04120064CITY OF CUPERTINO
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BUILDING DIVISION PERNIIT
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BUILDING ADDRESS:
NOVO CONSTRUCTION
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2.0400 STEVENS CR
ER'S NAME:
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PERMIT ISSUE DATE
PROMETHEUS
1042 HAMILTON COURT
19./10/2004
ONE:
SANITARY NO. CONTROL NO.
(650)701-1500..
ARCHITECT/ENGINEER: ' ...
BUILDING PERMIT INFO
BO ELECT PLUMB MECH
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LICENSED CONTRACTORS DECLARATION
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1 MmbY a1Rrm Nu i am littnssd shier pmvidoes NCIUPur 9 (rommcncind
wlNformanMl110of DlNdon Jof ds Budrea uld P,ofeismm Code, andmylicc�u
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License, am ', Lic.d
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ARCHITECTSDECLARATION
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I understand my plana shall he used as public records
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Lueeted Prowasioesl -
'. OWNER -BUILD ER DECLARATION
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I hereby affirm that 1 am aetnpt from the Contrano s Licence Law for the
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follnwing mann. (Samoa 7031.5, Business and Profaaioes Cade: Any city Or county
Impmw. dcmnllah,
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which. requires a permit m conuruct. slur. m mpdr ay auuetum
poor to its issuance. also requires the applicant forsuch permit to file a signed mmMCm
thathe is licensed pursuant the provisions of the Convector's Limme law(Chapter 9
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(commencing with Section 7000)of Divlown 3 of the Business and Professions Code) or
that he Is exetnpt Netefmm and the basis for dm alleged exemption. Any violation ofiP`�
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Section 7031.5 by any applicant fa a permit mbjests the applicant m a Clvll penury of
tmt mom than Bw bundmd dollars (4500).
Uy
0-1, as Owner of the property. or my employees with wiles a Neu sats compcomon.
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Required Inspections
will do the work and Neawclum is not intended or offered fonsle(Sm. 7044, Business
ub Profession, Code: The Comeames Uccon law does net apply m an Owner of
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propertywhobuilds or improve thereon.and whodmssuchwmk himalforthmugh his
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we employer, presided Nat such(mprammenu ate noHnwnded croffered for aide. If.
hownvnr, Ne building or improwmenl is am within am year ofcompledon. the Manor.
builder will Mw the burden Of proving that he did not build or improv for purpose Ofso"
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1, as Owner of the property. am excludwly contracting with licensed conmetars in-
numact the project (Sec. 7044. Basins and Professions Cade:) M Conuators U.
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ate law does not apply to an owes orpropenY who builds or improves demon. ad
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who contracts for such projects with a conuac,or(O limited punuam m Ne Contractors
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License Law. '. - , v,
❑ I am exempt under Sec. _i ,B& P C for this newass
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W RKERIS COMP NSAIT DECL(�
I hemby afMn under pw1,Y !perjury am of mC allowing declaationu:
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I haw and will maintain a Certificate of Conant to teff -moss for WOrkeh Compen--
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adon, as provided he by Section 3700 of site labor, Code. for the performance of Ne
work for which this permit le issued.
❑ I haw and will maintain Workers Comracemon la smm, as required by Section
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3700 of me labor Cade, for Ne performance of the work for which this permit is issued.
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My Workers Compeaadon Insurance carrier and Policy number ate:
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COMM Policy No.:
. CERTIFICATE OFEXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Tbb=ian nmd nal 1pcompleud if the pamlt 4 foronc hundmd dollam (5100)
or less.)
I comfy Mast in we perforce. of the work, for which No Penni, Is issued, I mail am
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employ any person inmysubmerse ambecome subject mtheWorkcn'Compemakin
Law of Cslifamia. Dam
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Applicant
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should
become subject w the Workers Compereation provisions of the Iabr Code, you must
forthwith comply with such provinces or this permit Mail W deemed mvoked.
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LENDING AGENCY
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rN~..CONSTRUCTION
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1 hereby Orion ties, Nem is aconmuWars lending agency for the performance of
the warkfar which this Permit is home! (Sec. 3M. CJ,. C.)
QIsomers
Leaders Addma
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I certify that 1 haw mad Lids applieadon and sus that the show info rnadu t is
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corset. I agree in comply with all city and county ominas:m and slow laws misting in
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building construction, and hereby authodre mpmsenmims of this city to Crum upon sic
above-mendoned property far impecdon purposes.
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(We) agree to taw, indemnify and keep harmless Ne City Of Cupertino agaiest
liabilities ,judgments, costs and expenses which May in mal way amus against said City
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In comeguence of the grating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N -POINT'
Issued by: _ _ Date
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Re -roofs
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HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
applleal or fumm Wilding occupa, am Orhandle hamar oos material
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the Cupenlno Municipal Code. Chapter 9.11• W the Health and Safety
t531(a)7
twoapplicant
All roofs shall be inspected prior to any roofing material being installed.
a roof is installed without firs[ obtaining an inspection, I agree to remove
or future building acumen, use equipment or devices whichIf
sir emiummants as dcimed'by Ne Bay Arm Air Quality Management
all new materials for inspection.
District
❑Yes �Nu
I haw mal site hiu mmr materials aqui mmem under Chapter 6.95 of the Cil i for.
No Health& Safety Code. Sredau 255G5.25533 and 25534. I understand Nu ifthe Wilding
docs not mrsamly how a mart, Na Il lr my mePa hili,y w notify the OCCUMM Of the
which run CLPeter m welaac or a CCmfeam Of Occrpary'
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Signature of Applicant Date
All roof coverings to be Class "B" or better
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