08050191 CITY OF CUPERTINOr a
BUILDING DIVISION PERMIT '£4 ONTRACTOR4N 0"ATa.,10N-
BuaPERMIT NO.
Rir�c VER. STELLING RD BLDG 58 WEST BUILDERS, INC. 08050191
AM PERMIT ISSUE DATE
ROMETHEUS 1608 4TH ST STE 120 07/09/2008
PHONE: SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHI'fER/ENGiNEpI:
BUILDING PEBMITINFO
" BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTORS DECLARATION Ib Description
mC 1 Naeby affirm Jus 1 ser lla sed under prmOeRGnPovmcm;of Chapter 9(Com
encing
ZW withSCnimr7WD)afDiYW 3artheBusinessuadProfessioeCode.and mylicenceu INSTALLATION OF EXTERIOR TEMPORARY PROPANE TANKS
<< in full forte ane erfa �r�5"yG`(J A
j Z Licence Cksyr.� CLk,o.I YJ J1' &
�-7-y'ARCHTrecrsDDEcuR TION TEMPORARY UNDERGROUND PIPES.
I understand my plans shell he used u public records
;yU
g e Licensed Professional
3 OWNER-BUILDER DECLARATION
.�i F I hcmhy eRrm them 1 am exempt from the Contractor's License Law for the
following mason.(section 7W I.S.Business and Professions Code:Any city m county
v
5$ which noucs a permit tocert 4 slier,improve,demolish.or repair any sound.
zy prior to its issumce,alt require theapplieant for such permit to file a signed statement
s�o that he is licensed pursuant to the provisions of We Commcur's Liccnm Law(Chapter-9 Sq.Ft. Floor Area Valuation
�r5 (Commencinj with Section 7(00).1'Division Sof the Business and Prefessimudc)ar Co $4000
S $ Jut heu eamept WOnfrom stud the basis for the alkbW moureption Any vblat{an of
Section 7031.5 by any applicant for a permit subjects We,appikanl in a civil penalty of
not mart Nan five hundred dollars(SSW). 3 2 6 0 9 0 5 6 AMN"k-7 Occupancy Type
0 I.as;owner of the property.or my employees with wade as Web sok campers salon,
win do thC wads and theavumme u notintendeA ser afford fmssk(Soo.]W4,Busiws
and Professions Cade:The Commodes License Law docs rot apply m an owner of Required Inspections
property who Wilds.,Improved thereon,and who does such work himself or through his
awn employee,provided Jut such improvemeau are not intended Or offered fa sale U.
however,We building m imp c.is sold within one year of Canpktion,the ownm-
builder will have the burden of proving that he did not Wild or improve for puryose of
ask.).
0 1.a caner of the property.and exclusively Connotes,with Bceescol cons rs m
continues the project(SCc.7064.Business and Protestant Cade:)The CoomnoA U. _
cense Law does not apply m an owner of property who builds or improm themmn,and.
rhoconmeaforsuchpojemawiths=m r(t)lie,nsed pursuambNeCanrsesofa
Liss.Law.
67
am uemptundm See ,B@PCfa Niamison
67
Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,ane of the following deckmtiara:
Ihsw and will mainuina Cenifiom of Caruenlmself-insurefaWohefsCampen-
radon.a pmvkkd foo by Section 3701)of the Labor Cade.fm the performance of the
wort for which Was permit is issued.
0 I have and will maintain Wofleds Compensation Insurance,as,required by section
37110 ofthe Labor Cade,for We perormanneo wart for which Nu permit u issued. '
M crier.keYa Co 'on ins c�rti '4561A01)00
�Policy number art:
Carrier: (x�r C7.f licy No.:
CERT1FICA7EOFEXEMPTION FROMW RK172S'
COMPENSATION INSURANCE
film;senlan recd not bc<anplcad if the permit is faros hundred dollars(sl W)
or loss)
1 certify that in the performsnee of the amt for which Nis permit is issued.l shall Trot
employ any person in any mannerso u to become subject to We Waders'CompceNan
taws of California.Dare
Applicant
NOTICE TO APPLICANT:IL after making this CeNOem of Fsemption.you should
become subject to the Workefs Compensation provisions of We Isba Code you much
0 O fo WwiN comply with such moviLoru or Nu permit shall be doomed revoked.
z CONSTRUCTION LENDING AGENCY
[-+ 1 hereby affirm that Jerre is s ImOr u Linn knot b.,rcy for Ne prf.aarxe.f
Nc work for which this permit ta issued(Soo.3097,Civ.C.)
ZLentlCYs Name
.r7. z Unites Address
1'J O 1 cmify Nat l lure read Nis mitilea io,and sum Nu the above information is
LL C.meL 1 agree m Comply with all city and county ordinances and sate laws misting to
.c) Wilding carurmmien,and herby anNodm repmsrnatim of over city m..up.Ne
4 above-m,jOdSnd ts.cos farinspnlan purposes
(We)agree to taw.indemnify and loop hurtles Ik City of Cupnino against
IiabiliJesjudgmenta.costa andcarp,-•--which may in any way sacnue abaiml.ssid City
(„) z in 17 71C,
of ebrantinb of Nis lamiL
^ APPLICANT D R ANDS AND IL OMPLY WITH ALL NON-POINT Issued by: Date �j 4;110 F
SOURCE R C
Re-roofs
Srbnuure a!
HAZARDOUS
Date
xAznrsn0U5 MATERIALS DISCLOSURE Or o RE Type of Roof
Will JoaC-"ufuture i ldingaeupaptrmcm handl Hath and
0ned by Ih Cupertino Municipal Cods.chapter 9.12,and We Health and Safety
.SeNen❑Yrs 25532(a)7 WNo All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will We applicant or furore Wining Paul use cquipmmt m device which $ agree to remove P
emit hazardous air conuminanrs as dcfincd by We Bay Arta Air Oddity Management all new materials for inspection.
Dimic17 P
SYe MIN.
I have
reactive lta NuumredalsmGuimmenounJrChapms6.95oflheCa)ifor-
nuxcatN&Safctyco Cu 251)5,25533 J 36.Iundmstantl Naiflhe Wilding
dace nor.moner l'M s Jw it u m n lily m rosily the occupant of the
rognimmrenta which a �c nU.m r � Signature Of Applicant Date
gJAll roof coverings to be Class';W'
Owner or aumhar cd ager Dam' $ or better