06070083 CITY OF CUPERTINO r � '^�" ' (y`
BUILDING DIVISION PERMIT RCOAI,TRAGT(jR INORMA' ION
BUILDING ADDRESS: a HILLHOUSE CONSTRUCTION PERMITNO.06070083
20450 STEVENS CRK 5T
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS 1670A ZANKER RD, 08/01/2006
E:
SANITARY NO. CONTROL NO.
(408) 467-1000
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: ,, BLDG ELECT PLUMB MECH
Bopp LICENSED CONTRACTOR'S DECLARATION Job Description
no F 1 Wnby affirm that I an limned under provitiau of Chapter 9(Commencing
IiE with Section IM(l)of Division]afthe Business and Professions Codc.and my liccma is
.3H ;n full forteud ecT. I . -NEW WALL CONST/RELOCATION OF (E) LIGHT
�„y z Liccnu class Lic.d S93 G L
; o Dam Cal. r FIXTURES-NEW ELECT/TELEPHONE DATA OUTLETS
ARCHITECTS DECLARATION PER PLAN DESCRIPTION.
i m< 1 understand my plans shall he=it u public records
lyU
o t; Liccnmd Professional
3
OWNER-BUILDER DECLARATIONnuch
)00 I hereby. alarm Not I em exempt from the Corms;Co License Law for the
:00 o fallowing vires a (Section]OJ L5,Business ud Profdimmns Code:My can sir county
which its requires a permit pe construct,ither.applicant
ireprove,deermitt,sir repair any nrunce,
pnorm its issuance.also rtquithe thcapphcut farsuch pctor's .asLaw(Cakmcm
Wm far is Ikamscd pursuanuo Nc Provisions of Nc Conuxur's limnse law(Chaparr9 Sq. Ft. Floor Area Valuation
2�2 (commencing with Section 7")of Division J of the Business=it Professions Code)or $484411
a 5$ Nat Ins u exempt therefrom and the basis for Ne alleged esemptiom My violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number Occupancy Type
nm more this five hundred dollen(ISM).
36901828 . 88
❑Luownu oldie property.sir my cmploym with wgraasthcir wk Compens.tion,
wed Profession
eane Ne the Cotisnotbiarmdede Law
apply
an,Bee,of
era property
who
ou Code:The Convector's License law doer out apply m nt owner of Required Inspections
property who Wiprovi i s t avv thereon,andwht are
intended
nt won notation ffr.rNrough his
own employees,biprovided this such improvements wins au not ear ofe oroedred for Mewl!.
haikkor.on buildingondess oproArusoldwithin arcyd or mproefor use owoer
Wilder will have tit WNan of proving Nu Ym did rot dull w improve for purgsu of
mky
❑1,as monarp of project
property,.m exclusively inend conuantng with licensed mnuacwn U. �
cclumbia=
Neproject(Sec.](ao,wner of andrty who
Code)Themdamsn.sar's and
jq
who law dams not apply Co in owner of property who Wilds or tmprovu Norton.and.
whom auacu for such proJ:cu with a canuacmHs)limned pursuant m the Contractor's
Lkcnm law.
❑lam exempt under Sm .B its PC for this,sawn �
Droner
Data � Z006
WORKER'S COMPENSATION DECLARATION
i hereby affirm under penalty of podury one of the following declarations:
.siva and pmyi*l for by a Cion 37Mfictuc of Continuo Cade,for the Wonefs ce of the k\1�Sf/I
n as provided far by Section 3]00 of the Later Code,far the perfotmarce of the
wort[for which Nii permit is ivuN.
Q 1 have and will maintain Worker's Compensation Iruuranm,as required by Section
3700.17 the labs Code,for dar performava of Ne work for which this peme,I,issued. '
My Workefs Compe//pp��ssauon InreaTrpro c--aaa�pin.c aand Pot_i5y)�tumber an:
Citric /L7[ L YNY PoltryaN4o/� 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(T3tisunloo rad not ComospinW if the permit is foram hundrtddollan(SIO.)
or less.)
I Comfy that in the Performance of the work fa which this Permit is issued.l shall tat
employ any pawn to any mannerw u in become subject in no Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,After making Nis Ccniftcam of Exemption,you should
become subject m the Wooer`s Compensation provisions of the lahar Cadc,you mum
.JO foMwith comply with such provisions or this permit shall be decreed ravelled.
zC7 CONSTRUMON LENDING AGENCY
[-+► I hereby.IRtm Na Noe is.emuv mm lendrtisi ay for the perfmmimm of .
TL>
the work for which do;permit is Wood(Sec.3091.Civ.C.)
fA Lcmic's Name
D'
z lender`s Address
a
U.O I certify that I have read thisapplication
and county
and soar the and
above l information in
U. F Correct.I agrm m comply here y city and county matins of and sok laws r upon t e
V building construction,and hcrebyamhonmreoses. tivcs of Nis ciymcnmr upon Nc
ahovc-mcnuunedproptny for expenses purpwhich ma
H y (We)agree to save.indemnify and keep harmless the City.(C.Pen;..against
Z liabilities,ence of ts.Stan and 0 3 which may in any w'+Y attme agalnsssald City
V,z in consequence of Ne panting of Nis reit.
APPLICANT UNDERSTANDS 'IL COMPLY WITH A NON-P INT Issued by: Date
SOURCE&EQU NS O� O/
Re-roofs ,
Signature of Applican a cmr em
HAZARDOUS MATERALSDISCLOSURE Type of Roof
Will Neapplicant or future Wildingmcupans,9.1ahandle Heardou mammal
u Cast.
Sm by the Cupertino Municipal Cade.Chaparr 9.II,and the NealN and Safety
Sade,oY us3tta)? 541. All roofs shall be inspected prior to any roofing material being installed.
Will the, scant or future building occupant use equipment If a roof is installed without first obtainingan inspection,I agree to remove
PP C e y preens or devices which IJ
hmardnns air Conumiwiu u defined by the Bay Arta Ail Quality Management all new materials for inspection.
a?
QYu ANp
1 have read Ne haameus reacrialemquionames under Chapisr 6.95 of Ne Califon
ria Hcahh&Safelycodc.secoom 5505 5535 and 25534.IuMcrsNnd Naif die building
docs trot currently have.tenant the,' s my noponability to reify the ema mr,or the
mqutmmcn hmum met rmissa .I.cntifiatea Signature of Applicant Date
O o All roof coverin s to be Class "B"or better
Owner sir auN.tirc0 gem Dec' g