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08060216CITY OF CUPERTINO BUILDING DIVISION PERT CO T BUIL[XNG p t�DRESS: PERMIT NO. 10��0 HOMESTEAD RD BLDG 8 WEST.BUILDERS, INC. 08060216 FERMrf ISSUE DATE OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 07/18/2008 SANITARY NO, CONTROL NO. PHONE: ARCHML-r/ENOMER: i p o LICENSED CONTRACTOR'S DECLARATION vCt, I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Xj e3 with Section 70W) of Division 3 of the Business and Professions Code. and y license is ' p H in full force and effectrJ —, 57 License Cl Lic. S �assf qqq Dale f'�� / i a Contractor CHITECTS DECLARATION I understand my plans shall be used as public records H Licensed Professional OWNER -BUILDER DECLARATION f hereby afr,. that I am exempt from the Contractor's License Law for the q O following mason. (Section 7031.5, Business and Professions Code: Any city or county <m 9 which requires a permit to concoct, alter, improve, demolish, or repair any structure o y prior to its issuance, also requires the applicant forsuch permit to rile a signed statement x C that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 9 Fr (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 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 Prefessdmus 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 oraffered forsale. If, however, the building or improvement is sold within one year orcompletion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sate.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The ContrscEnes 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 Sea B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I 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 Workees Compensation Insuran carrier and Policy number am: Carrier. 6-V �U;Z Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is fortme hundred dollars ($100) or Icss) 1 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 Califamia. 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 = O forthwith comply with such provisions or this Permit shall be deemed revoked. TR 0-4 CONSUCTION LENDING AGENCY -t ►n I hereby affirm that them is a construction lending agency for the performance of Si 5 the work for which this permit Is issued (Sec. 3097, Civ, C.) ALender's Name 24 = z Lcndees Address J 0 I certify that 1 have read this application and state that the above information is 0-4 correct I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction, and hereby authorize representatives of this city to enter upon the aabove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against ;.44 rj]. liabilldes,judgments, costs and expenses which may in any way accrue against said City J 7 in consequence or the granting of this permit, t� APPLICANT UND RSTANDS AND WILL COMPLY WITH ALL NON -POINT SO G S. A ` 6 Signature of Appl t/Contractor ` Date 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)? 0Yes VNo 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? ❑Ycs No I have mad the hazardous materials requirements under Chapter6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently hate tenant, that it is my responsibility to notify the occupant or the requi which nut t prior to issuance of a crtifica of Oc upancy. 12 6 Ownc r a ' . d ¢ Date BUILDING PERMIT INFO INSTL TEMP WTR SPLY& RETRN BD E� PLUMB ME�CH TIT P?ie TT scP `TT7tw ee III. ..m^_ ..�����_ _ _ 11�W��r �G�V1111LL Job Description Sq. Ft. Floor Area Valuation APN Number Occupancy Type Required Inspections Re -roofs Type of Roof 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