07060121 CITY OF CUPERTINO (��C1 T �kT4 :
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
20350 STEVENS CREEK BLVD #520 PRECISIO\T TRADES INC. 07060121
PERMIT ISSUE DATE
OWNER'S NAME:
PROMETHEUS REAL ESTATE 615 PALM AVE SANITARY NO. CONTROL NO.
NE:
(408) 463-9300
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
al Z LICENSED CONTRACTOR'S DECLARATION Job Description
0
w P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z w with Section 7000)t�p�mvislon 3 of the Business and Professions Code,and my license is 20 AMP F I CRO LINE,A/C HEAT PUMP,WASHER/DRYER HOOK
=y in full Coree and c�ec4! Lic.It UP ICE MAKER
v�Z Licensc�Iass r
p Datc
Contractor
F.w ARCHITECTS DECLARATION
i a< 1 understand my plans shall he used as public records
tyU
a H Licensed Professional
'o< OWNER-BUILDER DECLARATION
a from the Contractor's License Law for the
1 hereby affirm That 1 am exempt
In O 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
m"y prior to its issuance,also requires the applicant for such permit to f Ie a signed statement Ft.Floor Area Valuation
?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $4200
H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
.. that he is exempt therefrom and the basis for the alleged exemption.Any violation o[ A��l Number Occupancy Type
Secuon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 369010
2 E V G
not more than five hundred dollars($500).
❑I,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 does 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 of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,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-
cense 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.
❑I am exempt under See. B&P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby 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.
❑I 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 Work s Compensation Insurance ca •rand Policy number arc:
Carrier: � Polity No.: C�!>�
CERTIFICATE OF MPnUN FROM WORKERS'
COMPENSATION INSURANCE
(Ibis 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,I 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,alter 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 be deemed revoked.
Z- CONSTRUCTION LENDING AGENCY
(�Cn
I hereby affirm that there is a construction lending agency for the performance of
Qy> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Lender's Address
U C I certify that 1 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
.J U building construction,and hereby authorize representatives of this city to enter upon the
ahovc-mcntiuncd property for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
� liabilities,judgments,costs and expenses which may in any way ace c against said City
U Z in consequence of the granting of this permit. Date
►+ APPLICANT UNDER TA D WILL COMPLY WITH ALL NON-POINT Issued by: —
SOU EGULATI `I�,
� Re-roofs
Signature of Applicant/Contrac Dare Type of Roof
HAZARD US MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes J�'° If a roof:s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment ordevices gwhich all new materials for inspection.
emit hazardous air contaminants as defined by the Bay Area Air Qualil Management
District? y
❑Yes &Nu
1 have read the hazardous materials requirements undcrChapter 6.95 of the Califor-
nia Health&Safety Code,Seco 5.25533 and 25534.1 understand that if the building
does not currently haveWEh ' ponsibility to notify the occupant of the "Date
requ'Ki a is which mueL'Of C ufrcate of Oc pancy. ` Signature of Applicant1 [7/ All roof coverings tobe Class"B or better
cr or authorized aDatc