05080066W
U
Y OF CUPERTINO
INFORMATION
BUILDING DIVISION PERMIT
CONTRACTOR
s:
HILLHOUSE CONSTRUCTION
PP'fMITND'05080066
4
JN
R'S NAME:
PERMITISSURDATE
PROMETHEUS 850 8TH FL.
1670A ZANK R
2005
E;
SANITARY NO. CONTROL NO.
•
(408)467-1000
ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG PLUMB MECH
IfELECT
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hereby reform that, l am licences ander provisions of Chapter 9 (mmmcmes
With &,do. 7M) ofDivWon 3 of the Business and Profnssions Code, and my [iceme (a
I. full farm and, 9 �/
TI --2 WALLS TO CREAT SERVICE RM
Damxe 1 - - cmmove fid
MOVING 3 HEADS ADD 2 SPRINKLERS &
ARCHITECTS DECLARATION
INFILL (E) DOOR /3 OUTLETS
1 understand my plana shut] he used as public mentlrs
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I em exempt from the Contractor's License Law for the
following rumor. (Section 703 1.5, Business and Professions Code: My city or county
which requires a permit m construct. aims. Improve. demolish, or repair any atecture
poor on its issuance. dm requires the applicant forsuch permit m BIe a acgrted assmmem
be is Conuecmfs license Law 9
Sq. Ft. Floor Area
Valuation
mss licensed pursuant in the provisions of the (Chapter
(commencing wire Section 7!X10) of Division 3 of the Business roti Profession&Cmk) or
_
$14592
that he . axempl therefrom and the basis for the alleged exemption. My violation of
APN Number Occupancy Type
Seomon 70313 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than Ove hundred dollars (5500).
D 1, M vanes of the prumny, or my employcua with wgu u their sok compewJon,
will de tik work and mesuuctum b ecrmtinunded.offered t l..k (SM.7044, Business
r's License w does not apply m an owner of
and Profession& Cade: The Mumla
Required I s o 7 r
property who builds or improves thereon, and who does such work Mm ctfor mrough his
l/
own employees, provided that such improvements art not moral or offered for sale If.
however, the building or improvement is told within oro year of completion, the owner.
builder will hew the human of proving mat W did nm build or Improve for pugsom of
AUS
&ale.).
co Les ower of the property, one exclusively contracting with licensed i.
unbacumrs
caoswn the project (Sec, Business and Professions Cade) The Conlncmr.
o in and
cense Law dote Out apply to in awtva of poprnY who buim& or Improves thereon, ted,
/,,�
who camas.. forsuch pmjem with a mntrcmr(U Ikencd puratum m the Contractors
License law.
m exempt under Sc. . E 8 P C for lots meson
Cgy(rl yg�/'Jj f n
FW
r Dam
WORKERS COMPENSATION DECLARATION
1 hemby affirm under penslty of perjury arc of me following demntionr.
haveend will mdnuin a CeniOnm of Consent m xelf-inaum far Wah exCompcn-
I
, sm provided for by Section 37M of me Labor Code, fm Lha performmuc of me
._
for which this permit if lsmed.
have rend will mdnuin Wallace. Compensation ksuranm, as required by Section
of IM Ichor Cade, for the performance of um work fmwhirm this permit ashamed,
arkee, Compensation Insurance carrier and Paltry number are:
Cartier: C=T DAd/�. il7hlki o"cy No.:h ��
CERTFIGTE,OFFFXEM��TIONFRO WORKERS
COMPENSATION INSURANCE
(Tbla comm reed not accompleed If lle Permit isforonchundmddollan (SIM)
or leu.)
1 certify that In the performance of the work for which this permit Is banned, I shall not
employ any person in any manner an u In immerse subject to the Workers'Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making telt OmiRmm of Exemption, you mould
become subject in the Wonser'a Compensation provisions of the TaMr Code, you must
forthwith comply with such provisions or this permit mall be deemed mwked,
CONSTRUCTION LENDING AGENCY
I hereby affirm met them is emnwuctimt loading agency for the performance of
me walk for which Jus permit Is caused (Sec. 3097, Civ. C.)
Tender's Name
,
Lender's Address
1 mNfy that I haw read this applieatlod end tum that the above informNon Is
correct. l agree to comply with all city and county ordinances and stsk law rthdng he
Wilding construction. and bemby usthoore representatives of this city In mks NO the
also".mendoned property for Inspection purposes
(We) agmc in saw, indemnify and keep handles, the City of Cupertino against
liabilities, judgment, emu and expenses which may In any way acme, against said City
in consequence of the Starting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURrEGULATION .
!� 1/6
Re-roofs r
Type of Roof
Sign um aJ'Applican ter Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or forum building oecYpamstme or handle hvardaus material
Med by the Cupertino Municipal Code. Chapter 9.13. and the Health and Safety
. Smile. 25531(.)7
D You z9 -
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will rite applicant or future building Occupant use equipment or devices which
It havardous air cantsminants as defined by the Bay Arm Air quality Management
all new materials for inspection.
tstrim7
Dyes v�
1 have mad the haus dos matedds requirements underChap arli.95 ofthe Califor.
nia Health AS r tyCedc, Sc d.75505,15533 and 25534.1 command lots lfdso building
dace not currently hew a main. that It 4 my responsibility an naul'y the occupant of the
regdreme tswnkn muss be a rte isumce or a certificate or Drcapanmy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ow
eroraumorixcdeg Date