03050108 CITY OF CUPERTINO '° R �%^ r✓�wl. '99e'��
BUILDING DIVISION PERMIT WC 0NTRe, 'T,0 INFO ATION'Ah
BUILDINfj Da DPR CONSTRUCTION INC PERMIT NO.03050108
ER'S NAME: 1450 VETERANS BLVL$ 2/2003
JEER PFRMTANRTF,
PHONE: (650) 474-1450
SANITARY NO. 'CONTROL N0.
ARCHITECTMPIGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
10o
LICENSED CONTRACTOR'S DECLARATION lob Description
U I hereby ari that 1 Am licensed under pm.ants of Chapter 9(commencing p
wIII Sectlon]llq)of Divielan Sof Nr,Business-ijrofcaiun%Cm1w.nd my I1mnse ie
< in full forte ffm
jE? Lim nsoC Lk.N ,98g1(o DEMO
DAm
ARCHIIF.CI'SI or
it ATION0. eNSi'QIK1/pwl
I IF I and my plans shall he used u public records ill
C\>yU V
-u
Licensed Professional
OWNER-BUILDER DECLARATION \S
p2 I hcrthy.(Stns that 11. exempt from the ficsom ,Co License Law for the
O Which on oral a (Sadat 8151.4 Bulinus and wc.damns Code:Any city or county \)
5_fL PAW its MR1•permit a WAmUIM toot alar.improve,is permit i ore.sign d madam
-Zan tharw its&aaarumwraqulms too for Conrctoilmmnawiglmdauamcnl
C the menciensodpuraamtto )orDisiom nfthe MBuxmr'ed fteWon(Chapter9 Sq.Ft. Floor Area c2 Bl9lOn
2 $ (commcndtawithominate anddo Divisions themegenexeantlon.Anyvl Cnde)of
Nel he a evmpt thertfrom and the now for the alleged exemption.Any vlohtion of
Section 7031.5 by arty applicant fora permit subjects the applicant to a civil penally of 3 AIN ftbttet 0 0 Occupancy Type
tat mom Nan It handrail dollar(5500).
❑1,u owner of the property,of my employees with wage,u their sole compensation,
will do the work,end the swctme is not intended or offered for aide(Sec.7044,Business /U4 DEMO
And Pmfeselans Code:The Communes License law does not apply w in owner of Required Inspections
property who builds or Improves dsemon,and who does such work himself Wit his
own employee,pmvlded that uch improvements are notimended oro@rad for ale.If,
however,the building m improvement is sold within one yea of completion.the owner
builder will have the burden of proving that he did Act build m improve fur purpose of
ale.).
❑1.as Owner of the property.am exclusively wnuuling with licensed commons to
construct the pmjen(Sec.7016,Business and Professions Code)The Conuseto 3 U-
Anse law does not apply At an owner of property who builds or improv damon,and.
who contracts for such pmjem with a contractor(s)licensed pursuant men Conuaculs
Lkense Law.
❑I set exempt under See ,B k P C for this rteson
r Dan
WORKERS COMPENSATION DECLARATION
1 hereby alrnm under penalty of perjury one of the following deebrstitns:
❑I have and will maintain a Certificate of Consent to self-insum for Wmkefs Compete
cation,As provided for by Section 3700 of the labor Code.in,the performer.of Am
work for which Nis permit is issued.
1 have and will maintain Worker's Compensation Insurance,As required by Section
3700.(,he Lobar Code,for the pedormaam of the work for which this permit le Issued.
My Wmktrs Compematlonlmu—raQnco1c Ppr�srr'aend Pt ram:'
Caricr. IEtIBptFkprsYl{._91olky .: 7015-.g8
CER11FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tho wedon need not he completed if she permit is for one hundred dollars(SIW)
W tea)
I certify that in the performance of the work for which this permit is load,I shall not
employ any ponew In any manner a a a become abject to the Workers'Compcnsnlon
laws of California.Date
Applicant
NOME TO APPL ICANn If,after making this CcdiOeaw of Exemption,you should
become subjml in the Wohof's Compensation provisions of Am Labor Code,you raw
.,Z fonAwish comply with such provision or this permit shall M deemed revoked.
Z O
CONSTRUCTION LENDING AGENCY
[r I hereby affirm that Nett its mosinretinn lending agency far the PCrfmmme of
l�> the work for which this permit Is issued(Sec.3097,Cie C.) \
W
0 Lender,Name \`
7 z LcndWs Address
O Q I comfy that 1 have read this application and sum that the above infmmniun la
W toren.I agree to comply with all city and county ordinances and Stow laws rtlNng m
0U building construction,and hereby authorim repreenativ of this city to Anter upon the
tLl above-mentioned property for Inspection purposes.
W (We)Agra to save,indemnify and keep harmless the City of Cupcnint against
h liabilidea,judgments,cases and expenses which may in any way acnes against said City �a5
t.) Z in cansce,ence of Ne granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:qJ4_(2�1Date
03 Re-roofs
rtaf Iia .1.1 Dow
ORIS MATERIALS DISCLOSURE Type of Roof r
Will de-aPpiii Or future Wilding occupant pons m handle hoommus material
As
dclined by do C,Amno Municipal Code,Chapter 9.12.and the,Health and Safety
•.SC 25s32(a)7
❑y. (y�Tlo
All roofs shall be inspected prior to any roofing material being installed..
Yes
Will the applicant or future building occaparl use equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
emit Inam nus air conuminanu As defined by the Bay Arta Air Quality Management all new materials for inspection.
Disuicl7
❑Yes g5vo
I have mad the boallous materialsmquiwmenes under Chepwr6.95 of the Califon
tie Health A SafelyCode,Section 255(15,25533 and25534.1 undersand use ifthA building
does not currently have a unant.Nal it is my maponsibility amily tinoccupant of thc
wqutmmm veli( must ' rmi,AaAmaofaccmOA of curacy. Signature of Applicant Date
owner ser .sent ZDam All roof coverings to be Class"B"or better