06120052BUILDING DIVISION
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME: FbKwr lemur uAln
PROMETHEUS 1042 HAMILTON COURT 01 24 2007
PHONE: SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECTIENGINEER: BUILDING PERMIT INFO
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
✓ith Secdon 7000) of Division 3 of the Business and Professions Code, and my license is
n full force and effect. CS 1 �'1 r1
.Scenic as Lic, tl 7d..G
)arc Contractor
ARCHITECTS DECLARA7ON
I understa d my plans shall be used as public records
.(cc_nsedpntfcssional_ _. _ _ _
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for Oro
bllowing 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
)rior to its issuance, also requires the applicant for such permit to file a signed statement
hat 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
hat 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 penally of
tot more than five hundred dollars (S500).
L, as owner of the property, or my employers with wages as their sole 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 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 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.
0 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
El 1 hsve and will maintain a Certificate of Conscnt to self -insure for Worker'sCompcn-
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 Wor ds Compensation Insurance caries and Policy number are:
Cartier. ':rPolicy No.: /S eL0 `q -0S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less)
I certify that in the performance of the work for which this permit is ilucd, 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 revoked.
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 (See. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the above information Is
coned. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby amthor 7Z 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 or the granting of this permit.
APPLIC NDERSTANDS AN WILL COMPLY WITH ALL NON -POINT
SOUR ULA
m.
-0
Signat of ApplicanUConrractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
defined by the Cupertino Munici I Code, Chapter 9.12, and the Health and Safety
ode, Section 25532(a)?
❑Yes No
Will the applicant or future building occupant use equipment or devices which
z hazardous air contaminants u cfined by the Bay Area Air Quality Management
Dist
D str
❑ Yes No
Job Description
REVISION: BALCONY DOOR
ORIGINAL PERMIT: 06100010
Sq. Ft. Floor Area
3 69 010 2 8 .W Number
Issued by:
Re -roofs
Type of Roof
Valuation
$100000
Occupancy I
Required Inspections
Date / .2 `�—
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.
1 have read the hazardous materials requirements under Chapter6.95 of thc Califor-
nia Health & Safety Codc. Sections 25303.25333 and 25334.1 understand drat if the building
does not Mha
ve a IcnIn,, that it' my responsibility to notify the occupant of the
reyuircm mu met prior nuance of a Certificate of Occupancy,.I y,0
Ownc r authorized agent _ Date
Signature of Applicant Date
. All roof coverings to be Class "B" or better