05050127 CITY OF CUPERTINO tv • 9v�exw'`+ `� �'�* '` ` t u ��;;'
BUILDING DIVISION PERMIT X-ONTRA NOWINFO
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BUILDINGADDRESS: DPR CONSTRUCTIONy INC PERMIT ND.05050127
Inn RnMERTRAn Rn
OWNER'S NAME: PERMIT ISIRIE DATE
KAISER PERMANENTE 1450 VETERANS01/04/2006
E: SANITARY NO. CONTROL NO.
650) 474-1450
ARCHITECTfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
3 o LICENSED CONTRACTOR'S DECLARATION
1 hereby aOlrm Nal I am licensed under provisions of Chapter 9(commencing Job Description
with Section 7008)of Division 3 of the B Wmrseated professions Code,and my license is
inrdl(a.and eRatt
canso Clue Lk,{ REVISION--DELTA 9 & . 10
�? Ll
Data Cormactor NO NEW PERMIT ISSUED ORIG. #05010092
ARCHITECTS DECLARATION
I understand my plans shall he used u public records
5 m� Licensed Pmreuional
+��a OWNER-BUILDERexemptDECLARATION
<q I maseereby.m.(Sex that 1a.1. exempt ,n tic Contractor'sCoe:A nu law for the
oO which following maser.permit
](DL;BWnusand vs,demolish.
Code:Any mymroomy
$ which its ile s permit ne ennstme4 alter dmf for such
ri repair any auunum
�y Prior hscensed C,11190pursue tus the lhcappin of for Connermrlmfika,Law(ned statement
< Nalhaklittnscdpurmanrmthe pmvisiouofthe Canuactmslittvelaw(Chepter9 Sq.Ft. Floor Area Valuation 52
$ (.am.es exempt
with Section and
Qu basisoo r th the aged exemption.
on.Myosa laden of
That ha e exempt thertlrom and IK bore for the alleged exemption.yay Hokson ter
Secdon 7031.5 by say applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy e
nor ram than fin hundred dollars(M), 31609037 . 00 p yTyp
0 1,u owner of the pmpmy.ter my employers veto mgea u tlee cele compenudon.
will do the work and the su scone 6 notin¢Med moRered for We(Sec.70s/,Business
and Pmfcashms Cade:The Ommacmr's Lt..Law dose not apply m an owner at Required Inspections
Property who builds ter imposecat Hereon,and who dos such work himsel f ter through his
own employee,Provided that such Improvements are an,intended Mortared funk.If,
however.the building or improvement is sold within ane year of completion,the Owner- ,a
builder wl0 law the burden of proving Wt but did of build M Mprove rear purpose or C' \
rah.). C
0 1,u owner of the Property am exclusively canhacting with licca ed cm usclam to .w
to.La tides act tpply 0/I,Business and rty he Wildons .
or Tm.theam,U. \
cane taw does not apply m ts owner at property he sed p or improves themaa,and
who concocts for projects with a canlremr(s)licensed pursuant to the Contractors
Law.
0 1 am 1 em exempt under Sea ,B k P C far this Troon
Owner Gate
WORKER'S COMPENSATION DECLARATION
I hereby fran under penally of perjury arc of the following declarWmu:
I have and will maintain a Certificates of Concent to self-inaum fns WmkebCompen-
utlon,u provided fns by Section 3700 of can Inbar Code.for the performance of the
work far which this Permit is iuuM.
0 1 haw and will maintain WMker's Compemadon Insurance.u required by Secdon
7Wof the Labareedc,for the panormaMe of the work fwwhkh this pemth is iaaed.
My Workers COmpe®Nose Immono tinier and Polity min acr are:
Cartier. Polity No.: _
CER IFIGATEOFBKEM PnON FROM WORKERS
COMPENSATION INSURANCE '
(Thissatim decd ntbecompleted If tin permit is(mance bundrtA dollen($100)
Or less.)
1 ttniry that in the performance or the work fm which this Permit is blued,I shall not
employ any person foray mnmrso as m become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cceifiutc or Exemption,you should
become nbjem m the Workers Compensation provisions of the Later Code,you muse -
00 tarthwith comply with such provislom ter thermstil
is permit"I be deemed revoked.
q CONSTRUCnON LENDING AGENCY
F Ihereby of on that them Is a construction lending agency for lite performance,of
0. the work for which this permit Is issued(Sec.3097,Cih,C.)
Wy Q Lamicris Name
z Lcnders Address
U0 I certify that 1 haw mad this Application and mrd mat IM above information k
4,U co=t.l agree in comply with all city and county ordinances and sue laws whaling to
0 building eanatmction.and hereby authorise reprawnwives of this city to enter arm,the
D7 shove-memidgm property for irupcmmn purpowhich may
gy (We)agree to saw,indemnify and keep harmless she City of Cuperd am against
In in liabilities,judgments,ofhecauand ex peau which may in any wyattme against food City
C)7 A APPLICANT
NDER TANffifing of this D WILL
t� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by; Date
SOURCE REGULATIONS,
Re-roofs
Si{nuurt olApplieaRData
HAZARDOUS
S MATERIALS DISCLOSURE Type of Roof
Will the a Cupertino
or(serum building oc Chapter
nom m handle hoodoos material
u de.Scd o Ilia 32(a)9 Munielpal Code,Chapter 9.12:and the Health and Safely
Code.Secties zss3x(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑rte ❑rva
Will the applicant or future building accul l use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i
thenrdous air contaminants u dc0ned by the Bay Arca Air Quality Management all new materials for inspection.
Otos ONu
I haw read the hassmous materials requirements under Chapter 6.95 ofine Califor-
al"Sarerycade,Seetmu 25503.x5533 and 25534.1 iwenaM thatrtthe building
not cumren0y how a term,that It is my MaNuMbilty w nasty the oceupnt of the
rements which rated he MCI Poor at issuance oncenncatearoccupancy. Signature of Applicant Date
Owner or avthodnd agent Dam I All roof coverings to be Class aBa or better