08060190BUILDING DIVISION PERMIT
BUILDING ADDRESS: PElzMtl- NU.
20800 HOMESTEAD RD BLDG 54 WEST BUILDERS, INC. 08060190
OWNER'S NAME: PERMIT ISSUE DATE
PI«OMETHEUS 1608 4TH ST STE 120 07/18/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC IENGINEER:
u cd O Zp LICENSED CONTRACTOR'S DECLARATION
crei 1 hereby affirm that I am licensed under previsions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code and my license is
Re -1in full force and effect 25 ?�
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ic
eLic. 8
Date Contractor
A HCIECTS DECLARATION
ee I understand my plans shall be used as public records
tyU
4 U. H icensed Pmfcssional
y OWNER -BUILDER DECLARATION
'ys < I hereby affirm that 1 am exempt from the Contractor's License Law for the
L O O following reason. (Section 7031.5, Business and Professions Code: Any city or county
4.19 which requires a permit to construct, alter, improve, demolish, or repair any structure
a } prior to its issuance, also requires the applicant far such permit to file a signed statement
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 Code) or
i 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 (5500).
❑ I, as owner of the property, or my employees with wages as their solo compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors 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 proffered 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.).
❑ I, as owner of the. property, am exclusively contracting with licensed contractors to
constrict 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 See. B & P C for this reason
22
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ ]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 artier and Poll ur r are: `lb
.Came �`� olicyNo.:
'CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Chu section need not be completed if the permit is foronc hundred dollars ($I00)
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' Compcnsaton
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-dic performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lenders 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 grrl�rihdog of this permit.
APPLICANT UNDERSTAMS AND WILL COMPLY WITIJ ALL NON -POINT
HXZARDOUS 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 Po
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? ``��
❑ Yes SIN.
1 have mad the ha7mdous materials requirements under Chapter6.95 of the Califor-
nia Health& Safety Code, Sections 25505,25533and 25534.1understand that ifthe building
does not currently have a tenan4 that It is my responsibility to odfy the occupant of the
require hich u prior to issuance of Cc ' c of 1P
pancy.
Owner &a m Date '
BUILDING PERMIT INFO
INSTL TEMP WTR SUPLY & RET BO ELECT PLUMB
Job Description
q. Ft. Floor Area
Required Inspections
Issued by:
Re -roofs
Type of Roof
Valuation
Occupancy
Date �— (/'r''
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