08060185BUILDING DIVISION PERIVHT
BUILDING ADDRESS: Prttmtr Nu.
20800 HOMESTEAD RD BLDG 58 WEST BUILDERS, INC. 1 08060185
OWNER'S NAME: PERMIT ISSUE DATE
E'(�OMETHEUS 1608 4TH ST STE 120 07/18/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIFNGINEER:
1 O p LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 701i0) of Division 3 oCthe Business and Professions Code, and
(myyllicense is
y in full force and effect. 2 S
j Z License C Lic. N
F 0 Dam Contractor
AR ITECrS DECLARA ON
ifl1 understand my plans shall be used as public records
)t6
y o Licensed Professional
OWNER -BUILDER DECLARATION
' I hereby affirm that 1 am exempt from the Contractor's License Law for the
qo following reason. (Section 7031.5, Business and Professions Code: Any city or county
< 4 Pi which requires a permit to construct alter, improve, demolish, or repair any structure
Z r prior to its issuance, also requires the applicant far such permit to rile a signed statement
S G that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
a (commencing with Section 7000) of Division 3 of the Business and Professions Codo) 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 rive 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
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 sale. If,
however, the building or improvement is sold within one year of completion, the ownerm
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 Contractors
License Law.
❑ 1 am exempt under Sea B & P C for this reason
JZ
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby a[Brrn under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3100 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ f 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 are:
Carrier. ` f�CGI �] Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted if the permit is for ono 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, after making this Certificate or Exemption, you should
become subject to the Worker's Compensation provisions or the Labor Codc, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby atiirn that there is a consuucdon lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state 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 consequence of the grantig of this permit.
APPLICANT-tINDERSTAN0S,61,11) WILL COMPLY WITH ALL NON -POINT
HAZt4DOUS 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 Safety
Code, Section 25532(a)? y,''
❑ Yes f No
Will the applicant or future building occupant use equipment or devices which
emlthazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑Yes AN.
• 1 have mad the hazardous materials mquimmens under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 7.5534.1 understand that it the building
does not currently have a tenan that It is my responsibility to noti the occupant of the
requirements st be m p' issuance oCa fie Occu
Owner or auth Date
BUILDING PERMrrINFO
INSTL TEMP WTR SPLY& RETRN BLDG ELECT PLO
Job Description
Ft. Floor Area
APN
Required Inspections
Issued by:
Re -roofs
Type of Roof
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'. ' or better