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CITY OF CUPERTINO
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BUILDING DIVISION PERNUT
aulLQlIfQ4A,Ij1J6 N STELLING RD BLDG 47
UCA
WEST BUILDERS, INC.
PERMIT NO.
08050197
IIIIIIIIIIId-WI
PERMIT ISSUE DATE
PROMETHEUS
1608 4TH ST STE 120
07/09/2008
PHONE:
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHTIER7ENGINEER:
BUILDING PERMIT INFO
-
BLDG ELECT` PLUMB MECH
LICENSED CONIRACIVR'S DECLARATION
Job Description
ser uer Provisionsof Chapter 9 (Commencing
hereby affirm Nal 1 am um
with Section 70M) of Division S of NC Business and Professions Code, and my license is
INSTALLATION OF EXTERIOR TEMPORARY PROPANE TANKS
in full force and effect.
53 /)
& .
Liecnm Cl�an--��— Lie.# ,
Dam „F—�' rlr• Co oommr%531,E
FST wffVe15
ARCHITECTS DECLARATION
TEMPORARY UNDERGROUND PIPES.
1 understand my plans shall M used as Public recoNs
'
Licmued professional
OWNER -BUILDER DECLARATION
1 hereby alRtm that I am exempt from the Conoacmrs License Law for the
fallowing mason. (Scedon 71D 1.5. Business and Pmfvssiom Code: Any city or county
which me.i. a permit to C..a. mere. impmm. dsounib h- car .Pair my Smminm
Poor as its issuance. aiso m luims the applicant forsuch permit in file a signed statement
Com acmes License law (Chip., 9
Sq. Ft. Floor Area
Valuation
that he is limvcd purww in the provisions of the
7000) Division 3 Business Proresiau Code)
$4000
(commencing with Section of of the and or
. that he is exempt therefrom and the bass for the alleged eamnpdam. My violation of
32609056.)W4119"
Occupancy Type
Section 7031.5 by any applicant for a permit subjects Ne applicant W a civil penalty Of
Cot mom than five hundred dollas (SM
❑ I.uownerof the Napvry,mmy eoployce with mge uNe'v Cole compeamadon,
Required Inspections
will do the work. and the suuctun, is not munndedtar offered for tale(Sce. 70th, Budnea
and Pmfembus Cods: The ConY Licensdoes;b a Licenlaw doWt apply sh . of
l P
property who builds or improve Number. and wM doe a W h work himself or Nmugh his
-
even cmployces. provided that such improvements are not in.nded oroffcmd fersale If.
however. the building or improvement is sold within one year of completion- the owner -
builder will have the burden of Moving dw be did Wt build or improve for purpose of
YAC.]
0 1, as bwnu of the property, am a asively contracting with licensed Wnoanms b
construct the project (Sec 7064, Business and PmfessiaM Code:) The commences W-
ceue raw does not apply b an owner of property, who builds or improves thereon. and,
who eonuaes for such pmjeeu with a=tracor(s) licensed percent b the Conoacors
License law.
an exempt made Sec . B At P C for this won
Data
WORKERS COMPENSATION DECLARATION
I hereby afBtm under Penalty of perjury one of the following declarations:
❑ Ilui emdwRlmainxssna Cesditasof C...uoself.iMe.forWormes ComMo,
,
sation, as provided for by Seeder 3700 of the labor Code, fm Ne Md.. W the
work for which this permit is buteG
0 1 have and will maintain Workers Compensation I.., as required by Section
3700 of the lather Code. for the performance of Ne were for which NS Permit is sued.
My Wortrrs CompenYdon Wuraum amu aM PoRry number are:
Carrier: SrA-rP_ r-u�un PoBry No.: =S/eliiA�Q%3
ERI7Fl�PIION FROM WORKERS'
COMPENSATION INSURANCE
,
(Nis scCtiW meed our be Completed if Ne permit is forone hundred doBan(SIM)
or less.)
I caro(? Nat in to perfan ome. of Ne work for which this permit is Wood. I cineI rel
employ any partner In my mummer s0 as b became subject b the Wodmre Compensation
laws of Calrfomia. O.te
Applicant
NOTICE TO APPLICANT: If, aper making this Certificate of Exemption, you should
become subject an be Wmker'a Compensation previsi. of the labor Cods, you man
---
' forthwith comply with such provisions or this permit small W doemcd mated.
j CONSTRUCTION LENDING AGENCY
iom
' by len ding ageuy for the PerlemaWe of
thi NutMrtsacd(Sen.
t,for which 30
' de work for whim dtis permit s issued (Sec. 7091, Civ. C)
Undoes thane
ladders Assam••
i I certify that 1 have and this application and sus Na the above information is
' WInYL 1 agree b comply wort all city and county .dim n¢s and auto Ire reining to
Wilding consumcdon. aM hereby auNu mropmonandics of this City W Comer upon the
arose -mentioned pmMny for inspection purymbs
(We) agree to ave, indemnify and kecp handles de City of Cupertino agaiut
j liabilities judgments, toss and expenses which may in my way anc=agaim, said City
in conxgmnee car the granting of Ns permit.
' APPLICANT U ST NDS AND WILL MPLY WITH ALL NON -POINT
/m
Issued by: Date — l�
SOURCER 0
Re -roofs
1_ g'6t;6
Signature of4plismuromsiffor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will de applicant or fuuuc Wilding aavpanta rte or handle huardou material
MM by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety
. Section 25532(ar
❑Ye $j No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I agree to
Wan thea applicant or rums Wilding Occupant use which
Pp g P equipment or
P g remove
emit haraNnu air contaminants u defined by the Bay Area Air Quality Management
Mane
all new materials for inspection.
Dsoid7
❑Ye 26No
1 have mad the haardmumuedab mqui.mensunder ChmP 6.95errNeCalifor-
n. Health &Sa@ty Cade. Secden255D5.25533 and 15534.1 understand Nadi a building
dons Out curmndy haw a ten it my repmmab'lit b mdiry the occupant of the
require== which most t ria. of Occupancy.
Signature of Applicant Date
��
All roof coverings to be Class ';IV' or better
Owner or aathedved agrn, Date