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08040001R. < z 3f'tou DyU %WF .03 n y foo —�< Y�O 0 O z.. F� i1+ 0 �z UO OU Ha U CITY OF CUPERTINO BUILDING DIVISION PERMIT Bu1I_q.6iiP4�9'kEVENS CREEK BLVD L (J RKG ASSOCIATES P08040001 OW N A PERMIT ISSUE DATE PROMETHEUS 15559 UNION AVE STE 128' 04/01/2008 PHONE: (408) 761-5008 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION licensed Chapter 9 Job Description 1 hereby affirm that I am under provisions of (commencing with Section 70W) of Division 3 of the Business and Professions Code, and my license is REV, REVISE EXISTING PLANS; OR I G #08030008 in full force and effect License Clan Lie. k Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct alta, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed to dre of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant provisions Section 7000) of Division 3 of the Business Professions Code) or $ 0 (commencing with and that he is exempt therefrom and the basis for the alleged exemption. Any violation of �' tuber 3 6 9 5 3 9 9 9 A_fW Occupancy P Y Type Section 70315 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 employes with wages as their sok compensation, will do the work, and die structure is not intended oroffered for sale (Sec.7044,Business e Required Inspections and Professions Code: The Contractors License Law does not apply m an owner of ns Q p property who builds or improves tlmcon, 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 owner of the property, am exclusively contracting with licensed contractors to ooatroct 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 contras for such projects with a conuactor(s) licensed pursuant to the Conuactoes License Law. ❑ I am exe rpt under Sev'?-- & P C f this rcasop Owner Date O Q{% R COMPENSATION DECLARATION 1 hereb affirm under penalty of perjury one of the following declarations: ❑ 1 hsve and will maintain a Certificate of Consent to self -insure for WorkeesCompen- sation, as provided for by Section 3700 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 Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or Icss) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in y manner so as to become subject to thearkcrs' Com nsation Laws of Califo i e Applicant NOTICE TO C f, r kog this Certificate 6fEidiription, you should become ;ubjcKlo the rkers Compensation provisions of the Labor Cade, 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 (Sec. 3097, Civ, C.) Lenders Name ' Lenders Address I certify that I have read this application and state that the above information is correct. l 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 acme against said City Aconsequence of the f this permit N'T APPLICANT . D T S NO WILL COMPLY WITH ALL NON -POINT Issued by: Date �(� V SOURCE REG Re -roofs Type of Roof Signature of A cars✓ tractor 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 Cade, Section 25532(a)? ❑ Yes All roofs shall be inspected prior to any roofing material being installed. Will future If a roof is installed without first obtaining an inspection, I agree to remove the applicant or building occupant use equipment or devices which emit hazardous air contaminaptsfmcd by the Bay Area Air Quality Management all new materials for inspection. District?f ❑ Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth & Safety Code Scc 25505, 25533 and 25534.1 understand that if the building does not c sly h t it is my pondhility to notify the occupant of the requiremens i m poi to iss of a Certificate of cup �� Signature Of Applicant Date CITY OF CUPERTINOga �a .,..ya„�� rgme r' -�.'<.,E$n�c'r1 BUILDING DIVISION ISERNIIT »#�0�1�ta-LW0--- °��,�I�1- - Bun.pNHESkEVENS CREEK BLVD RKG ASSOCIATES 08046001 N A PERMITISSUEDATE PROMETHEUS 15559 UNION AVE STE 128 04/01/2008 IPHONF- SANITARY NO. COMROL NO. (408) 761-5008 CHI EC(ENGINEER: BUILDING PERMIT INFO BIRO ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATIONIOb D0SCr1 nOn V1 hereby Arm Nn 1 Am 1'uxmN under provisions of Chapter 9(rnmmencing P t wBIn Section 7")ofDivision3 of Ne Business and Prolamines Code,I my)team=1, REV, REVISE EXISTING PLANS; ORIG {08030008 ^ y in full force and effect. j UA2 Line.Class Lic.0 t- Date Coshocton ARCHITECT'S DECLARATION 1 undersand my plans shall he used As public records G Licensed Professional OWNER-BUILDER DECLARATION <5i I tummy affirm Not 1 am esempt from the Contractor's License Law for the ipoo following reassert.Section 70 LS,Business and Professions Cade:Any city or county 3_ which inquire s permit to construct.slut.imprme,demo)W,m repel,any struclum _Z'y^ prior b its issuance.Alan acquires the applicant for such permit to file a signed sutemctn < thathetsnamedpur=.m lollreprove;uoneo(meconuacwraluen=I�wfehapmr9 Sq.Ft. Floor AreaValuation F�$ (c(constructingwith Section 700M of Division 3 of the Business an $0d Frontal..Cres) _ that he is exempt theinfrom and the basis for d=alleged esemption.Anis vialadm of Section 7031.5 by any applicant for a permit subjects the applicant to a dull penally ofrobes Occupancy Type Ant mare Nan five hundred dollars(ISM). 3 6 9 5 3 9 9 9!Y�4�' ❑Lasowner of W Fop”,or my employees with wages u their m)e compew0on, Will do Newark.And the aWLlum is notinutnded mediated for saMN,(See 7OBusinessRe aired Inspections and Professions Code:The Cony=cora Liar=Law does net apply to An owner of q P property who builds or improves Wmon,and who doessuchwok him=Iforthrough his ownemploymn,Provided that such improvemeou arc not intended oro0krtd formic.It. hawevm,the building or Improvement 4=Id within aro year of comptedon.the owner builder win have don burdat of proving that he did not build or improve for purpose of As .). owner of the Property,am exclusively conuuvng with licensed comranbrs to Nlmel cite pmjea(See.7004,Business and ROffStian{Godes)The Con racb's U. cave Law does not apply An an owner or pmpwy who builds or improves there>n,and, who contracts for such pmjeas with a contracbr(s)liaved Pwmcm,to the Contractors umme Law. ❑lamas plundo Se ,BRPC( Wsrusq noDate () A COMPENSATION DECLARATION I hmb Ring under penalty of Perjury aro often fallowing declaration: ❑Thaw and will for eCerd3cate of Gov Labor Code.furefo Waorma Campeo-nation, rproh provided for al Section 3700 of the labor Cade,for the performance of ink work for which this parrot)u issued. ' ❑I have and will maintain Workers Compensation Insurance.As required by Sadao 37W of the Labor Code•for tite performance of the work for which this permh Is Issued. ' My Warkers Campem mon Ivbana carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE This suction need nest be completed line Permit is format hundreddellan(SIM) or leu) I certify ba,In the performance of the work For which this perm))is issued,)shall mol employ any per=min agy manne =asbbarome subjectbdte rkem'Com don Laws ape Ca)irolniar➢((e • f n Applicant I'til ��f NOTICE TO C 1(�{fcr {thts Certificate ol�Em pdo become sub b the liters Compewuon provisions of the lobo Code you most - .JO forthwith comply with such provisions or this Penni shall be domed invoked. Z y CONSTRUCTION LENDING AGENCY 1 hesehy affirm that Nem I&.covuuman lending agency for the perf enowsm of 1t.> the vert for whim thts Permit is issued(Sec.Som.Cho.C.) QLender's Name 7 Z LemderaAddmm U O 1 certify that I have mad this application and Anne thin the shove Information Is kr H correct.I agree to comply with all city and county ordinances and Also,laws relating to OU building convection,and hereby suthada mprasenlativn of this city to enter upon the W above-memianed property for inspeaion Inspect Pk, (We)Agine to save,indemnify and kap lu mlea the City of Cupertino against liabilities,judgments.costs and expenses which may in any try acerae again,aid City U2 ineonapermofthegrandn fthis permit. r� ^t APPLICANT�S ND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REG �� /] OJ Re-roofs signuam ors eanv Data Type of Roof HAZARDOUS MATERIALS MATERIALS DISOSURU0.E WIO the applicant ofuture Wilding occupant.ChaptAmro2,And ulsh eahlb material as de0ned by the Cupertino M Code.Chapter 9.11,and du Hcalth uW Safety .scales 535334T kok, Cl YesAll roofs shall be inspected prior to any roofing material being installed. Will the applicant or filum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hmaNnn air==ivnup dcfood by Ne Bay Area Air QUWLy Management all new materials for inspection. District? 0Yes [have mW the hnmdev materials metuimmenu under Chapter6.95 ofthe Celifor. nia Hculth&Safay Cade So25505.25533 am125534.1 undcnand thul(mM Wilding cites no,corruptly h t. it is my ponsibility b notify dm oo pant ord. scgUlmmcnts I m At =into of Delineateor ofco p Signature of Applicant Date Owner or cosh coed agent � Dab All roof coverings to be Class';T'or better