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06050182 CITY OF CUPERTINO ZR +�TN BUILDING DIVISION PERMIT e PERMIT NO. BUILDING ADDRESS: 123 N WOLFE RD DPR CO PERMITLSSUEDATE OWNER'S NAME: -jANDMARK PROPERTIES MGMT 1450 VETERANS BLV 01/16/2007 SANITARY NO. CONTROL NO. jNE: (650) 474-1450 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description d U I hereby affirm shat I am licensed under provisions of Chapter 9(commencing e Z M with Secuon 7000)of Di'' n 3 of the Business and Professions Code,and my license is REVISION FOR THEATER SUPER STRUCTURE. a'o H in full force and effect ORIGINAL PERMIT #05110089 ? License Claw CCWNrsyor r t Date I ARCHITECT'S DECLARATION a< I understand my plans shall be used as public records �yU Oin Licensed Professional n 3 OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the L a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county 0.9 which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation Z 4n prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 1' 0 YF (commencing with Section 70tH))of Division 3 of the Business and Professions Code)or J2 that he is exempt therefrom and the basis for the alleged exemption.Any violation of �p�Number Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3162003 7 .`l7Y!' not more than five hundred dollars(5500). ❑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 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cade:)The Contractor's Li- cense Law docs 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. B&P C for this reason ❑1 am exempt under Sec. owner Date 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 Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work foor which this permit is issued. J Qtve and will maintain Worker's Compensation Insurance,as required by Section 00 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Irtstrrance carrier and Policy number arc: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 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.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 Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY F~t ham. I hereby affirm that there is a construction lending agency for the performance of p! the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name a Lander's Address C)z 1 certify that I have read this ppli 'on and sate that the above information is L>~ correct I agree ro comply with 1 ty and only ordinances and state laws relating to U building conswction,and he thortz representatives of this city to enter upon the above-mentioned property for" ctio urposes. W (Wc)agree to save,' c nify d keep harmless the City of Cupertino against liabilities,judgments, ¢expo s which may in any way accrue against said City in consequence of t¢E qg of is permit Date C)Z APPLICANT UNb AND D WILL COMPLY WITH ALL NON-POINT Issued by SOURCEREG Re-roofs Signature o Appl ontractor Dare T of R oof DOUS MATERIALS DISCLOSURE Type Il 'app ant Of future building occupant store or handle hazardous material as define the pertino Municipal Code.Chapter 9.12,and the Health and Safety Code, SccUon25532(a)? �j All roofs shall be inspected prior to any roofing material being installed. (:]Yes ( If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contami is fined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 1 have read the a ous materials requirements under Chapter 6.95 of thc Califor- nia Health&Sa C ons 25505,25533 and 25534.1 undcrstartd that if the building docs not curruh h e to t that it is my responsibility to notify the occupant of the Date requirement¢ M st met prior to issuance of a Certificate of Occupancy. Slgnaturt Of Applicant All roof coverings to be Class"B"or better Owner thori gent Date'