06030076 CITY OF CUPERTINO
BUILDING DIVISION PERMITS IN }RM�TI€IN
p'^'DING ADDRESS: PERMIT NO.06030076
123 N WOLFE RD # EPS4
PERMIT ISSUE DATE
OWNER'S NAME:
LANDMARK-VALLCO 10106/2006
SANITARY NO. CONTROL NO.
PHONE:
ABUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
1 O p LICENSED CONTRACTOR'S DECLARATION Job DBSCTIptIOn
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
?z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
>>y in full force and effect PARKING GARAGE-JC PENNEY
v�Z License Class Lic.8
o Date a Contractor 4, EAST PARKING STRUCTURE #4
e ARCHITECT'S DECLARATION
L 2< 1 understand my plans shall be used as public records
)WU
y Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
e,�, 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 rile a signed statement Sq.Ft. Floor Area VO
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 qq
H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or (t
i 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 APN Number Occupancy Type
not more than five hundred dollars(5500). 31620038 . 00
❑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.).
Q 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does 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
-se law.
am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Q 1 have and will maintain a Certificate of Consent to self-insure for Workces Compcn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 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 manncrso as to become subject to the Workcrs'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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z , CONSTRUCTION LENDING AGENCY
H►CA-. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(See.3097,Civ.C.)
W Q Lendcr's Name
z Lender's Address
U C) I certify that I have read this application and state that the above information is
LL�+
correct.I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save, dcmnify and keep harmless the City of Cupertino against
liabilities,judgments,co nd expenses which may in any way accrue against said City
U z in consequence a( a ting of this permit. Date
^' APPLICANT ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE RE NS. 16
- • 0,6
Re-roofs
Signature pl' t/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? � All roofs shall be inspected prior to any roofing material being installed.
❑
Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
Yes
I have read the haza w ma quirements under Chapter 6.95 of the Califor-
nia Health&SafetyCedc, coons 2 5533 and 25534.1 understand that if the building
docs not currently ve nant, at is my responsibility to notify the occupant of the
requirements whi m be me ri to issuance of a certificate of Occupancy, Signature of Applicant Date
Owner or aulhri- d agent Date All roof coverings to be Class"B"or better