06050181 71 7 77 7
CITY OF CUPERTIN0
BUILDING DIVISION PERMIT RA URI-.
PERMIT"o
DPR CONSTRUCTION INC .06050181
BUILDING ADDRESS: ,
10123 N WOLFE RD PERMIT ISSUE DATE
^"'NER'S NAME:
LANDMARK PROPERTIES MGMT 1450 VETE SANITARY NO. CONTROL NO.
PHONE:
(650) 474-1450
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG EO PLUMB MEECCH,
i pO LICENSED CONTRACTOR'S DECLARATION Job Description
m C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
e Zm with Section 7400)of Division 3 of Ute Business and Professions Code.aJnd license is
<a. in full force and affect. ��( � TEMPORARY PERMIT FOR TI ORIGINAL PERMIT 0511008
Licen C?! Lic.x EXPIRES 30 DAYS FROM ISSUANCE 6/22/06
} Contractor
eF °ate - pARCHITECTS DECLARATI N
C a U-cl I understand my plans shall be used as public records
)y
oH Licensed Professional
H OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
co following reason.(Section 703 1.5,Business and Professions Code:Any city or county
a$ which requires a permit to constructalter,improve,demolish.or repair any swcture
prior to its issuance•also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation $0
-?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �l
tZ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
not more than five hundred dollars(5500). 31620037 . 00
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Conuwwr's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec .B&P C for this reason
-ner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decls$ations:
❑1 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 Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.-
My
ssued.My Worker' Compensation rance tamer Policy number arc Mu/5
Cartier. : Policy No.: t� V C?
CERTIFICATE F XEMPTION FROM ORKERS'
COMPENSATION INSURANCE '
(This section need not be completed if the permit is for one hundred dollars(5100)
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.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Codc,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(~.t I hereby affirm that there is a construction lending agency for the performance of
[Y> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
correct.l agree to comply with all city and county ordinances and state laws relating to
0 U building conswction•and hereby autho'e representatives of this city to enter upon the
W above-mcmioncd property for inspcc' purposes.
W (We)agree to sav,indemni and keep harmless the City of Cupertino against
P.t) liabilities,judgments, is and nses which may in any way accrue against said City
V Z in consequence of ranting is permit. Date
►+ APPLICA U RSTA S AND WILL COMPLY WITH ALL NON-POINT Issued by: J
SOURC G ATIONS
Re-ro6(2�
ofs
Signa of Ii
ntractor Date Type Of Roof
H OUS MATERIALS DISCLOSURE
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
"ldc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which
If a roof is 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 haza ous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safc ode, tions 25505.25533 and 25534.I understand that if the building
docs not curie It tenant that itis my responsibility w notify the occupant of the , Date
requirements ich themetpriorwissuanceplaf�crtificofoee�panry. Signature of Applicant
`[ All roof coverings to be Class 'B or better
Owner OfAutowpetigcrit Date