08060173BUILDING DIVISION PERMIT
BUILDING ADDRESS: Pdklhl r NU.
20800 HOMESTEAD RD BLDG 59 WEST BUILDERS, INC. 08060173
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS 1608 4TH ST STE 120 07/18 2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
u O p LICENSED CONTRACTOR'S DECLARATION
v I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
zz with Section 7000) of Division 3 of the Business and Professions Code, and my license is
7 y in full force and effect. LSj3RS
License CI s Lic. S
qqq Da1c Conlractar
p�� A irrECrS DECLARATION
5w l understand my plans shall be used as public records
w
4 o y Licensed Professional
� y � OWNER -BUILDER DECLARATION
I hereby affirm that ( am exempt from the Contractor's License Law for the
p ofallowing mason. (Section 7031.5, Business and Professions Code: Any city or county
m 9 which requires a permit to construct, alter. improve, demolish, or repair any structure
o z In prior to its issuance, also requires the applicant tar such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
F $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y .. 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 penalty of
not more than five hundred dollars ($500).
❑ 1, 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
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
awn employees, provided that such improvements are not intended or offered for We, 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. 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.
❑ l am exempt under Sea B & P C for this mason
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Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a CeriBcate 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 Worker's Compensation Insurance
eccarrier and Policy um ram:
Cartie-
CERTIFICATE OTER P 09FROMWORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is far anc hundred dollar ($100)
or Icss)
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 at 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 Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit Is issued (Sec. 3097, Civ, C.)
Lender's Name
L.cndees Address
1 certify that I have read this application and state that the above information is
COMM 1 agree to comply with all city and county ordinances and stale laws relating to
building construction, and hereby 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
liabilities, judgments, costs and expenses which may in any way accrue against said City
in conseauence of the erandrd of this Dermit.
WILL COMPLY I� ALI+ NON -POINT
HAZAfRDOUS 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)7
❑Yes 9No
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?
❑Ycs No
Ihaveroadthe hazaMous atcrialsrequirementsunderChapter6.95oftheCalifor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a ram, khat It is my responsibility m n09ry the occupant of the
reel; is whichlrrust tlC ttraCp4ior to issuance of a rcrtificale pf OccWancy.
BUILDING PERMIT INFO
INSTL TEMP WTR SPLY& RET BLDG ELECT PO
Tr .: Job Description
Sq. Ft. Floor Area
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date 9
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 '%`' or better
nwnn.n:, &,1L.4.ln 'v - 1 Y Data