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07030232jadz Op SUES �a iaa 1qU Q N uoff u°•°rr =?a =C Y tS'q L"+� CITY OF CUPERTINO a BUILDING DIVISION PERMIT MIT BUIL INc�,A DRESS: PERMIT NO. �OG3 0 STEVENS CREEK BLVD TBD — TO BE DETERMINED 07030232 OWNER'S NAME: PERMIT ISSUE DATE PROMETHEUS REAL ESTATE 03/23/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CON'TRACTOR'S DECLARATION Job Description p 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing With Section 7000) of Division 3 of the Business and Professions Code, and my license is UNIT #407 2 0 AMP in full force and e . r Lleensc lana 3 Lic. 8 . 1`/l�CROLINE; A/C; HEAT PUMP, WASHER DRYER, HOOKUP, ICE MAKER Date cv - Contractor 'vi TY4ftj RCHITECI-S DECLARATION 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following mason. (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 fik a signed statement that he is licensed to the of the Contractors Litmnse Law (Chapter9 Sq. Ft. Floor Area Valuation pursuant provisions 4 2 0 0 (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 36901026 °! Number Occupancy Type Section 7031.5 by any applicant for a permit subjccu the applicant to a civil penalty of not more than five hundred dollars (E500). : 0 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of q 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.). 0 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 contracts for such projects with a coniractor(s) licensed pursuant to the Contractors License Law. Q I am exempt under See. , B & P C for this reason Owner Date 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 Workers Compensation�,rance carrier and Polity number arc: Cartier. r-- L )('-4(7 1 ) Policy No.: 713 —O&S 0,� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (E IOO) 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, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Lahor Coda you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of y the work for which this permit is issued (Sec. 3097, Civ. C.) " Lender's Name Lender's Address 1 certify that 1 have read this application and state that the above information is " correct. I agree to comply with all city and county ordinances and sure laws relating to building construction. and hemby authorize representatives 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 1 liabilities,judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of is permit. • APPLICANT UNDEIR T t S D WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR EGULATIO Re -roofs 'Type of Roof Signature of Applican on acto Date HAZARDQQ MATERIALS DISCLOSURE Will the applicant or futfue building occupant stom 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. ❑ Yu 'I SNo 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 harardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? C]Yes Po I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a hat it is my responsibility to notify the occupant of the requir enuwhichmu a `rior ts c"QCertificate orOccu ancy. Signature of Applicant Date ' �^ All roof coverings to be Class "B" or better Owner or authori-rcd agcm , Date CUPEf�TINO 0 CITY OF CUPERTINO tW4�- PERMIT APPLICATION FORM -7 0 APN # TDate: z � Building Address: Palin Address (if different from building address): �2e�1� L)e � c� Owner's Name: o / w�.� w. i�e�. f�� L� P�'r� Phone #: / Vd8 Contractor: 'C: 3 o� � ��'S ni�' . License #: 4 % � In�Z Contact: Phone: 5(Dg 0$ Cupertino Business License#: r�,C- �L.&D Fax: goo 3 MECHANICAL Building Permit Info: �; ��t�o� -- a��w-o✓� Bldg ❑ Elect D Plumb Pl<— Mech ET, Job Description: ZoA.,.p v ,CQc� C Residential ❑ v3&k"c72 e 1 �ic�(L • .�� "� Kee -Commercial ElSq.Ft. Floor Area: Sq.Ft.: Cost of Project: , j� � Occupancy Group: MECHANICAL BCONSTAX Type of Construction: Please check this box if the project is a BCONSTAX second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ BCONSTAXBQ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 Community Development 10300 Torre Avenue zr Cupertino CA 95014 Telephone (408) 777-3228 Cy OF Fax (408) 777-3333 CUPEkTINO Building Department I am not using any subcontractors: Signa Date Please check applicable subcontractors and comvletelthe following information: JOB ADDRESS: 2�� 3 (D C Pe l6 PERMIT # 4�0-1 o� 2 BUSINESS NAME OWNER'S NAME: PHONE # d8 - J - Z Cabinets & Millwork GENERAL CONTRACTOR —��)2e C ' FAX # 416>,63, - I am not using any subcontractors: Signa Date Please check applicable subcontractors and comvletelthe following information: �_ 90 Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring. Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile �_ 90 Date