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07030054BUILDING DIVISION PERMIT BUILD N ADDRESS: 450 STEVENS CREEK BLVD #100 NOVO CONSTRUCTION "NER'S NAME: PROMETHEUS REAL ESTATE 1042 HAMILTON COURT PHONE: ARCHITEC rfENGINEER: 1g, c LICENSED CONTRACTOR'S DECLARATION w t: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z ��j 1U. with Section 7000) of Division 3 of the Business and Professions Codc, and my license is -.9 y in fullCorce and effect f� v� z License Class �� Lic. $ y Dam '��—� ">I. F� Contracts S ARCHITECTS DECLARATION z< I understand my plans shall be used as public records )yU U. y Licensed Professional 2 OWNER -BUILDER DECLARATION > 1 hereby affirm that I am exempt from the Contractors License Law for the jp Ofollowing reason. (Section 7031.5, Business and Professions Code: Any city or county i which requires a permit to construct alter, improve, demolish, or repair any structure a Z prior w its issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 2 F (commencing with Section 7000) of Division 3 of the Business and Professions Code) or L that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by arty 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 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 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. IL 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. ❑ 1 am exempt under Sec. B & P C for this reason ,ner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ] 1 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 Worker's Compensation Insurance, as required by Section I700 of the Labor Code, for the performance of the work for which this permit is issued. fly woker's Compensation Insurance carrier and Policy number are: ATE OF EXEMP IO14 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 issued, 1 shall not employ any person in any manner so 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 I 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.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is 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 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 of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Signature of pplicant/C ttractor 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 Safcty ide,Section 25532(a)? ❑ Yes Will the applicant or 11.6. building occupant use equipment or devices which emit hazardous air contaminants defined by the Bay Area Air Quality Management District? ❑Yes o 1 havc read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if tltc building docs not currently have a tenant that it is my responsibility to notify the occupant of the requirements to st ae met a i ance of a Certirrcate of Occupancy. Owner or Date (650)70'--1500 PERMIT NO. 07030054 PERMIT ISSUE DATE 03/23/2007 SANITARY NO. CONTROL NO. Job Description DEMO KICHEN—SEAL TYPE I SHAFT 0q. Ft. Floor Area 3690102) Issued by Re -roofs Type of Roof BUILDING PERMIT INFO BLDG ELECT PLUMB uation $17000 ,'Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roof i s installed without first obtaining an inspection, I agree to remove all new rr aterials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date CITY OF CUPEkTINO PERMIT APPLICATION FORM 0 705CIvs;Y APN # CO Date: Building Address: Mailing Address (if different from building address): BAPPLOTHER Owner's Name: Phone #: BBOILERI License #: Contractor: BBOILER2 Boiler > 100K to 500K Btu Contact: s`o -m Phone: 6, ?0._9 S 0 Cupertino Business License#: Boiler > 500K to 1M Btu MECHANICAL Building Permit Info: Bldg q Elect ❑ Plumb ❑ Mech ❑ Job Description: -/S m Residential ❑ Commercial Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: BUILDING BCONSTAX Type of Construction: Please check this box if the project is a _ - second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ BCONSTAXH Quantity Fee ID Fee Description Fee. Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY`Of CUPE[,TINO O l!"ERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACIULOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING IX BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Ston- /Rain Water PLUMBING -----__ - "- _ BPTRAP Kitchen Trap PLUlVIBING - BPVENT Alt of Drain & Vent PLUMBING - - -` - ----_-BPWATER Install/Alter Water Pipe PLUMBING-- BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cf n MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3