06070152 CITY OF CUPERTINO
BUILDING DIVISION PERMIT -� ON ukke-T,
BUILDING ADDRESS: NOVO CONSTRUCTION PERMITNO,06070152
20450 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT ISSUE DATE
Is PROMETHEUS REAL ESTATE 1042. HAMILTON COURT oR /n-:I /2oo6
..NE:
SANITARY NO. CONTROL NO.
(650) 701-1500
ARCHITEC fENGLNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
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0, LICENSED CONTRACTOR'S DECLARATION Job Description%ne 1 hreby allow that 1 am licensed under provisions of Chapter 9(commencing
=W with Sceuon 90(10)of Division 3 of NC Boldness and Professions Code,wd my license
in thn mon cera effect. a79102 TI COMMERCIAL NON STRUCTURAL
l�? License Cyys Contractor F Doth Contractor
1 ARCHRECTS DECLARATION
i¢� 1 understand my plans shall be used as public mcorJs
>yU
o
Licensed Pmfcsxicnal
5 OWNER-BUILDER DECLARATION
aC L hm o alarm Nat 11. escropt from Nc Canins Co Liana Law for the
p O following msec..(Schon](131.5,Business and Professions Code:Any city ler county
m which mquima a permit to a,n s the pfic improve,h PermiN,tare a sig any Structureant $145000
prior to its issuance.ealso lequira Neapplic o for Contrarmiuo file asigncdsammem
Nat mencccnscdpuraamtothepmvisionsofdmContractorindProfsaw(CMpm9 Sq.Ft. Floor Area Valuation
��O dust he s exam
ith Section)000)of basis
l of the B ed Corr pt on.Any
Code)of
Nat h u eumpt therefrom and the bazu for the alleged esempuan AnY violation of
Section 7031.5 by any applicant for a permit subjects the applicanno a civil penally of Occupancy Type
not more Nere an fhundred dollars($500).
1,u owner of th propasy,a my errPlQYco with wage u Ne'v sole celnpesua0on,
will do Ne work and daman.u mitiou ndcd ser effered forsale(Sec.load,Busmen a
and Prefeaic, Codns not apply to e:The Conuacmes License Law dean owner of Required_ InspectiUs
prepcny who builds or lmPmvo thereon,and whodaosuch work himselfor through his
own coployces,provided that such improvements ara rat intended orefferad Tea sale H,
however,the building or improvement is sold within one your of compleuon.tine owner f f
builder will have the Wri en of proving that he did not build or improve for pur pow of p�g
cele,). bey O�
❑1,as owner ej ct property..B siness and cContainingofesswith: Tienlicensed ntracc mors I. Npg/a916�
cow La the project apply
an s Business and Professions ds or i Theves the on.I.I.
,volaelaw doeseelapplyman Owner of property who
ce WildaerImprn the ormouc and
whonse Lacts for such pmjetts with a canuacmrts)licensed pursuant m the Conma:mis rrAA..
License law.
❑1 ons exempt under See. .B k P C for this moan
Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under crafty of perjury me of the following declarations:
p 1Asm and will maintain aces+Be,mofconeenthowlf-imammrWarlicesCompen-
sation.as provided for by Section 37W of the labor Code,for the performance of the
work far which this permit is iaued. ,
0 1 have and will maintain Workcls CompcnsNen low...u recoiled by Section
37M of Ne labor Code,for the Performance of the work for which this pmmit is issued.
My Worker's Compensation Ltsu.aria and Poli,,number art:
Carter. h6e, 7„dr�r.tt Poli„Ne: L �65
C`Eyn{,L'TIFICATE OF MON FROM WORK RS'
Ca r fLfwry COMPEN ATION INSURANCE
most s,vtiae need not be complcmd if Ole permit is fmonc hunNW dollars($100)
Its'.)
I canary the in the performance of the woh for which this permit u issued.l shall not
employ any pacer in any manor.as in become subject in the Werlao'Compcnatien
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.if,after making this Ccnifiau,of Exemption,you should
become Subject in the Workefs Compensation provisions of the Label Code.you muse
wJ O forthwith comply with such provisions or this Permit shall be decreed mvokcd.
Z'N CONSTRUCTION LENDING AGENCY
P: Ihochyaffirm Nathere isaeensuuctinn lendin,agency tar the performanceof
CNe work for which this permit Is issued(Sec.3097,Civ,C.)
6W. Q Under',Name
r7 z tenants Addma
U C) 1 certify that 1 have read Nis application and sate Na dim a Wve information is
(x. E”' Corea I agree m comply with all city and county ordinances and sme laws relating w
QU Wilding construction.and hereby authorise reproenmivu or this city to elan upon the
CSJ above-ourtloned property for inspection purposes.
F, 0. (We)a,me to ave,indemnify and keep ham0us the City of Cupcnino against
eolitia,judgocna,cents and Calicoes;Calicoes;Calicoes;which may in any way accrue ainsCitygat aid
C)Z in
nsequcice of the granting of this permit. /
^ APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �. �1:.
SOU R ULA S.
o ob Re-roofs ��----
Bigmt clef Applicam/C.--m am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WSII the applicant or Imum Wilding omp ase.Or handle hicadaus mamtal
as Roca by the Cupertino Mu "'al
al Code.Chapter 9.11.and she Health and Safety
.Salyer 15531(a)7
Ely. NAll roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an agree to remove inspection,I
Will the applicant or future building coupons sex equipment or acerata which P
cors harardnus air conaminants defrmd by the Bay Arta Air Qudity Management all new materials for inspection.
Discicl7
Myna Nu
1 have mal the h eenio s mamtalsmquimmems untie(Chapter 6.95 ofth Califor-
-ia Hcdthd SOICAyCnde.Savors 15505.25533 anti 25534.1 undersand thaif Ne Wilding
X
tly have a mom,than it a my responsibility to nouly Jen acup.,of the., uabem ptortniananarracerifafmnr3ryP06y Signature of Applicant Date
a // All roof coverings to be Class"B"or better
rized agent Dam-