08060187BUILDING DIVISION PERMIT
BOIL 1 G D ESS: PB$Mrr NO.
��5� HOMESTEAD RD BLDG 56 WEST BUILDERS, INC. 08060187
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS 1608 4TH ST STE 120 07/18/2008
PHONE:
SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER:
LICENSED CONTRA=R•s UhLLArr•AI rUN
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Coda, and my license is
n full force and effect. t•'� .L�; C Jt3
-1cense Class Lic. X (�
32re Conlractarm:;
A HI fECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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 file 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).
[11, as owner of the property, or my employees with wages as their sale 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 net 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 contractors) licensed pursuant to the Contractors
License law.
❑ 1 am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm 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 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 carrier and Policy number am:
Carier.'5;'�FQ� "-� Policy No.: 95ZOO\
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed if the permit is forone hundred dollars IWO)
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 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 Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed ravoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a concoction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lcpdees Address
1 certify that 1 have read this application and state that the above information is
Colmar. I agree to comply with all city and county ordinances and state laws relating to
building concoction, 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
liabilides,judgmems, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UN ERS ND AND WILL COMPLY WITH ALL NON -POINT
S GU TIO
0
Signature o pplicanU D to
H ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7
❑ Yes ❑ No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as dcrined by the Bay Area Air Quality Management
District?
❑Yes C] No
1 have road 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 haw a nan t is my responsibility to notify the occupant of the
requi is must t pri to issuance of a c�cate` `occ9p cy`
BUILDING PERMIT INFO
INSTL TEMP WTR SUPLY & RETRN BLDG ELECT PLUMB
P-I PN3 ; IPdrrT-1:3 PIES , I = O
m --m Job Description
Ft. Floor Area
APN
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date �� f
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 r'j` or better
Owner
Data