06120034 CITE'OF CUPERTINO
BUILDING DIVISIONPERMITCO... `g TQ Z `6i--. �
BUILDING ADDRESS:
PERMIT NO.
20450 STEVENS CREEK BLVD TURNER CONSTRUCTION CID n6l ?003A
OWNER'S NAME:
PERMIT ISSUE DATE
PROMETHEUS 142 W SANTA CLARA ST 01/05/2007
-10NE: (408) 25-7598 SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0
j�Z
O O LICENSED CONTRACTOR'S DECLARATION Job Description
eui P I hereby affirm that[am licensed under provisions of Chapter 9(commencing T. I. —ID''CLUDES ELECT/MECH
=Z with Section 7000)of Division 3 of the Business and Professions Code.and m license is
y in full force and effect. O 3
D,2? License Cl 6Lic.#
t O Date f ` Contractor
ARCHITECTS DECLARATION
a
U 1 understand my plans shall be used as public records
Z.Q y Licensed Professional
y-1 OWNER-BUILDER DECLARATION
2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K rZ which requires a permit to construct,alter,improve,demolish,or repair any structure
v Z
In prior to its issuance,also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area $485000 Valuation
X t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 3 6 9 O 1 O 9 .6bN Number Occupancy Type
not more than five hundred dollars(5500)
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sal.If,
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
ccnse Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sec. B&P C for this reason
OwnerDale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worke s�ompensation Insurance carrier and Policy n r O�+ f _Q '
Cartier. t' � 4Policy No.: `� o
CERTIFICIATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date—
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall b:deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(.�►-. I hereby affirm that there is a construction lending agency for the performance of
py> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
aZ Lcndees Address
U 0 1 certify that I have read this application and state that the above information is
(L" correct.I agree to comply with all city and county ordinances and state laws relating to
0Vbuilding construction,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspc lion purposes.
;"t nWi (We)agree save,ind and keep harmless the City of Cupertino against
F.„..,to liabilities,j g osis pensee which may in any way accrue against said City
U Z in conseq grand f this permit
�. Date
APPLI RST S AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR 0 Is
Re-roof:
Sr h ARDS MATERIALS DISCLOSURE DateType of F oof
i icam or future building occupant store or handle hazardous material
to Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code, tie 5532(a)? All roof,;shall be inspected prior to any roofing material being installed.
�No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes NO
ave a ousmaterials requirements under Chapter 6.95ofthe Califor-
nia Ilh ctions 25505,25533 and 25534.1 understand that if the building
d no a tenant.that its my responsibility to notify the occupant of the
ui St be met prior to issuance of a Ceruficate of k704- Signatur-.of Applicant ' ”Date
wn r '.cd agent pate
r All roof coverings to be Class 'B or better
BUILDING DIVISION LrY/3ti�(j'L`��1gx'<y47y+s74F�✓hr.
.....-......
BUILDING ADDRESS: PERMITNO.
20450 STEVENS CREEK BLVD TURNER CONSTRUCTION
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS 142 W SANTA CLARA ST 01/05/2007
PHONE: SAMTARY NO. CONTROL NO.
(408)295-7598
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�
ndZ
J00 LICENSED CONTRACTOR'S DECLARATION
UI hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z ui with Section 7000) of Division 3 of the Business and Professions Code, and m license is
w in full force and effecL '� Q 7,q
n ? License Claps _ Lic. 11 l
Date Contractor
ARCHITECTS DECLARATION
r LU I understand my plans shall be used as public records
D'
4 C t; Licensed Professional
OWNER -BUILDER DECLARATION
+ a'I 1 hereby affirm that 1 am exempt from the Contractors License Law for the
00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter. improve, demolish, or repair any structure
n Zprior W its issuance, also requires the applicant for such permit to tilt a signed statement
E= G that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Y t- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y $ that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 1, as owner ofthe property, or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law docs not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year o(compiction, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cense Law docs not apply to an owner of property who builds or improves thereon, and.
who conracLs for such projects with a contractors) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Job Description
T.I.—INCLUDES ELECT/MECH
Sq.: Ft. Floor Area
36901029.W Number
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worke�s�Campensation Insurance carrier and Policy nymper O j �O
Carrier.//'']]'ll t •}� yyrx}Cu'lPoliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that In the performance of the work for which this permit is Issued. 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California Dau —
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
Qforthwith comply with such provisions or this permit shall be deemed revoked.
z it CONSTRUCTION LENDING AGENCY
.�
F -t it 1 hereby affirm that there is x construction lending agency for the performance of
pG .7 the work for which this permit is issued (Sec. 3097, Civ. C.)
LLi Q Lenders Name
2 Lenders Address
U Q 1 certify that I have read this application and state that the above information is
U. i -i correct. I agree to comply with all city and county ordinances and state laws relating to
O U building construction, and hereby authorise representatives of this city to enter upon the
(Ll ahove-mentioned property for inspc 'on purposes
G>~
(W`)#
Wc) agrrx save, ind r and kap harmless the City of Cupertino against
((abilities, j g osts prSnsu which may in any way accrue against said City
V 7 in conuq c gtanti f this permlL
r� APPLI RST S AND WILL COMPLY WITH ALL NON -POINT
SOUR O
Signa f li Contractor Date
AZARDOUS MATERIALS DISCLOSURE
t e a scant or future building occupant store or handle hazardous material
nn Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, 'o 532(a)7 /!!�
s �No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
Dlstrlct7
❑ Yesfm
o
avcaterialsrequiremensundcrChapter6.95ofthcCalifor.
ria Ith25505.25533 and 25534.1 understand that ifdtc building
d noat it is my responsibility to notify the occupant of the
u' ior to issuance of a Certificate of OcFupahg .
wn r t ' .cd agent fr/ Date -
Issued by:
Re -roofs
Type of Roof
$485000 Valuation
Required Inspections
Type
Date r / el
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
Date
All roof coverings to be Class "B" or better