08080209 CITY OF CUPERTINO m+e.>rsBNkx�« � ,lel *:%Y $''c�n
IT
DIVISION PERNIIT "RCUN RAC�'TQR'�IN. ORM�A,T IQN,
BUILDING ADDRESS: PERMIT NO.
70150 STEVENS CREEK BLVD HILLHOUSE CONSTRUCTION 08080209
R'S NAME: PERMIT LSSUE DATE
11ROMETHEUS 140 CHARCOT AVE 08/26/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
MINOR ALTERATION TO 7TH FL. BLDG ELECT PLUMB MECH
FIRE)VIBE NEW
�oo LICENSED CONTRACTOR'S DECORATION O O O O
S�= Ikmbyainrmthat lsur llcawed under provisions ofChapter 9(commencing -__. ..___.._ .-. _____.IobDescription
n? with section 7000)of Division]of the Busincu soul Prefosuaw Code.ands. I' I
? In full fame and effect
License Class U. g .513 6
Dam LL�-Conlnctor /
ALTS OECI.aRAT10N C O ( d
Q 1 understand my plants shtll o used u public records
ktad Licensed prefew...l
5 ta Oal I am a ompt( DECORATION
1 bamhy.Imre that I am oxompt from the Contractors
.:A n c ty o for to
O 6 following moon. ecom, 701J.Badness and Profesaioro Coda:Any city or county
9 whim its Issuance.
ton reennawetpplicoprow,domolW,ore A sig mystructure
that he its wnM,alLllul In the
the
ovisio sof for such Congo ten's Ehase Law
statement
<
(commencing
llaweJpueswntmdmpmvivision3the CanuacmrYLmwelAw(Chapte9 Sq.Ft. Floor Area Valuation
B that he
exempt Section of Division of theeged Business An vi Cade)or
Nat k M exempt themlrom and me beta far 0c alleged eumptian.Any violation of
section 7071.3 by any applicant for a Permit subjcces the applicant to a civil penalty of APN Number Occupancy Type
not ream than live hundred dollen(SSW). P Y YP
❑I,uowaer ofdcproperty.or my employees with wagwu Neirmleeompewation,
will do thtwodt.and the structure,is rmtimmded m o@red for sale(Sec.704/,BudmAs
ane Predicted..Code:TM Contranmrs LIcense Law does Out oat apply m an odder of Required Inspections
property who bullas orimpaowta thermal,and wk does rucn woak himself pr through his
own employees,provided mat such improvements me not intended motioned forsale a,
however,the building or hnphu.t Is sold within me year of completian,the owxr-
builder will Mw the Maden of proving that he did net build or improve for purpose of
nleJ.
❑I,u owner of he property,am exclusively contracting with heeded coneacmfa m
construct the project(!inc.7044,Business and Professions Code:)Tk Cmuacmr's U-
Mass Law does not apply in an owner of property who builds sir improve themem.and
who contracts for such pmjccm with m ennu ctupO licensed punwnt in the Contractors
Lleenm Law.
❑1'rea mnep tsodersee ,Bk PCfarthismamn
Dam
WORKERS COMPENSATION DECLARATION
1 hereby aBim under pointy of perjury ore of the following derlantiorta
1 M.and will maintain a Ceninomol Consent no self-alum for Workers Compoo-
salon.as provided for by section 5700 of do Labe Cade,for W perfameanm of the
woak( hieh this permit is ihmd.
haw and will maintain Workers Compensation Insurance,u required by Section
37W of the Labor Co te•for the pedormancs of me work
forwhich this permit
is laswd.
My Workers Compensation mmnce caraiornd Policy
CatrkrPolicy No.: Yr '70
-
CERTIFICATE OF EXEMP ION FROM WORKERS
COMPENSATION INSURANCE -
(This scam aesd Out be completed Ilds,Permit is fm mm hundred donass($1011)
or lest)
I certify dint in die perfarmarce of the work for which this perch is issued,I doll mat -
employ any Porton in my manners,as to nttoma subject in the WohmY Compmw0on
I..of CW farof t.Dam
Applies.[
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject an the Worker's Compeuatlon previsions of me Lather Code.you most
.J O forthwith comply with such Provisions m this permit shall be deemed revoked.
,zt F.r CONSTRUCTION LENDING AGENCY
[ti r I barony written Nu men isa.onsuucdmn lending agency fm mo Mufurmano of
C(. > the work for which this Perron M haued(Sec.8(197,Civ.C)
QLsndeh Nene
.7 Z. lendeu
lenders Addra
(••)Q I redly that 1 have had this appliwion and sum that the move WomNun u
w!'� cmmeL I agree in comply who all city and county aNlOarleef and stale laws readng Or
building com uction,and hereby muthodm rtpresenutives ofthus city in enter upon the
W sow-mentioned property for Inspection purposes.
(Ws)agora to new,indemnify and keep harmless the City of Cupertino against
pl IhbilWo.judgmrus,casts and eapeneen which may 1.my way amus attires.old City
IJ z in consegwn g ting ofmt perm[[.
r"r APPLIC"MU
STAND DWI PLY WITH ALL NON-POINT Issued by: - Date
SO 0.EGU ONS.
Re-roofs
of IirmVCon Dale -
MPJUALs DISCLOsuIlE Type of Roof
Will y t applicator or forum building occupant 0 1 .Mable Health
mamriil
Reed by the Cupenina MYoldryl Code,puPsee9.11.and cite NNth and safety
.s l enzssyz(a)7 All roofs shall be inspected nor to an roofing material beim installed.
❑res rpyt� P P � Y g B
Will the applicant or future building Occupant use equipment or Jcvlcu which If a roof is installed without first obtaining an inspection,I agree to remove
7.quitento
dbytheBayAneAirQualityManagementall new materials for inspection.
lct7❑YesI haw read thepeadausmuerMM req mcrostmdUMpmr6.95ofineCalifm-
caILh SafctyCd[SaUwg 605. 7am1cmaylrtwhi mnachum of a Crnificate of Occupancy.J6 ` Signature of Applicant Date
cr oraumoimd as Date All roof coverings to be Class'J{."or better