06060237 CITY OF CUPERTINO
BUILDING DIVISION PERMIT -�f.'ONTRt1CT�RI�1T'CIRNTATIQkV k�
BUILDING ADDRESS: DPR CONSTRUCTION INC PERMIT No06060237
10123 N WOLFE RD # 2030
ER'S NAME: PERMIT ISSUE DATE
LANDMARK PROP. 1450 VETERANS BLV 08 /0'1 /2006
PHONE:
SANITARY NO. CONTROL NO.
(650) 474-1450
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
;oo LICENSED CONTRACTOR'S DECLARATION IobDescrip[ion
i C I hereby affirm Net 1 em licensed under previsions of Chapter 9(commencing
U withis
Suon 7000)of DiAs .3o(Mr Business and Professions Code,and my license is
+�dmm0mmeandeffect. THEATERS-SUPERSTRUCTURE/ARCHITECTURAL
' Da¢ Contractor License ClearLlo'g STRUCTURAL RFI
O
)fit ARCHITECTS DECLARATION REVISION TO ORIGINAL 05110089
i e< 1 understood my plans shall be used u public records
aaU
a0� Licensed Pmfcssional
5 OWNER-BUILDER m the Com ION
1 beech,affirm Nos 1 em exempt from do Comm�Cc :Any c law for the
p O following reason.(Section 71D 1.5,Business and Professions Code:Any city or county
<m which mqui=a permit to cowrucl alms,improve,demobh.or repair my structure
YZ" prior at os issuance.alau mquim1111C applicant rot such Permit to fie ialgned alalemrnt
< Met he is licensed pursuant to the provisions of the Contractor's Liccmc Law(Chapter 9 Sq.F[.Floor Area Valuation
aFC (commencing with Semon7000)ofDwision3ofone Basin.MdProfessionsCode)ar $0
$ that he a exempt thetefmm and Ne basis for the alleged exampu so.Any violation of Y
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mart Nan five hundred dollars(S500h
❑I.mowuer of this,property.or my employees with wages as their tole compensation,
will do the work and Ne.tenon isnot intended or offend for sale(Sec.7041,Busimmsit
Md Profushous Cade:The Conmctors Liccme Law done ret apply an an owuer or Required Inspections
property who builds c r i naprove theirs.,and who dos sus h work himself.through his
own employes.Pmi ided thatsuch impreacments Me not intended molferW for sale.If.
however.the building or improwmmt is mid within rue year of cmnpution,die owner-
builder will have the burden of proving that he did not build or improve for purpose of
sat.).
❑1.u cow.,of the property,am caclosively contracting with licensed contruors to
chrutmct the project(Sec.7044.Business and Professions Cade:)The Contractor's U.
menu law done not apply to an owner of property who Wilds or impmw thereon,and.
wW ca.mcts for such projects with a contrector(s)licensed pursuant in due Contractors
Law.
0 1.L1 am aempt under Sec B$P C for desAdw mason
r
pan WORKERS COMPENSATION DECLARATION
I hereby alarm under penalty of leader,one of do following declinations:
❑Iham and T maintain a Certificate of Continuo uhf-insure for Workers Compan. fK�J
cation.m providod for by Section 3700 of the labor Code.for the performazxx of the
work for which this permit is issued.
1 bate arid will maintain Workers Compensation I.e..41 mgrlmd by section
3700 of the Labor Chain Tor Ne performance of Ne wart for which this permit is Issued. '
MyWorkers Compensation Wurmce artier end Policy. Wrap:
Carrier. Policy No.:�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tu section need notbc completed if the permit u foranc hundred dollars($100)
or less.)
I certify that in the performance of the wart for which this permit Ls issued,l shall oat
employ any person in my mannose u in become subject to the Worker Compensation
Laws of Califorma.Date
Applicant
NOTICE TO APPLICANT:If,a0cr making Nu Certificate of Exemption,you should
become'object m the Worker's Compensation previsions of the labor Cade,you muse
.,O forthwith comply with such Provisions o this NMitalall W deemed revoked.
z� CONSTRUCTION LENDING AGENCY
[-. 1 Wmhy affirm Out then is a construction lending agency for the performance of
CL 7 the Muir rut which this permit is issued(Sec.3(197,Civ.C.)
QLenders Name
.7 z Lenders Address
U Q 1 certify that 1 ban mad this application and sate that the sit information is
E-' correct.)agree is comply with all city and county on imuueet and sun laws relating in
QU building construction,and hemby authorim retire tativa of thiscity oentcrupnn the
ahuvc.mentioned property for ins rccdon leu
(We)agmc to eve,indmo and p hs City of Cupertino against
F rajl liabiliuu.judgments.costs mdea�plteon cA yi ny way Kerma aims said City n
U z APPL CANT UN Ee.of the RSTAN s«mN Wlt / MPLY WITH A NO DINE Issued by: Dale g� '1 ' G
SOURCE REGULATIONS. 1-'/
Re-roofs
Signature of Applimah n t pa
H D S ATERIALS DISCLOS RE Type of Roof
Will the,applinntmfu ilding ocupamsonor handle havallous..most
dcOmd by the Cupertino to cipal Cade.Chapter 9.12.and the Halth and Safety
.section 25532(a)7
0y. 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building one ani, equipment sr devices which If a roof is installed without first obtaining an inspection,I agree to remove
cconit ca�rsuair contaminants u der, db, Say ma Air Quality Management all new materials for inspection.
Currr0Ya PNo
Himecradthehvardnus amri mqm nU..&,c r6.95.1 Czlifor.
nice Halth&SafctyCode, ,M ,255 am125534.1undc dthazif Wilding
dos not currently hart e L in nesp onimuty o tify tic upmt of the
requimmcntr Which m mal r tastmce ref.c�tirm yf Y. Signature of Applicant Date
owmr ar aaman gent 0 prem All roof coverings to be Class 'B"or better