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08060214BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 20800 HOMESTEAD RD BLDG 10 WEST BUILDERS, INC. 1 08060214 OWNER'S NAME: PERMIT ISSUE DATE 13ROMETHEUS 1608 4TH ST STE 120 07/18/2008 PHONE: SANITARY NO. CONTROL NO. ARCHTIECT/ENGINEER: p p LICENSED CONTRACTOR'S DECLARATION Zd C 1 hereby affirm that I am licensed. under provisions of Chapter 9 (commencing X Ut,,l with Section 7000) of Division 3 of the Business and ProfessionsCn , and my license is � y in full force and effect. �_ll t� License Clas%Lic. # Contractor ARCHITECTS DECLAR T10 7 a 1 understand my plans shall be used as public records V cy Licensed Professional y OWNER -BUILDER DECLARATION ' 1 hereby affirm that 1 am exempt from the Contractors License Law for the c <p O following reason. (Section 7031.5, Business and Professions Code: Any city or county 4.i which requires a permit to construct, alter, improve, demolish, or repair any structure ? Z�' 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 uF $ (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (S500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, wiB do the work, and the structure is not intended or offered for sale (Sec. 7044, Business 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.), Cl 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. ❑ 1 am exempt under Sea B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 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. ❑ 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 Worker's Compensation Insurance carrier and Policy number am: Carrier.�� , Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone 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 Werkam' Compensation Laws of Caliromia. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions or the Labor Codc, you must Oforthwith comply with such provisions or this pcpnil shall be deemed revoked. y CONSTRUCTION LENDING AGENCY -- I hereby aff m that there is a construction lending agency for the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.) AL.endees Name Z L.endees Address 0 1 certify that I have read this application and state that the above information is H correct. I agree to comply with all city and county ordinances and state laws relating to 5 V building construction, and hereby authorize representatives of this city to enter upon the above-mcndoned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against y C/J liabilities, judgments, costs and expenses which may in any way accrue against said City `L in consequence of the granting of this permit. i--t APPLICANT UNDER*TA14DS AND WILL COMPLY WITH ALL NON -POINT SOURREGULATI .�� v � HAZARDOUS MATERIALS DISCLOSURE 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 Safely Code, Section 25532(a)? ❑ Yes To 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 District? �7�r ❑Yes PTO 1 have read the hazardous materials requirements under Chapter 6,95 or the Califor- nia Health & Safety Code, Sections 25505, 25533 and 75534.1 understand that if the building does not currently have a icnanuhat it is my responsibility to notify the occupant or the re me which ust r to issuance of a Ccrtif ate of upan Owner or a a nl I Date " BUILDING PERMrrlNFO INSTL TEMP WTR SPLY& RETRN BQ ELECT PLUMB MEOCH TI T TITTI" r T s rp 'a,Zl�Isi_Gl.dTa17,. , 1VV 11''JJ��VV �1.. �11111�:��1111 _ :. Job Description Ft. Floor Area Issued by: Re -roofs Type of Roof Required Inspections Valuation Occupancy Date 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'n" or better