06070060 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �°COIVTRACT,(?RTNFQRMATION
BUILDING ADDRESS: C LES PANKOW, BUILDERS LT 5ERMIT N0.06070060
10123 N WOLFE RD
OWNER'S NAME: PERMIT ISSUE DATE
WE:
LANDMARK PROPERTIES MGMT 2101 WEBSTER ST STE 1500 07/12/2006
SANITARY NO. CONTROL NO.
(510) 893-5170
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i0Z, LICENSED CONTRACTOR'S DECLARATION Job Description%w I hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing
$Zmwith Section?IXIU)of Division J ofthe Business soul Pmftadumr Code.and my licertm is i--�
t« in full forte and offset. NORTH PARKING STRUCTURE -Fo MACYI S @ VALLCO
>'q_ uanmclaaa Lm.a
Dam Cmnmumr TEMPORARY PERMIT EXPIRES 8/12/06
q F
ARCHITECTS DECLARATION 4 _^^^` • f�-vI
E�< I understand my plans shall bo used u public mrorJs Y+Yrv'ry-T/�v\VI/VVVA444)y
,yu
cGy Licensed Profenional
S OWNER-BUILDER DECLARATION
S 1 hereby arm at 1 am exempt from the Con"clor's License Law for the
CC following mason.(Section 7831.5,Business and Professions Cole:Any city or county
ua$9 which requires a permit In construct.alma impmvc,demnli h.or repair any swctum
0prior to its issuance,also requires the applicant for such Permit to File a signed summer,
Nat he is licensed pursuant to the provisions of the Contractor's uccpe law(Chapmr 9 Sq. Ft. Floor Area Valuation 0
e_G (commencing with Section?BOB)of Division 3 of dm Business and Profauions Cadc)or
i 3 Na,M is attempt threfrom and the basis for the alleged uemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penally of
not mom than Ova hundred dollars(s5uB). 3�P�I,rlppt,� . 00 0 Occupancy Type
❑1.asowner of the property.or my employees with wages as Heir talc compensation, 6 vv VV..33
will do the work and destruction is nm imarded maQemd for sale(Sec.]044,Business
sod limitations Code:The Centaacmes Lscepdam not Law danot apply m an dame of Required Inspections
propeny who bui Ids m impmvcs thrones,and who does soch work himul f or through his
awn employees.provided than uch improvements are not intended oroRered faradic.It.
however.the building or improvement is sold within ane year of wmpktion,the owner- /J
builder will mt.the burden of proving Nat Im did nm build ar improve for purpose of
Sam)
0 o e owner or the property.am exclusively and Impacting with licensed cnnuu,rs -
wmtroct it not (Sec?an owner
of and property
whoans Code:)The Contractors nd /
c nae Taw cts f not apply a an awns of Proper(who builds or impmvu Neuron,and -
Lwho im.contracts for such projects with a canwcmrts)licensed pursuant m the CmnBumh J
Lim.
0 l asci exempt under Sea .B&P C for Nis m,.mn
Data O�
WORKERS COMPENSATION DECLARATION
1 bembY affirm under penalty of perjury one of the following declanuans:
❑Ihsreaul will mainuinaCetiOmuofCartsenlmulfinsurtfaWartefsCompen-
sation,az provided far by Section 37M of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,az acquired by Section
37W of the labor Code,far the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance tinier and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(.Tis send.need nos bounmpleuA if the permit is fa'one handled dollars($100)
in less.)
1 Mildly lost in me perfarmanec of Jur work fm which this permit's issued.I shall not
employ any Person in my manner an az to became subject to the Worleri Compemaaan
Laws of California.Data
Applicam
NOTICE TO APPLICANT:If.after making this Certificate of Fmmpaon,You should
locations subject in me Workch Compensation provisions of the Labor Cede,you muse
.J z I'oMwith comply with such provisions or this permit shall M deemed invoked.
z"0 CONSTRUCTION LENDING AGENCY
[-� I hereby affirm that Nem is a constitution lending agency for the Performance of
LY, the ,it(or which this Permit 4 issued(Sec.3097,Ci,C.)
W� Q Lsncier's Nene
M z I<ainer Address
U Q 1 certify Nat I have mad this application and sum that the above information is
Iso. P corrett I agree to comply with all city and coumy ordinances and sum we relating m
C U building construction.and hereby amhotim termemativcs of this city to enter eirm the
6W. aho.c-menl dginincd pmpc sit for ie peNon purposes.
(We)agree,o Save.indemnify and keep harmless Jur City of Cupertino against
F' Z incoitles.judgmcn¢coasand expenses which may in anyway,accrue agaipluid City
U z APPLICAINTIUNDERSTANDS Athis
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
HAZARDOUS
E RI
Signature ofApplicaData
HAtoffor US MATALSDISCLOSURE Type of Roof
Will Nantof for=Wilding occupantSIM of handle Health and
az defined io the Cupertino Municipal Code.Chapter 9.13,mJ the Health mJ Sa(ely
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu �No
Will the applicant or future buildingaccupxnl man equipment Of devices,which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardaus air canumim til as refined by the Bay Area Air Quality Management allnew materials for inspection.
District?
Fly. ❑No
1 have mail am hvardsms materials acquirements under Chapmr6.95 of IM Califor-
niaH.Sh1h a Safely Code,Secdom 25505.25533 and 25534.1undesund matiflhe Wilding
deet not currently have a mrmt,mm itis MY reapod ibili,Y In hoary the oce.pNI of the
"uimmenm which mus be metprior to We.ofd Cerarmam of Occupancy. Signature Of Applicant Date
Owner M mtharrred agent Dam All roof coverings to be Class "B" or better