04080198 ..... ----- ....
CITY OF CUPERTINO 7 "rw
BUILDING DIVISION PERMIT
BUILDINGADDRESS: MCLARNEY CONSTRUCTION PERMIT'cb4 0 8 0198
20488 STEVENS rREEK PLIED
OWNER'S NAME: PERMIT USUE DATE
PROMETHEUS (#2040) 355 S DMIEL WAY _'n"29_24
WE: SANITARY NO. CONTROL NO.
4082468600
ARCHTTECTIENGTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Dcscri
LICENSED CONTRACIOWS DECLARATION
flinuNet lanah mcd?ndorpmAw ons of Chapter Slam ormuch.j TI--'MODA ITALIA
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z 5;mm�_ Contractor
/ ARCHITECTS DEC ON
I u'&.tmod.9 ph.shall W used the remods OCT Jf 2004
Licensed Professional
0 following..I,(Section 7031.5,Btainc.,md Prodfamamus Coda:Any city.1 only BUILDI
G OWNER-BUILDER DECLARATION
I hereby affirm that I am mempt from ft Comment's License Law for the
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which".I..incounit to mossurs,.[an,improv,demolish.or repair any ma.m. n
poor In its hansom.also acquires ft applicant for such permit to rile a signed smommat
Met M is licensed pursuant to N provisions or Me Comenclor's Umnse Law(Chapacr 9 Sq.Ft. Floor Area Valuation
(commencing with Saxon 7001)of Division 3 of the Businessand Professions;Code)w
ERR that M I,exempt Mansufams and the basis for the alleged exemption.Any vialathen of
Section 7031.5 by my applicant for a parran subjects the applicant to a civil Penalty of -i V&NSLjh*e10 0 Occupancy Type
not mom Man rive hundred dollars($503).
0 1,as owner ofth,pr;pmy,or my employees wfib wages as their sale conspesneallon.
will do thawak.nd fttrumers,I,not intended".ffk.d f...I.(Sec.7044.11usirms
and Profession Costs:The Contractor's Laccone Law dean not apply M an owner of Required Inspections
property who wilds.,iners.thearcon,aned.h.dom.uch work himself.,through his
croormiployeass,provided that such Improvement;ase not mucound oroffered for We.If.
howevoo,We building or improvement is sold within one year of completion,We owner.
builder will have We burden of proving Net he did not Wild or improve for purpose of
sale.).
0 1,as comer of the property,am asselo3jvcly contracting with licensed commscuum to
construct the project(Sec.7044,Business and Professions CWc:)no Controccurr's Li.
came,Law d=not apply to an owner of property who Wilds or improves Mercer,and
who contracts;for such pmjem with a contractor(s)licensed personal to the Contractors
Likerse,Law.
0 1 ma exempt under Sec. B&P C for this mason
Owner Data-
pIWORKER'S COMPENSATION DECLARATION
I hereby&Man under Penalty of perjury a=of We following declareatiome
as
action,asprovided for by Section 37M of Me Labor Code,for the Performance of We
work for which this petraft is brand.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37M oftW Labor Code.for We performance of We work for which this panel,is issued.
My Workers,C..Kmtionrn7.,.ad Policy rumbe
dm�.Slic�tj
CERTIFICATE OF EXEMPTION FROM WO
COMPENSATION INSURANCE
(1143 section need not W completed ifits,permit is Imane hundred dollars(SIM)
less.)
I certify Met in the Performance or We work for which this mooch is hued,I A.11 not
employ any Poston In any comencrim as to becorm,subject to Me Worlacor Commonomolon
Laws of Calif.ram.Data
Applicant
NOTICE TO APPLICANT:If,ono,na.kin,this conoricate,or Eccomption.you&hout;
became, object to the Worker's Compensation previsions of We Ulan,Code,you must
z rmahwiffi mra,I,with Such p.vl.i...01 this moonlit 1hall In demand revoked.
z CONSTRUCTION LENDING AGENCY
' I lareby.M.that ftrt is a consurnefinn lending agency for We perforroarms of
> ft wurt for which this permit is burned(Sm.3091.Co.C.)
Undoes Nasna
UndIn'.Ammeat
U r7 I cartify dem I have tend this application and state that the sheve information in
I:, correct.I agree to comply with all city and county ordinances and soon laws relating to
0 Wilding construxuan,and hereby moonrise naposeenuaim or this city to enter upon We
above-martioned property for mospecumn puripaums.
(We)¢gra w save,indemnify and keep harmless;ft City of Cupcourm against
,4
liabilifiesjudgmenu.costs and expenses which may In any way accrue almost said City
APPLI�Ahl
U incon�wM,oNDERSTANDSlll,g�nlin,ollAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SSAGU TION)r,U
a!�9U Re-roofs _C7
mum. Applin too 6 1,Data/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or for.re building omorparat aare cor handle hanounimm,armanod
as deffied by the Cupent. icipal Code.ch.me,9.12,and By Health and Safety
Conn.seem.25532(.:
0yes No 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
Will the applicant or Future building occupant use equipment or devices which
11 haloodaus air conuuminams a defined by to Bay Area Air Quality Management all new materials for inspection.
District,
o yet
y" No
as
Ih..Wffi,h.,dls..Wriais�uimmenmunderC�pmr6.95ofNeCalifory
e te
nizHcal"SAIciyCo�d.�ffons25505.25533md25534,lun&m=dLhaifft amount,
a. ve a
date. MIY be. Waste,I.,it I.on,responsibility to notify the cap.(of the
re me which I prior W notmax, fa COMIzC f0c No Mu Signature of Applicant Date
sone ora o All roof coverings to be Class "B"or better
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