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03030093 CITY OF CUPERTINO - - ' ' '' ' ' BUILDING DIVISION PERMIT CgNTRACTUR INFURMATION., R +,. .'31#zt ah" $:?i, - '$ BUILDINGADDRESS: VENTURE BUILDERS PERMIT No 03030093 oWNER'SNAME: 1509 INDUSTRIAL RD "ES6T7b2/2003 METHEUS E: (650) 598-3999 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MITCH +�sOij LICENSED CONTRACTOR'S DECLARATION Job Description I Mrtb ,Dino IMt 1 am Iim=d under pmHs ms of Chpw 9(commencing P tth SccuoE] )a(DlWaion3.fft Buvn�slr�d Pmfosiom Codt.andmylicc=is in full(Drax/l�E eGett ,/ z Lt., .Cld Uc.g Li-7Z 4S9 TENANT IMPROVEMENT z Dam � BB CIn In aF7T 1 - CONTRACTOR: VENTURE 'BUILDERS ARCHV-uZm!my pins shallnCrS ll he used opuhl1icmenrds AUG 1 2003 Luemed Professional OWNER- ER DECLARATION BUILDING I hemby olfiNm exempt rm 1 am exempt frothee CRATonirIm elora License law for mite S:02 following moon.(Section 7D3 1.5,Business and Pmnfeaions Cale:Any city Or county y S which requires a permit to construct,alcor.improve.demolish,fir repair any structure prior In its issuance,also requires Me applicant for such permit m file a signed statement < Met he is licensed pursuant to Ne provision of Me Contractor's Ulric LAW(Chapter 9 Sq.Ft. Floor Area Valuation C (commencing with Section 1000)of Division 3 or Me Business and Prmrosiam Cods)or 3— that he is manafn therefrom and Ne basis for the alleged exemption.Any viola0on of Section 7031.5 by a"applicant for a permit subjects dee applicant IP a civil penalty of APN Number Occupancy Type oat more than five hundred dollars(5300). 01,as mwnmof the propeny,nr myemplayees with weges u their mile wmpenutlon. 36901029 . 00 will do the work,and the swc,um is Out intended mattered!for We(Sec.7004,Boinrss and Professions Code:The Csnmctoh License law dors not apply m n owmr Of 101 - FOUNDA Required gON d Inspections Property who build,orimprow,thereon,and whomessuch Werk himaelf orthrough his own employcca,provided that such lmprowmenU arc not imm�tled oro@mA for We.IL 102 — PIERS however,Ne building or improvement is sold within one yes of completion,Ne owner. builder will have Ne burden of proving that M did not Wild or improve for purpose of 103 — UFER ale'/. 104 - REBAR 0 1,as ower of Ota property,am exclusively connecting with licensed coousetma an 10 5 - ANCHOR BOLTS. mrs met the prole,(Sec.7044,Business and Profession Cade:)The Com shots Li- cameLawdonanotapplymanownerofpruptny who builds or improves thereon,and, 106 — SEWER & WATER who contracts for such projects with a comncmr(s)licensed pursuant to the Contractors Liumma aw. 202 - UNDERFLOOR PLUMBING O l am exempt under See .B k P C for this moon 203 - UNDERFLOOR MECHANICAL Weer Data 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury oro or the following decloa0ons: 205 — UNDERFLOOR INSULATION I haw and will maintain a Certificate ofCooeno ro self-imum for Wwwr,Compen- 301 — ROUGH PLUMBING moist,a provided rte by Semon 3700 of the labor Code,fm the performance of the 302 - TUB & OR SHOWER Work for whim this Permit is issum. 303 - ROUGH MECHANICAL ❑I haw and will maintain Wortrrs Compensation Insurance,u rcyulrctl by Sudan War the labor Code,for the performance or the work far which this permit is issued. 304 — ROUGH ELECTRICAL My Worker,Comrasadon Insurance eariennd Policy number am: 305 — FRAME car AT ' �Pnney No. 306 - HOLDOWNS CERTIFlCA OF E%EMPfION FR WORKERS' COMPENSATION IN NCE 307 - INSULATION finis rection nadmt hacompimad irtie Permit is rmm.hundred doll.(SIW) 308 - SHEETROCK fir lea') 309 - EXTERIOR LATH e certify that In the in my mane or the work for which this permit u.,Com Compensation not ' employ nrpernnfinny mnarroombceome subject rothe wortrn'Csmpemoation 310 — INTERIOR LATH Laws of Califmnla.Data 311 - SCRATCH COAT AppLent NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 313 - ROOF NAIL become object m duce WorkeM1 Com(moatisn proviuom of Nu Labor Cndc,you must .Jz forthwith comply with such provisions orthisPermit shall andcemedrtwtrd. 501 — FINAL ELECTRICAL ENERGY Z� CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby than Nat Marc isa contraction lending agency for the performmm.1' 503 - FINAL MECHANICAL ENERGY p$� Newark far which this pertnilbissued(Sa.7097,Civ.C.) Lender's Name 504 - FINAL BUILDING ENERGY W Q aZ Lender'sAadm•• 505 - FINAL ELECTRICAL U o 1 certify that 1 lawman Nis application and sum that the show information is 506 - GAS TEST .(1,F comma I qme he comply with all city rad county ordicances and state law,raining to OU building convection,and hereby authorise representatives mitts city m caw upon the FINA PLUMBI G - W above-mentioned propeny for Inspection purposes. (We)agree to on,indemnify and keep harmless the City Or Cupertino against 0 8 FIN L W Ilabllitia,judgmenu,costs and expenses which may In ray way secruc againetaid City e, Uz, in conaqusom or duo gaming of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date oistdcl, G t... Z a _ J Re-roofs Applica AZARD or Data HAZARD S MATERIALS DISCLOSURE Type of Roof the a Cupe o car forum Wilding Cg k.Chapter orhandlem hosrdons material the Cupertino Municipal Cock.Chapter 9.11,anal tlM Health and Safety n15531(a)? / All roofs shall be inspected prior to any roofing material being installed. 61q l If a roof is installed without first obtaining an inspection,I agree to remove the applicant or futures building by me nvem equipment or devices which m Dir contaminate a dc0ned by tic Bay Ama Air Quality Management all new materials for inspection. ❑Yo gKu 1 hew mad the haxardeo materials myuimments underchapierei.95 ordM Celirom nia HmlM&Safely Codc.Sauoo 25505.25533 and 25534.1 understand dot lithe building docs cot currently haw a Mom that it u my ropooihility the occPart.1 the roqu' cot tswhithmustecmetprior issuamesra ClNncalao conal 6� Signature of Applicant Date ��` / Owner or authomncd agent All roof coverings to be Class"B"or betterLl (/ DaM .0oo W U Z n<a �Z z�o n t—W U 20 �Za 0 z w a .�7 U W O U CITY OF CUPERTINO BUILDING DIVISION PERMIT�� BUILDING ADDRESS: VENTURE BUILDERS PERMIT NO03030093 OWNER'S NAME: 1509 INDUSTRIAL RD �f� L Fgn 2/ 2 0 0 3 PROMETHEUS PHONE: (6 5 0) 5 9 8- 3 9 9 9 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Socti 7 ) of Division 3 of the Bust and Professions Code, and my license is in full force d -t c'1 a cffecLr7 14 License Chutes Lic. M y TENANT IMPROVEMENT Date : / z�—Contractor SIV` _f c :/ _ CONTRACTOR: VENTURE BUILDERS ARCHITECT -S U� ARATION 4-./c. and my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the 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 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 Valuation (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 of $1500000 APN Number Occupancy Type Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). 3 6901029.00 ❑ 1, as owner of the property, or my employers with wages as their sole compensation, d will do the work and the swcture is not intended or offered forsale (Sec. 7044, Business Contractor's License law docs not apply to an owner of and Professions Code: The Contractorns 101 - g Inspections FOUNDRRequired -ON property who builds or improves thereon, and who does such work himself or through his 1 own employees, provided that such improvements are not intended or offered for sale. If, 1 02 — PIERS 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 10 3 - UFER sale.). 104 - REBAR ❑ 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- 10 5 - ANCHOR BOLTS ccrse Law docs not apply to an owner of property who builds or improves thereon, and 10 6 - SEWER & WATER who contracts for such projects with a contractors) licensed pursuant to the Contractors License Law, 202 - UNDERFLOOR PLUMBING El am exempt under Sec . B & P C for this reason 203 - UNDERFLOOR MECHANICAL °ivnC7°O 2 04 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 205 - UNDERFLOOR INSULATION 301 — ROUGH PLUMBING ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the labor Code, for the performance of the 302 - TUB & OR SHOWER work for which this permit is issued. 303 - ROUGH MECHANICAL ❑ 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. 304 - ROUGH ELECTRICAL My Workers Compensation Insurance carrier and Policy number are: 3 05 — FRAME Polity Ntr�_ I Z� _ 306 - HOLDOWNS CERTIFICA OFEXEMP770NFRA WORKERS' COMPENSATION INSURANCE 307 - INSULATION (fhissection need not be completed if the permit is for one hundred dollars (SI00) 308 - S HEE TRO C K or less.) 309 - EXTERIOR LATH 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 Workcri Compensation 310 — INTERIOR LATH Laws ofCalifornia. Date Applicant 311 - 313 - SCRATCH COAT ROOF NAIL NOl-ICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 501 — F I NAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY 1 hereby affirm that there is a construction lending agency for the performance of 503 - F I NAL ME C HAN I CAL ENERGY the work for which this permit Is issued (Sec. 3097, Civ. C.) Lenders Name 504 - 505 - FINAL BUILDING ENERGY FINAL ELECTRICAL L.ender'sAddmss I certify that 1 have read this application and state that the above information is 506 - GAS TEST COMM I agree to comply with all city and county ordinances and state laws mlating to building construction. and hereby authorize representatives of this city to enter upon theF I NA P LUMB I G above-mentioned property for inspection purposes Q 8 (We) agree to save, indemnify and keep harmless the City of Cupertino against F I N L liabilities, judgments, costs and expenses which may in any way accrue againatsaid City t, in consequence of the granting of this permiL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued bys affi6NG Date SOU CE EG T{ONS. J Z t`i 0�' ` Re -roofs Signaturc ol'Applicanr/Conuactor Date HAZARD9US MATERIALS DISCLOSURE Type of Roof Will the applicant or future building oceupantstore 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 o If a roof is installed 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 Arca Air Quality Management all new materials for inspection. District? Yes Q u 1 have read the hazardous materials requirements under Chapter 6.95 of thc Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant that it is my responsibility the occupant of the emcnts which must ik met rior u issuance of a Ccrtilcate of e , .�y P % �}I' re-✓ V_1u Signature. of Applicant Date All roof coverings to be Class "B" or better Owncrorauthorixcdagcnl Date