04010131 CIIN
TY OF CUPEWFINO
BUILDING,DIVISION PERMIT CONTRACTOR FORMATIONr
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BUILDING ADDRESS: DPR CONSTRUCTION INC PERMITN1b4010131
c-n TJ TANTATT Aug
ER'S NAME: PERMTf ISSUEDATE
i
NE: SANITARY NO. CONTROL NO.
e
(650) 474-1450
ARCHITE-CTIENGINIZER
474-
ARCHITECr/ENGINEER: BUILDING PERMIT INFO J
BLDG ELECT PLUMB MECH
C7 O D O
jdo LICENSED CONTIed under
DECLARATION Job Description
F 1 herehy affirm that I an licensed unacr pmvisiom of Chapter 9(commencingit
`Iy' with 5cmian ))of Division 3af NC ami rad Prufcnsinns Code,and my license is �
^ � in full I.. ec. TI--SINK
�= Licen 11 ContrLie.0actor
FINALE
PIT
�= DOW `�-w Cummcmr ,
# C an m IARCM( used puhii records D i
go000 Licensed Pod anal FEB 12 2004 1
WNER-BU B DECLARATION
E 1 hcmhy a mm that I am exempt from the Contractors License law for the '
00 following mmnn.(Section 703 Lsine
5,Buss and Profeuiona Calle:Any city or county .I
K g� which requirns a Permit in construct,elle.improve,demnllah,or repair any structure al III
4;j poor to its issuance.also rtquims the applicant for such Permit to Glc a signed statement
3� n1h1M 2000
that he is licensed puravU
ano the previsions mf the Contractor's License Law(Charter 9 Sq.Ft. Floor Area a M ion
(commencing with Section RXXd of Division 3 of the Business and Pmfeutons Code)in
^$ Net he is eaempt themfmm and the basis far Ina alicged exemption.Any volution of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of 3]/�ID8�It3fibet00 Occupancy
not more than five hundred done,,(SYNy. Type
❑1.as owner of the property,or my employees with wages u their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business 1
and Professions Code:The Contractor's License law dors not apply to an owner of Required Inspections ?
property who builds or impmvv thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended oroRered for sale,If,
however;the building or improvement is sold within one year of completion,the owner-
builder will have the burden or proving tMI he did not Wild or improve for purpose of I
sale.).
❑1,se awmr of the pr.p ot,,am exclusively mourned,with licensed conuacton 1. {
common the pmjem(Sec.71114,Business and Profusions Cade:)The Convector's U.
tonne Law does not apply to an owner of Finnerty who Wilds or improves themon,and
who contracts for such projects with a comractar(s)licensed pu®ant to the Contractor's
License Law.
❑I am exempt under See ,B A P C for this reason
Date
WORKER'S COMPENSATION DECLARATION
1 hereby armor under penalty of perjury one of the following declmtians:
I have and will maintain•Certificate of Consenuo self-insum for Workers Compcm
Orion,n provided for by Station 3700 of the Labor Code,for Ina perfonatmen of the
work for which this permit is clued.
I have and will maintain Worker's Compensation Insurance,as;Ili by Section
37013 of the labor Code,for the performance ofthe work for which this Permit is issued. I�i
My Workers Compensation lnsanna artier and Policy numberaR:
mer.Al4rL b t#6AI F{�d Policy No.:
CERTIFICATE OF EXEMPTION FR ORKERS' 1
COMPENSATION INSURA CE
Fins seetion need not becomplead If be Permit is formic hundred dollars(SI00) Jtl
or lea)
I calory Net in the performance of the work far which this permit 4 issued.I shall Out
employ any Person in any manner an u to hecomuubjectto the Worked Compensation
Laws of Cal ifomla.Data _ {
APPlicam '
NOTICE TO APPLICANT:IL after making Nis Car ifiaa of Exemption,you should i
become subject to the Worker's Compcmation provisions of one IaMr Code,you must
.J O forthwith comply with such provisions or this imned,sh.11 be deemed mvnked.
Z h CONSTRUCTION LENDING AGENCY
vase I lamhy than our there is a construction lending gency for the Perfmmenm of I'I
lY ti thc work for which this permit is issued(See.3157,Civ.C.) -
W Lendcel Name
J z Lcodn's Address
U O 1 certify that 1 haw mad this application said state that the above Information is
pg, cormeL I agree to amply wit all city and county ordinances and state laws relating to
0 building construction,and hereby iuthodre mpresenmiws of this city to enter upon the ^,
[Ll abovomentiuned property far impecdon purposes l
G (Wc)ague to save,indemnify and keep harmless the City of Cupcnina against f
In liabilities,judgment coats and expenses which may in any way accrue against mid City f
U Inconsequence of the granting of this permit.
APPLICANT UNDERSTA14 S ND.WILL COMPLY WIT N A L ON POINT Issued by: Date
sq�p E ATIONS ) '.
"/ = N /d� Re-roofs
gators Apples v onApplic t/ ontnclar Dale
�HAZ RDbu§_MA ERIALSDISCLOSURE Type of Roof
Will Neapplicantar forum buildingoccupant nomor handle
asMunicipal
ardousSafety .. r
defined by the Cupertino MunicipalHc
pal Code.Chapter 9.12,and the Health andd Safety
e.S 1yiaa.25532(a)? iia All roofs shall be inspected prior to any roofing material being installed. �qr
Will the epplicam or future building occupant use eyulpmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hanrdnu air mmuminants u defined by the Bay Area Air Quality Maagement all new materials for inspection.
7::,
in?
❑Yu P1 Nu
I have mad the hersrdrms materials requirements under Chapmr6.95 of the Califor.
ealth h SafetyCodc.Sections 25515,25533 and 25534.1 underalaM that ifthc Wilding
hility a notify the occupant of daccmrwaao(OeSignature of Applicant DateAll roof coverings to be Class "B"or betterhmniea�6cnt Dam 'j
.f