with all city and county eNinawes add sue lam relating to
0[) building construction,and hereby amhoriae mpreacnmtires or oris City to Enter upon me
W ahovomcndewd us, Us
inspection Pugesx.
F gy (Wc)agree to save,indemnify and keep bmmlcss the City of Cupertino agaiml
rp Ii cmuno,jnna,of ts, ua&of .nsu is may in eny wayacemc against said City
V z A PLICA we of ,ag afJl n
^ APPLICANT U � 'AN 6 1 W C MPLY WITH ALL NON POINT
SOUR[E REGU S.
Issued by: Date 6--7—o dr'
.A
Re-roofs
Signore of Applicant/Conaacbr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant or future weeing oraovanl am m barWle nanous m,mrist
deEwd by the Cupenine Mumcipel Coda,Chapter 9.13,and the Health and Safety
In.sac 35532(a)? All roofs shall be inspected prior to any roofing material being installed.
Will mE applicant or future building cccupaml use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanNnes air di.;;'n dcfi by me Bay Arta Air Quality Managcmem all new materials for inspection.
Distr ct?
❑Yes Nu
I havemad thehm 1-materishumq immmn under Ch Pter6.95ofine Califon
ria Health&Safcty Cerin Sectiam 355115.25537 and 35530.1 ondcnmmd matifNc Wilding
dee wLcwrend h ) fit u my reespmuibility b notify lM occupant of the
mgmrtments syl l tljaLtr wuawcera CErificateer Occupancy. Signature of Applicant Date
Owucr or amhoreed agent Dae All roof coverings to be Class"B"or better