06100028 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �1 'IZ�iC C� Imo( RM . ... . ''
BUILDING ADDRESS: PERMIT NO.
10123 N WOLFE RD DPR CONSTRUCTION INC 06100028
PERMIT ISSUE DATE
'BR'S NAME:
.LANDMARK PROPERTY MANAGEMENT 1450 VETE
SANITARY NO. CONTROL NO.
PHONE:
(650) 471-1450
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0
cc LICENSED CONTRACTOR'S DECLARATION Job Description
U
P I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
:Z cru with Section 7000)of ' isio 3 o[the Business and Professions Code,and my license is REV I S I ON-T I THEATRES ORIGINAL P ERM I T#
ha0.
w in full force and eCf
i License Class Lk.#
A 06030175-EXTERIOR ELEVATION "FOR REFERENCE ONLY"
Dam ITE&S F�ARA ARE NOT APPROVED UNDER THIS T. I .
i x< I undo nd my lans shall be used as public records
)yU
Licensed Professional
H OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve.demolish,or repair any structure
-Z y prior to its issuance,also requires the applicant for such permil to rile a signed statement Valuation
_ that he is licensed pursuant to the provisions of the Contmcwr's License Law(Chapter 9 Sq.Ft.Floor Area
I- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9999999
r,R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of T Number Occupancy Type
not more than rive hundred dollars($500). 31620067
,�V
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law does not apply m an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under See B&P C for this reason
er Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Lode,for the performance of the
work for which this permit is issued.
and will ma' rain Workces Compensation Insurance,az Im by Sectionof the Lbor C jo the performance o(the work for which it is issued.
My Worker's Comp ti Insurance carrier and Policy number ar
Carrier � Policy No.:
LATE OF EXEMPTION FROM WORK
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z" CONSTRUCTION LENDING AGENCY
F~-h CA I hereby affirm that there is a construction lending agency for the performance of _
(Yi> the work for which this permit is issued(Sec.3097,Civ.C.)
Lender's Name
z Lender's Address
U C) I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
0U building conswction,and hereb orise representatives of this city to enter upon the
W above-mentioned property feu,
or spcctiauthon purposes.
Q. ree to save,' dcmnify and keep harmless the City of Cupertino against
r�r !NHAZARDOUS
.cos and expenses which may in any way accrue against said City
V Z of c g Ling of this permit. Date
►+ U DE ANDS AND WILL COMPLY TH LL NO -POINT Issued b)
S. /. _"t
%�
'` (/' Re-roofs
plicantlConuactor D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
de,Section 25532(a)? All roofs shall be inspected prior to any roofing m
fiaterial being installed.
[:]
Yes
Will the applicant orkfuturc building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 have read the hazy o materials requirements under Chap 6.95 of the i
cor_
nia Health&Sof Code, cions 25505,25533 and 25534.1 undo d that if the ilding
docs not cu have tenant that itis my responsihili to no&y y the Occup t of the
requiremen ich t be met prior to issuance of a Ce hca r pan . Signature of Applicant Date
zzAll roof coverings to be Class 'B or better
Owner oLmfhori7.cd agent Date