09030065['Y OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
4 INFINITE LOOP #1L4 DPR CONSTRUCTION INC 109030065
OWNER'S NAME: I PERMIT ISSUE DATE
PHONE:
ARCHiTECIENGINEER
zo p LICENSED CONTRACTOR'S DECLARATION
C I hereby affirm thin I am licensed under provisions of Chapter 9 (commencing
m with Section 7000) of Division 3 of the Business and Profeasions Code, and my liconte is
a in full force and effect. r-
zLicense Class Lte.
Date Contractor
/ CHrTEC`rS DECL.ARATI
kb
1 unda6stand Iny plans shall be used as puhlic records
yU
o Licensed Professional
y j OWNER -BUILDER DECLARATION
j I hereby affirm that 1 am exempt from the Contractor's License Law for the
❑ o following reason. (Section 7031.5, Business and Professions Code. Any city or county
e (i 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 permit to file a signed statement
< that he is licensed pursuant to the provisions of the Conuactnes Lictense Law (Chapter 9
n (commencing with Section 7000) of Division 3 of the B usiness and Professions Code) c
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
not more than five hundred dollars ("W).
❑ L as owner of the property. or my employes with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044. Business
and Professions Code. The Contnctoes License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
owo employees. provided that such improvements are not Intended or offered for ode. 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
saleJ.
❑ I, as owner of the property, atm 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 contacts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec . B At P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury arse of the following declarations
❑ I have and will maintain a Certificate of Consent to self -Insure for WorkresCompen-
swim as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permits issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the tabor Code, for the performance of the work for which this permit Is issued
My Workers Compensation Insurance carrier and Policy number are:
Carrier. O1& L
CERTIFICATE OF EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
Clhis section need not be completed if the permit a for one hundred dollars ($100)
or Icsa)
1 certify that in the performance of the work for which this permit is issued. 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Lave of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
OCn CONSTRUCTION LENDING AGENCY
-n I hereby affirm that there is ■ constnrction lending agency for the performance of
x the work for which this permit Is issued (Sec. 3097. Civ. C.)
Z) A Lenders Name
z Lenders Address
O I certify that I have read this application and state that the above information is
L ) correct. I agree to comply with all city and county ordinances and sate laws relating to
D U building construction. and hereby authorize representatives of this city to enter upon the
Uabove -mentioned property for inspection purposes-
y (We) agree to save. indemnify and keep harmless the City of Cupertino against
fin liabilities, judgments, costs and expenses which may In any way accrue against said City
4 in conse4uence of the granting of this permit.
-APYLTCANTUNDERMWNDS ANUW,tLI�-COMPLYNMK-AI.L-NON=POINT
_ HAZARD S ATER ALS DISCLOSURE
WIB the applipnt o fu ding occupant store or handle hazardous material
as defined by the Cupertino M I Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)7
❑ yes No
Will the applicant or future buildin Occupant use equipment or devices which
emit hazardous air contaminants as ed by the Bay Arca Air Quality Management
District')
❑Yes No
1 have read cite hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code. Sri dons 25505. 25533 and 25534. 1 understand that If dx building
does not currently are a tenant, dat it irs my nsibility tonotify the occupant of
requirementsch nust be met prior to issit3ptpfofa Cetifxax of Occup-A.
(650)474-1450
Job Description
CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
TI INTERIOR ONLY/DEMO INTERIOR NON-BRNG INTER
PRTNS& CONS INTER NON-BRNG PRTNS&FNISHS-1ST FLR
ONLY.
Sq. Ft. Floor Area Valuation
1350000
APN Number Occupancy Type
r31602108.IL4
Required Inspections
Re -roofs
Type of Roof
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class '%' " or better