06060092CITY OF CUPERTINO
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BUILDING
BUILDINGDIVISION PERMIT
uCONTRACTORI , ,,'
BUILDING ADDRESS:
HILLHOUSE CONSTRUCTION
PP'IM'TNOD6060092
20400 STEVENS CRK 4 850
OWNER'S NAME:
PERMIT LSSUE DATE
PROMETHEUS REG.
1670A ZANKER
07/24/2006
IF:
SANITARY NO. CONTROL NO.
(408)467-1000
A0.CHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PWMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job DOSCIlpnOn
I hereby grim Out l am licenced under Poomm" of Chapter 9 (commencing
with Section 70sM)) of Division 3 of the Business and Proressiam Code, and my license is
0, full Tome andefrect. s'93 L g
DEMO/TI COMMERCIAL OFFICE SPACE
License Class Lie. g tG
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Dam -C7�Geometer iII Noesis SG 7e i
ARCHITECTS DECLARATION
1 unxataod my plana shall w used as public meet&
Licensed Professional
OW NER-BUIIDER DECLARATION
I hereby alArm Nal I am eacmpl from the COnmctors License law for the
following mason. (Section 7031.5, Business and Professioe Code: Any city or county
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which requires a permit m eorwuet. sore. impmvc, demoRN, or sepal, any atmetum
$160000
prior m its issuance, also requires the applicant for such permit to file a signed suument
Nat he is licensed pursuant to to provisions of the Coma:turi License Law (Charter 9
Sq. Ft. Floor Area
Valuation
(commencing wRb Section 7(00)of Division 3 m(the Boommes and Professions Code) or
Nat he u exempt themfrom and the basis for the alleged exemption. Any violation of
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or
not more than five hundred dollar (M).
❑ 1. as owner of Ne pmprny, a my emplmyces with wages as Heir sok eompensetion,
Required Inspections
will do the work. and theawcmre a not intended or offered forms, (SM. 7044, Busincas
And Pmressww Cox The Commissars License law does et apply m sa owner or
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property who buildsorimpmws thereon, and who doessuch work himselforturough his
Own employees, provided Nat such improvements are Dot intended oroQered forsale B,
however, the building or improvement u sold within me year of completion. the owne,
builder will have mm bode. of proving Out M did not build or improve for purpose of
-
Ago.).
❑ 1, a ower of the pmperty, am exclusively contracting with licensed ronmctor w
cmisimet dim project (See. 7m . Business and PrerWlm s Cade:) The ConlreW's Li.
come, law does not apply b an owner or property who blit& or improves themen, and.
who contracts for such projects with a contra smr(s) tieeneed pursuant w the Contractors
Licence law.
p BI
❑nem eaemDt under See .Bk PCfmr Nu reason
Owner Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of perjury rn Of the following declaruuons:
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Ihave m twill rumugn aCcrufs®tear Cmnsemmself-imem forwmimes Compen.
sation. u provided for by Section 3700 or the Labor Code. for the performao¢ or the
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were for which Nis permit is issued.
❑ 1 have and will maintain Woreces Compensation Insurance, as myuimd by Section
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vv (- 2 J
3700 of the Labor Code. for the Performance of the work for which this permit is issued.
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My Wmrily—COmpemadon hnu. prriSjod Policy number am:
�r IIV+/ ll/'V�?_
Camer.'�5,pv��.a[ it.1DMs'Policy No.; 14 SCA
CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
(ibis section need norbe completed if tho permit u forone hundred dollars (SIM)
fur lett)
1 certify Out in to perfamenee of the work for which this Permit is wood. I .Nall not
employ any person in any manerse u N become subject to lite Worker' Compensation
Laws of Cahrianda Dau
Applicant
NOTICE TO APPLICANT: If, after making this CeNficam of Exemption, you should
become subject b use Workers Compensation pmvWons of Ne Labor Code. you most
comply with such provisions or Nis Permit shall be deemed tevolow.
CONSTRUCTION LENDING AGENCY
I mouthy affirm thm thea is a construction lending agency for the im furmance of
the work for which dtis permit u issued (Sec. 3097, Civ. C.)
Isnders Name
Lenders Address
1 certify that 1 have mad this applicatimm roti stats Out Ne above Wro u ht. u
cont¢ I agme to comply with all city and county ordinances and state laws relating to
building construction, and hereby mum ize mpmsenta lves Of this city m enter opno the
a1wns-mem0oned prolvrty for inspecuon puymses.
(We) a,me to rove, indemnify and keep hareless Ne City of Cupertino against
liabilities, Judgments, casts and expenses which may in any way acrnse against said City
in consequence of the granung of this permit.
APPLICANT UNDERSTANDS ANDYILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REC�y(.ATIONS. i u'
Re -roofs
Type of Roof
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1
Si t&
graaurco pp .can 1USMATERIALS DISCLOSURE Dau
Will the applicaun or forum wilding occupant atom orhandlc hvallous material
as defined by 0u Cupertino Municipal Code. Chapter 9.12, and the Health and Safely
Cale. Section =2(a)?
0y. WNu
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wilding occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mit hmasunus it contaminants as defined by the Bay Arta Air Quality Management
all new materials for inspection.
District?
❑Yu Wo
I havemad Nehvan m=rialsmyuimmcnuunder Chapter6.95afthe Califon
ria H-1th& SafctyCOde, Sa .25505, 25533 and25534.1 tmxsund thatif the building
does not curenrly hoc a tenant, Nat' es my mpmmibility to houfy, the mccupam or the
myuircmcnts ihmuv metp m of. CcNfuamofOccupancy.
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Signature of Applicant Date
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All roof coverings to be Class "B" or better
ownermraut orae age Date I