01020086 CITY OF CUP6RTIN0
nutt.DtnG Dlrlsto:. PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: DPR CONSTRUCTION I Nu'1'NO. 0102008b
20450 STEVENS CREEK BLV GG�..F
(1WNIIR'5 NAMli'. I LIGAfIDN SUJAay,,a.i�„]1'dt� '
CUPERTINO CITY CENTER A SOCI'AT 555 TWIN DOLPHIN
I'IIONIi:
E50) 592-4800 SANI'T'ARY NO. CONTROL NO,
(
a90%O ARCHITECI'AiNGINHER: BUILDING PERNIIT INTO
pt❑ BLDG Ii1.E,7F PLUMB MECH
SSW 1-1 I_I 1=1 1=1 .
y�y
S foln[ACle9CD COcenRACIOR nalcli DECLARATION Job Description
0 L= I hev,hy uffnn r:r la:,licensed provici�me of Chapter')IammmncinF
y F.w wall Section TNMBufllividnn3uf Wt,BminnnmN l'mlene'ionp Code.and nrylias TEMPORARY PERMIT
zY^ is full force and.
s w License ase Lic.p�� O
O e Ua,e - 7 Connaclnr n'1 I( b
3'+ ARCHITECT'S DECLAfi7\T]ON
F 1= g 1 undersrnJ n,y pl my ehu11 be used no public ncod.0
}
m v o Lhensm rmm..im,nl
%a( f1WNlilt-❑UII.IICR hour
Im Co cralN
W z 1 ceiro aft inn t1at1 am cxcn,pt from Inc C..ion, re Licmuc Low tort the
t—].¢ %hien ing res s ti,enn,io17031.5.Business and pool de roll Code Any dry fir county _
O which rc4uircsne.alsoreenn.ame,aper,improve.h permits orreWir any gedswnere
nt
Prior mite issunrc.:dsumb,th,lw applicant or such permit License gm(Chamrnl
(comarx ingwdpne Section fD.iisi n3oftheEla<mc,andP l;,wlsnarvery Sq. FL Floor Area Valuation
or that he is a with Section on and
a Division 3 0l the alleged
ws and Professions Calc)
r Thalia is exempt tacrefrom noel the basis for the alleged exemr t to Any vitiationcanly
Wf are.....e ILSW m1yopplicvntfornpermit euhjectx the applicommacivil penalty
fir na muse n,a:,live 11a1mrcd ddmer 1:6580). APN N,9ly6 1 029. 01z1 Occupancy Type
01,no owner of the prupanly,onny employees with wages as Their sole u:1„raa:nion.
sort d the k J the urione is.,if intended fir offered f (See 9044.
Bu'rneos and Proes%ion,Cooke:The c t errs L eeme Law does not apply to an 304 — �Igfgd klls'I'g4)RsI CAL
owner of property Who ho build o mP ms s ,hereon,and who doe,,such work himself
,r through his own employees.provided that such improvements am not intended fir
oBercJ for.role.H.however,the building or improvement is sold within one year of
iompletion.theowncr-hudder will have the burden nfproving that he JW not build or
mprove for putpna of safe.).
01.a of the croy,no v,cla,orl,cnmmaing with I—ewd aunm:mon m
......rm,l h p 1 't(So,,91144 Basalt— ]fine .. ,eC dc:)Tire L hatrorx
Licaid L olives Itapply
such 011 I ry '1 poli P n tho the
aid sic t t' such projects ':J, IM licensed pursuantto the
fir I License'
0 I nm cscmpl unJm lea. .e&P C f nh ..in
Owner Date
WORKIiR'S COMPENSATION I(1N UIiCL\RATION
I hereby Allen under perally of per,inD one al the followmg declarations,
• 0 1 Lava and will maintain a Cordillera,of Cnneent to orb-insure for Worker's
Cnmpcnsmiun, us provided fur by Section 3700 of the Lnhof Codes for I)to
,,to... of Tho xsxA ILP which thin permit is koated.
01 have and will lnaintain Worker's Comprnmtion Insumrc as rcyuined by Section
39110 of the Labor Code.filethe
Wiformancc of the work for which this permit is
ol.
Pfic
Card :M�C-0-oLz ON(11'1 XtriGMI'N'ONcl9t(IDt �L-
//1���' COMPBNSA'I'ION INSURANCL'
(111, ccuum need not be completed if the permit is for one hundred dollen
01118 in le".)
I verify that in the peffermance of the work for which this Ibcromi is issued.1
shall not employ any person in any manner m as m weather subject to the Worked
Conlpersainn Laws of California.Date
Applicant
NOTICE To I APPLICANT:11.ala n akin,it...Cerf,r,efe of Csemp on.you should
hearnne"alb,alu fire Worker,COmpcnsanon, s nnG
s lthe Lanur ale.yrs: m:pt
Q O Ilvthwfth comply with such provisions art this l a mol nh:dl he deemed revoked.11
Z
F' CUNSem is a cONLENDING AGENCY
I hk for eli n thus three is u caned sore. lending,C.) tonne performance
none work for which phis pem,it is oaueJ ISec.11N],Civ.C.l
L Q [.endcr'x Name
;5Z Lcndcr'x Address
U 1 eerily thin I first,read dr,appli,mon or I ,am that he alove iofnnnatinn is
ria H .Yt.I ngnc m urn*with:Jtotally
I oily 1md nnllnances:uW elate laws relating
ro lndldingonmutfun.a (hereby amend,mpm...alevcn of Ulk err m emc-rpm,
�s fs7 file move-memntioned property Int h,xpce,im,purpnew.
F.:
M. (We)agreen,wee.mounalfy and keep hxrndem the Cityor Copcnln,upainst
fn liabilities,juJgmind,costs and expenses which may in any way acerae against said
U Z City inco,aagnence of the granting of this permit.
APPLB` 'UNDESl'ANDSANDWILLC(1MPLYWITHALyNONPOINT Issued by: Date
SOUR,; IGUI I Ny�� ,.. /.^ / Y
SiF:bmore 0f phcmulContrnaaa (� Dar— Re-roofs
Ili\%AI<UOUS MATERIAI,ti DISCLUSUkF,
Will the applleont n1 future wilAing:xuupanurtnc fir handle ha.am0ne lnwudul Type ul'Roof
,is shined by the Cupertino Municipal Cock,Chapter 9,12,and the Hcolth and Solely
Code.Senile 255321a1!
0 Yes ON. All roofs shall be inspected prior to any roofing material being installed.
WiN the applicant or future heading roupanl use eyuipmem nor des ices whieb If a roof is installed without first obtaining an inspection, I agree to remove
emit hamrdous air comaminams as learned by the lay Arca Air Quality Mann,anent
Daniel, all new materials for inspection. Applicant understands and will comply with
0Ve, 0 N all non-point source regulations.
I nave rod Int,fivurlist x m.."nal,1'cynirmnelnn under cnup,er h 45 of the
Lord rn!a Heallh&safety Cn It,Sections 25505,25513 and 25594.1 unJeamnd that ,
if the building dors an currently have a Tenant.Ilw1 itis my respunsihilay In mtily the
or, Ce i1icam of
keu ( J
2��� Signature of Applicant Dale
Owner ra ;edrgr,t Irate All roof coverings to be Class "Bb'or better
OFFICE