08030008 CITY I CUPERTINO
BUILOIN.'�DIVISION PERMITCOI�ITRACTQRINFU].tMA.Tt pN^-
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Buf1,Q124gADpReSsTEVENS CREEK BLVD #2040 TBD — TO BE DETERMINED P�OtlUD30008
WNIEER''s4NAME: 5 PERMIT ISSUE DATE
PROMETHEUS 03/14/2008
HONE: SANITARY NO, CONTROL NO.
ARCHTIECnFNGINEER: BUILDING PERMIT INFO
T. I . —NEWFLOOR,T— 'BLDG ELECT PLUMBMECH
0 0 0 0
30Zp LICENSED CONTRACTOR'S DECLARATION dOIYDtlOn
1 be.by,ofnno that 1 am licensed under provision of Chapter 9(commencing ' 06Gr tP
Sj wits Section 7M)ofDivfuan 3 of am Business and Professions Code,and my license is
^a in fail form and.fast
Llceme Class IJc.g
f. Dam Contractor
S p
ARCHITECTS DECLARATION
lea+ I understand my plans shall M and u public records
gtad Licensed Pmfewonal -
5 that I am BUILDER mDECLARATION
0 S 1 hamhy a1Brm mm 11. exempt from the Conuano o :Licensec Law for the,
0 o following wan.(Satan 7031.5,Business and Profusions Cade:Any city ofs county
9 which rcquha a permit re rnres than alma improve.h Permit
t t ri mash any su ment
�Sn Pdarmiuissuensgaiso.quirou meapplteanf for anchpermr's UcteuLMdmmment
�0 Nn W is licensed puuuanUo Nc provislom of the Contractor's LIcelLC thaw(Chapter 9 Sq.Ft.Floor Area Valuation
S (commencing with Section 7000)of Division 3 of Nm Business and Professions Code)at
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that he is suanpt therefrom and the buts for N.alleged eaereptm.Any violation of
Section 7031.5 by any applicant for a permit mbjecu Ne applicant to a civil panWy of APN Number Occupancy e
Ms mase Nan On hundred d.ftb m(SMP Y EYP
❑I,uownerofd pmpwy,mmyamployenswilhwmg utheirmiccommmaton,
will do meworh-and theauumuse is mtlmended"ofered formal.(Sec.70N,Bnsinus
and Pmfeatms,Code:The CommelmY License Law does not apply an an owner of Required Inspections
property who Wilds aimpmsa ustrmn.and wW dms.uch wmkhinuelreba odugh his
own cmpluym,provided that such impmwmmu am not intended moRmed fasde B.
howaser,Ne building or improvement W sold within arc year of complain a.me.
Wilder will have the Wrden of proving that W did rot Wild or Improve for purpose of
um).
uvnsr of tha property...uelulvely,contracting with licensed conammors an
wet Ne project(Sec 7044.Bun n ss and Professions Cade:)The Conoamota Li-
-
taww does out appy an an owner of property who Wilda or improses Neon,and,
who corms far such projew NN•cormacmr(a)licensed pmRunt to the Cmumemr's
Lice.Law.
❑1 am uemps a dm S .B!P C for this mon.
war Data - �0
C COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following declMaknec .
❑Ihawandwillmainuina CcrifiataofC...tmself-Immefmwormn'.Compen-
action,an provided for by Section 37M a(the Iahm Cod.,per the performance of tai
wart for which this pemit is Issued.
I have and will maiouin Worlme,Compensation Insurance,u required by Section
371D of aha lJWr Code,for the Fri...native work fur which this permit is issued.
My Worker'.Compensation lnuumce mrria and Policy rumWc am:
Carrier. Policy No.:
CERTIFICATE OF EKEMFnON FROM WORKERS'
COMPENSATION INSURANCE
(This oration nod has W cwplemd If tai Iermitls faoM hundred dollars($100)
or leu)
1 certify hast In also perfwmmmo of the work for which this pewit is issued,I.hall yea
employany Penan inan sum become state. Ne Workers pensWan
{Jwf of GlifamYe.�d 17 - �
NOnCE TO AP ANT.If,a r making Nu Carillon,of mpti n,you should
become sub) WorkeYs Compensation pmNsions of tai Labor Code,you mem
vJ 0 forthwith comply with such provisions or this pewit Nall W themed tooted.
CONSTRUCTION LENDING AGENCY
[r IW.by affirm that them isa construction lending agency for me Informarvm of
orithe work for which this permit I.load(Sec.3097.Cl,C.)
fender's '
Q Name
Ctv
.:) z IcnEets Add.
U O 1 rarefy,Nat I have rod has appliaton and sum Nu dm when information is
iL cams 1 agree to comply with all city and county Maritices and sum Ion relating to
0 Wilding construction.and hertbyaumod..pmxnutiveaofNiscity menter.M.Ne
Nd aWve-memianed property fa inspection Purposes
�' gy (We)agree to save,indemnify and mcp humless the City of Cupertino against
rye liabilities,judgmmu,toms and upmuA which may In any way seenm againR acid City
U z
in consegamo,of ms,granting of this permit,
.. APPLICANT UNDi(SgT�ANnDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sou: u /// "" _21L'!4 61 • Re-roofs
Signst� of AppllanuContrsemr I—I Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof -
Will me applicant or form Wilding oaupant Rom ahandk harardou mammal
as de0mti by Ne Cupenim,Municipal Code.Chapter 9.12.and the Health and Safety
ode.Section I5533(a)7 (I All roofs shall be inspected prior to any roofing material being installed.
❑Yon
Will the applicant or`_jhlh--
f m Wilding oxupaM use equipment or derlcru which If a roof is installed without first obtaining an inspection,.1 agree to remove
c nit husNnu air conuminanta as dc0ad by aha Bay A.a Air Quality Management all new materials for inspection.
D strict?
CYa No
I have mad the haurdmu materials.quimmenu under Chapter 6.95 of the Califor-
niaHrslN&SafetyCotleSx aons2S505.25533and25534.Imuk dNulf Jon building
d Mt cu my I�sK.t ant,Net It is my noporalhility to Macy to oaupun of the
coq re re mel ' rent mof.CertifiesJr pw�y0� Signature of Applicant Date
Ovmmm..mmiredagem I Dam All roof coverings to be Class'W'or better