07060119C
7
CITY OF CUPERTINO
PERAUT
7777777777
BUILDING DIVISION
BUILDING ADDRESS:
PERMIT NO.
20350 STEVENS CREEK BLVD #319
PRECISION TRADES INC.
07060119
OWNER'S NAME:
PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE
615 PALM AVE
06 14 2007
PHON;
SANITARY NO. CONTROL NO.
(408) 463-9300
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
i hereby affirm that 1. am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Profession Code, and my license is
20 AMP MICRO LINE, A / C HEAT PUMP WASHER / DRYER
in full force and
,
Li«nae f�7asr Lie. K
HOOK
Dam f7 Conulctmr .t
DECLARATION
UP, ICE MAKER.
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to cousin L. ahem, improve. demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to fdc a signed statemcm
License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of theConuactor's
(commencing with Section 70D0) of Division 3 of the Business and Professions Code) or
$ 4 2 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Number
Occupancy ljrpe
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (SYM
36901026
❑ L as owner of the property, or my employees with wages as thew sole compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (See. 7044, Business
and Professions Cede: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himaelf 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 of completion, 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. 704-4. Business and Professions Code:) The Cootractues Li-
cense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a comramor(s) licensed pursuant to theContnetors
License raw.
❑ I am exempt under Sec. , B & P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I herby affirm under penalty of perjury one of the following declarations:
❑ 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.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers CornonInsurance carrier and Policy nuillh
Carrie ( er�:
r.. C �e7 `^ ' � Polity No.:
CERTIFICATE OF PTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not he complcmd 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, I shall not
employ any person in any manner so as to become subject to the Workers' Compensadon
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
' forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that then; is a constructinn lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. Q
Lender's Name
Landers Address
1 certify that I have read this application and state that the above information is
' correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize repmsenuatives of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
+ APPLICANT UNDERSTAN A L COMPLY WITH ALL NON -POINT
Issued by: Date C S
SOUR ULAnONS. -0
Re -roofs >
Type of Roof
Signature of Aprpliciiii/Comraci6r Dam
HAZARDOUS ALS DISCLOSURE
Will the applicant or future liggifing occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.1Z and the Health and Safety
Code, section
All shall be inspected to any roofing material being installed.
yu.25532(a)?
roofs prior
If a roof is in without first obtaining an inspection, I agree to remove
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
all new materials for inspection.
District?
C] Yes ❑Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sccdons 25505, 25533 and 25534.1 understand thinif he building
does not curtenLI have r. • my raponsihllity to notify they�upant of the
n which miss ri trance of a Cenificauc of an .9,
.� Y p
X..
Signature of Applicant Date
All roof coverings to be Class "B" or better
authariztdagcn Dam