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CITY OF CUPERTINO
BUILDING DIVISION PERMIT����'
BUILDING ADDRESS: PERMIT NO.
20800 HOMESTEAD RD BLDG 57 WEST BUILDERS, INC. 08060186
OWNER'S NAME: PERMIT 15SSUEDATE
PROMETHEUS 1608 4TH ST STE 120 07/18/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECffENGINEER:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7o0o) of Division 3 of the Business and Professions Co c, and my Itcense is
in full force and effect. S
License Class Lie. 8
Date Conlracter '��� i
ARCHITECTS DECLARATION
I understand my plans shall he used as public records
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's 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 rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(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 penalty of
not more than five 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 Ptofessions 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.).
❑ 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.
❑ I am exempt under Sec B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Ccrlificate of Consent to self-insum 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 Workees Compensation Insurance carrier and Policy number am:
Carrier A-sy D"'Ve JFO%�Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted if the permit is forone hundred dollars ($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 mannerso 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 Workcrs 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 conswctinn lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
L-endoes Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. 1 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.
(Wo) agree to save, indemnify and keep harmless the City of Cupertino against
liabilides,judgmcnis, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY PITH ALL NON -POINT
Signat A i clor I — I Date
AZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle hazardous material
as defined by the Cupertino VN.
'paI Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑Yes
Will the applicant orbuildingoccupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
C] Yes;
�rlvu
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor.
niaHealth &SafcryCodc, Sections 25505,25533and 25534.1understand thatifthe building
does not currently have abnaQ6 that it is my responsibility to noti ant oC the
requi n htch mus 'or to issuance oC CC 'f cupancy.
Owner or thmrized� ent Dam
BUILDING PERMIT INFO
INSTL TEMP WTR SUPLY& RET ob DescriptBELECTPLUMB
Job
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 'A" or better