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CITY OF CUPERTINO
PERMIT
BUILDING DIVISION
BUILDING ADDRESS:
20800 HOMESTEAD RD BLDG 11
WEST BUILDERS, INC.
PERMIT NO.
08060213
OWNER'S NAME:
PERMIT ISSUE DATE
PROMETHEUS
1608 4TH ST STE 120
07/18/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
INSTL TEMP WTR SPLY& RETRN
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
^^^ Job Description
1 hereby affirm that I am licensed under provisions of Chapter (commencing
with Scction 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effecL S T
License Clas Lic. A
Date Contra
A HfrECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prier to its issuance, also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(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
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ L, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
awn employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is said within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon, and •
who contracts for such projects with a coniractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under See. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My Worker's Compensation Insurance ca er and PolLcy numbc arc:
Carrier. C `1 olicy No.: ��0l
CERTIFICATE OF EXEMPTION FROM WORMS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars ($I00)
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 Workers 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.)
L.endefs 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 misting to
building construction, and hereby authorize representatives or 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
inconsequence of the ranting of this permit.
APPLICANT UND S ANDS AND WILL COMPLY WITH ALL N-POINT
Issued by: Date
S RE UL 0
Re -roofs--
Type of Roof
7
Sig entraclor are
HAZARDOUS 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)? fp/'o
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ®N
If a roof is installed without first obtaining an inspection', I agree to remove
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
all new materials for inspection.
District?
❑ Yes YIN.
I have read the hazardous materials requirements under Chapter 6.95 or the Califer.
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that irthc building
dots not currently ha a tc ant, that it is my responsibility to atify occupant of the
mgai hich elpdortoissuanceof Cc ie ernP_ er•
Z
Signature,ofApplieant Date
All roof coverings to be Class'n" or better
Owner nr aurhnri�r scent Date