06030067 CITY OF CUPERTINOga-`
BUILDING DIVISION PERMIT S CONTRACTOR INFORMATION'
BUILDING ADDRESS: NOVO CONSTRUCTION PERMR No,06030067
20450 STEVENS CRK 1ST FLR
�1[NER'S NAME: PQthff[LSUEDAiE
PROMETHEUS 1042 HAMILTON COURT 04/25/2006
ONE:
SANITARY NO, CONTROL NO.
(650) 701-1500
A0.CHITER/ENGINEER:
BUILDING PERMM INFO
BLDG ELECT PLUMB MECH
0 0 0 0
;op LICENSED CONTRACTORS DECLARATION - Job Description
wF I hereby affirm that 1 am licensed under pruvidoes of Chapter 9(commencing p
�Zy, wise Seetion7IXM1)of Division Jof the Husinu atW[+ro(essiou Code.atW�t yliceveis
]Zsy
in full g�Giip2 NEW WALL CONSTRUCTION/PARTITIONS/NEW CEILING
z License Cl Li[.a
� Dam Can., 12:1 1JC3 LIGHT FIXTURES/NEW FLOOR
ARCHLTECTS DECLARATION
1
9, I understand my plans shall W used az public records
Ica
G� Lixrnmd Professional
N 5 OWNER-BUILDER DECLARATION
f 1 hereby affirm that I am exempt from the ConoacmYs License Law for me
:CC following recon.(section 701.3.Business and P nlesriuns Code:My city or county
3q_ which requires a Permit m construct,alter.improve,dcmoluh,or minor any structure
ZY prior m is issuance.slag require the applicant for such Permit to file asigned statement
< Nat he is licensed pursuant to the provisional of the Contractor's License Law(charter 9 Sq. Ft.Floor Area VaICa1J815000
«� (commencing with Section 7000)of Division J of the Busmassand Professiau Code)or
$ that M is eumpt therefrom and ft basis for dum alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects me aWlican to a civil penalty of APN Number Occupancy Type
cot seam than five hundred dollars(M). 36901029 . 00
❑ w
will do the work,.ad meawaum is out unsound ar aBered for sale(SM.loan,flowmss Required Inspections
and Professions Cade:The ConvacmLiss
ureas Lsn oee Law denot apply s an owner of q P
property who Wi Ids m im proves damage.and who does such work himself o mmugh his
awn employ..provided that such improvements..or intended eronesd forsom.IL
however,me building or improvement is cold within ore year ufcompktim,the ewncn /
builder will have the WNcn of proving mat k did oat build or improve for purpose of
aakd.
❑1,as owner of the property,am exclusively contracting with licnud contractors In
construct the project(Sec.704a,Business and Profusion Code:)The Con uses',U.
cense law docs cot apply to an owner of property was,builds or improves merwn,and
who contacts for such projects with a eanuscmr(s)licensed pursuant to the Contractors -/0/
License law.
❑l oro ucmptundn Set .B&PCformia.von
Das /WORKER'S COMPENSATION DECLARATION
fro
1 hereby as under penalty of perjury arc of the following dnlarauone: O/
C)Iham and will maintain aCertiftus of Covent to self-insure fm Warkcrs Compen-
.can.As provided far by Section 37M of me labor Cock,far she perfomanec of the
work for which oris permit is meed.
❑1 have and will maintain Worker,Campcamion Inama ce.as,required by Section
3700.f the labor Code.for the perfaommectfine wok for which this permit is Lound '
My Workers ca nnevation mon.corrin,and Poli,nu fcr D
Cartier. ST Pa,VL Poli,No.: /
CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu scrim need not bo completed if me permit is forces hundred dollars(SIM) a
or tut)
I certify mat in the performance of me work for which this Permit a isacd,I shall not
employ any person in try manneran as to become subject to the Workni Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certifium of Eaemption,you should
become subject to the Workers Compensation provisions of me labor Code,you mug
.JO foMwidN..Ply wish such provision o mu permit shall bn deemed revoked.
z CONSTRUCTION LENDING AGENCY
4 Ihemh grim Wt then is a eonstaxdm[endin a
(^� the work for which dlu B gena'for the Perlwmmm of
ai permit u iumd(Su.J091,Civ.C.)
[gl Q fenders Name
jz 1<nders Audreu
U Q 1 sonify that I have read his application and sum that the abmx information to
Ly correct.1 agree to comply with all city and county eminences and sus laws relating to
OU building construction.and hereby authorize mprenuvn m the
uof this city enmr upon
ahove-me mm.o da,grounds,
for inspection putPeses.
F y (We)agree m ears,indemnify and keep harmless the City of Cupertino against
Vy liabilitln,judgmcnu.cosu and expenw which may in any wayaecmc agaivtuid City
V z in nee of the Bunting of this permit.
PPLICA UNDERSTANDS AND WILL Y WITH ALL NOWPOINf Issued by: Date
OVRCE EGU
11 (D r� Re-roofs
Signewrcaf i< eARDO! Dam
HAZARDOUS b MATE RIALS DISCLOSURE Type of Roof
Will ds applicant or future building occupant emrc or handle Health g material
az dc0Sed by 725 Cupertino Municipal Code.Chapter 9.11,and she Hulse scot Safety
'•k,Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu u '
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicam m forum bttyyyald ng he num eyvi imem ar Ikvicn which P g
emit havardmu air conuminanu aa�Cfimd by the Bay Asea Air Quality Management all new materials for inspection.
DistricR (]/
❑Ya No
I have mad the Weardousmamriau cruumkrChapter6.95oftheCahfm-
niaHealm&Safety Ceue,Sec.nW5. 5JJ S34.lunuc dot irtmldin
Jun not cu ctrl,have a mnam,that it u .11, te 'y the rise
not at'-h apuo ormivaauaeo C rte r Signature of Applicant Date
Gwaerarsoman;cl agent Date All roof coverings to be Class"B"or better