06020024 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONPI2 'GTORANFORMATIO I
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BUILDING ADDRESS: NOVO CONSTRUCTION PERMIT NO.06020024
20450 STEVENS CRK BLVD
ER'S NAME: PERMrf LSUEDATE
PROMETHEUS (#300) 1042 HAMILTON COURT 02/23/2006
NE: SANITARY NO. CONTROL NO.
(650) 701-1500
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION
da Z C 1 hereby affirm that I am litenud under Provisions of Chapter 9(commencing Job Description
<b witha
SfirA 7 10)of Divi' n S of Ne Biuea,and Professions Code,aM my Inc.is
in
HfullfamandeRaL 7e9�0 �a RETROFIT EXISTING CORRIDOR PARTIION
D Z Lianm lux Lie.P
�ARCHnECTS10ECLA�R�ATION7- 1 HOUR FIRE RATING
5a 1 understand my plans shall he used As public recoils 3RD FLOOR
5�u
t o t Licensed Pmfessional
3 OWNER-BUILDER DECLARATION
I I M1caby affirm Nal I em exempt from dm Canlaeta!s License law for the
ZOO following mason.(Section]ID 1.5,Business and Pmfesstuns Code:Any city or county
$ which rmuires a permit us consumer,alcor.improve,demolish,or repair any swerun
prior as its issuance.also requires the applicant for such permit to rile a signed statement
-�< Nn he is licensed pursuant N the provisions of the CarollaafsLiccnte Law(Chapter 9 Sq.Ft. Floor Area Valuation
yF$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or $149295
Yy _ Oat bthm
e is exempt erefroand the basis for the alleged exemption.Any violation of
Section 7031.5 by any appliant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom Nan rias hundred dollars(5500).
I,uowner of Ne pmpeny,ormy employees with wagesu Nc'v sok compewtion, 69-3029
will do Ne work.And timtnKdare u not intended arRc
orcd fm state(See.7W.Besi.as 00
Required Inspections
and Professions Code:The Cor;daemon,
std who law dose or apply if r t owner of tl P
property who builds iimproveschicon,endwhad.ss.hwork bimselfor through his Ya`
awn a erne tax Wilding
Nat vemimprosemenchor not intended cooffitmplati ed for Ole If,
builder..Ne building or improvement is sell a did o=year of mpro a for the Owner-
builder
of
builder will M1rve the burden of proving Nat he did not build of improve for purpose of
salt.). /
❑1,As construct the p of the Sac.property.amusia ssivnd contracting Cm1:)ceased tuna Loon l. Q7C/
enLa the project(Sec.o an Business and Professions Cade:)The Contractor's Li
cave law doss not apply m an whoa of essus(Y)wha builds or improves Comm and.
who conuacu for such DmKas lith a conu.mr(s)licensed punwm m th Contnnoh ®/
Lkense law. \/O
❑lam exempt under Sec. ,BkPCfor this recon ,
Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm,under penalty of perjury one of Ne following declanuionc
satIhm and will far by Section
37M of OnsentmCoate,far forWorkehCompcn-
workfu Provided for by Section 3]00 of Ne labor Code,far the penfa.....f dm
work for which Nis permit is tuned.
❑1 have and will maintain Wokcls Compensation W as moc,As uryuited by Sccdon
3700 of the labor Code,for Nc performance of Ne work for which this permit is issued.
My WorksGm mdutimilnsu.teecartL�r and Policy number tic:
Grrier. e �, .v/L licY No.: 1Sa0c'19 Os
CERTIFICATE OF EXE. ON FROM WORKERS'
/a rw✓CbgIPENSAD N INSURANCE
Turs.6.need not h completed If tine Permit is fora.hundred dollars(5100)
or lcsaJ
1 certify Nal in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an As k Mcome object to th Workeri Compenvtion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CeniOcare of Emmpbon.you should
become subjeel to the Worke's Compecul provisions of the Ialmf Code,you mesa
.J O fmMwilh comply with such provisions or this permit shall h deemed revoked.
Z"; CONSTRUCTION LENDING AGENCY
.�. Iheb Mon Nat them iaa consumctinn kolin a a for Nc
H Ya a .) y perfurman ear
6i the dark for which Nis.rmis is issued(Sec.3097,Civ.C.1
G0 lender.Name
z landeri Address
U Q I only Nn 1 have read this application and sum thin Nor above infartnatiun is -
D. F connect.I agree to comply with all city and county oNinamxs and sus laws rclauing to
0U building condensation,and hemby audrorine repnscnlities of Nis city ter enter Open th
r Wabovcmemionad property for inspection purposes.
Q. (We)agree to save,indemnify and kap harmless the City of Cupertino against
rF.r fA liabilities,judgmenu.cosu udexpenN.which may in any way attnm againstsaiO City
U Z in conseg..e of Ne graining of Nis it.
�^ APPLI NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date L J L
SOUR E EG TION14A
i
-d 0)6 Re-roofs
Signamr ofAppliamMon err -- ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
will tho applicant or futam building occupant stat orhan lk,hvaNuus material
�Ax Med by ash Cupertino Municipal Cade.Chapter 9.12.and Ne Health and Safny
k.Saban zssu(.n All roofs shall be inspected prior to an roofing material beim
❑Yrs Nu P P Y g g installed.
Will the. leant or future Wilding was If a roof is installed without first obtainin an inspection,I agree to remove
Applicant d pain tau ea Air Qu wt Marta which g P g
emit District? nus air contaminants u dcrincd by Ih Bay Arca Air Quality Management all new materials for inspection.
Disain? 3�
Yes IQN//u
1 have man the hvaNrms materialsuquimmenrs undcrChapter6.95of the Califor-
niaHcalth&SaelyCwdc,Sadonsl5 5.255JJ and 2SSN.l understand!Na if the building
does.t cu 11 ham a tenenk N 't k my responsibility m notify Bte casual of the
mquirem mh my eta prio missuuncc ofa Ccoifcau,of Qct cy.
� d� Signature of Applicant Date
All roof coverings to be Class "B"or better
Owncr aw etagcm Date g