070802713a
CITY OF CUPERTINO
Y Ci�C�R ilIA�4.
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
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PERMIT NO.
20350 STEVENS CREEK BLVD UNIT
PRECISION TRADES INC.
07080271
OWN AME:
PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE CROUP
615 PALM AVE
_
PHONE:
SANITARY NO. CONTROL NO.
(408) 4 63 -93 00
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code• and my license is
in full force and CIRT ?7
20 AMPS MICRO LINE, AC HEAT PUMP, WASHER DRYER,
se Cla=s `�J Lie."
ICE MAKER
Dare f� Contractor
'
ARCHITECTS DECLARATION
I understand my plans shall he used as public «e"rck
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I 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 ennsiruct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
is licensed Contractor's Latent Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he pursuant to the provisions of the
(commencing with Section 70D0) of Division 3 of the Business and Professions Code) or
$ 4 2 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
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 (S500).
36901026 U 7
1, as owner of the property, or my employers with wages as their sole compensation,
Required Inspections
will do the work. and the structure is not intended or offered for We (Sec.7044, Business
and Professions Coder 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
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 Contractors 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 Contractor's
LIC Law.
0 I am exempt under See , B & P C for this reason
Owner - -- - Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I hsve and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 37DO of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 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 Workers/Qlmwpen�taad rt(�o'{ance gamier and Policy no ber are:
Cartier. =Pr '` Aka,_-+' `Policy No.: I 00
O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seWon need not be completed if the permit is for one hundred dollars (SI00)
or less)
1 cenifv that in the performance of the work for which this permit is issued. 1 gall not
employ any person in any manner so as to become subject to the WorkeW Compcnsation
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 rooked.
1
CONSTRUCTION LENDING AGENCY
1 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.endces Name
Lenders Address
I i certify that 1 have read this application and state that the above information is
'
4 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 properly for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, costs and expenses which may in any way accrue against said City
AC
' in consegtrerrce of the gnnlin of this D WILL
' APP NT UND AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUkCIbREGULA ^^
^ 0-9
T
s
r—A
Re —roofs �L
Type,of Roof
Signature of Applicant/Contra Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occuparttstore or handle hazardous material
as damned by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, \
All roofs shall be inspected prior to any roofing material being installed.
DYee3n23332(a)?
n
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building octvpant use equipment or devices which
cmli hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District? '
Yes tNo
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code. Sections 255D5.25533 and 25534. I understand that if die building
does not currently have a tenant, that il' risibility to notify the occupant of the
requirements wnl ust be met i oI a icaig of cy.Z- �— 0
Signature of Applicant Date
C— c�
All roof coverings to be Class "B" or better
Owner or authorized agent Date