06090214 CITY OF CUPERTINO G� TRAGTOR� tQR1 �T :QN:
BUILDING DIVISION PERMIT pERMITNO.
BUIL
HILLHOUSE CONSTRUCTION 06090214
`450 STEVENS CRK STH FLR PERMIT ISSUE DATE
dER'S NAME: 1 0 0 6 2 0 0 6
PROMETHEUS 1670A ZANKER RD.
SANITARY NO. CONTROL NO.
PHONE:
(408) 467-1000 BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ARCHITECT/ENGINEER:
(� (� 0 r
p 00 LICENSED CONTRACTOR'S DECLARATION lob Description
mC I hereby affirm that I am licensed under provisions of Chapter 9(commencing
U
m with Section 70(10)of Division 3 of the Business and Professions Code,and my license is REVISION-INSTALL MOVING WALL AT CONFERENCE ROOM
y in full force and effect .�7 3 6 6�
,�? License Class tic.# RIGINAL PERMIT: 06070083-NO NEW PERMIT
i t- Date Contractor L.L
-i ARCHITECTS DECLARATION
12< I understand my plans shall be used as public records
>yU
'tr.y Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
C O following reason.(Section 703 1.5,Business and Professions Code:Any city or county
1.Pi which requires a permit to construct,alter,improve.demolish,or repair any structure Val i8 4 4 11
J—rA prior m its issuance,also requires the applicant for such permit to file a signed statement S(1 Ft.Floor Area
-?< )hat he is liccnscd pursuant to the provisions of the Contractor's License Law(Chapter 9
Ema 11,- (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 Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3�t01028 . 00
Number
u
not more than five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation, Required Inspections
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 docs 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 contractor(s)licensed pursuant to the Contractor's
-vose Law' B&P C for this reason
am exempt under Sec.
,
Date
ner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers 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,az required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Copmpens tion�InAsyuran carrier and Policy nu y r�:6 0
Carrier.`�r I QU�_V u V 100 Policy No.:y[[
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 issued,I shall not
employ any person in any manner so az 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
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
rZ 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.)
Lia A Lender's Name
f� Lender's Address
I certify that l have read this application and state that the above information is
V.0 correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize rcprescntativcs of this city to enter upon the
above-mentioned property for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
�CA liabilities,judgments, and expcnscs which any way accrue against said City
V Z in consequence of the uu
ng of is per . Date
APPLICANT UN D STAN AND OMPLY WITH ALL NON-POINT Issued by:
SOURCE REGU TIONS
Re-roofs
Si n pplicanUCon Dare T of Roof
HAZ D ALS DISCLOSURE Ty
Will the applicant or future building occupant store or handle hazardous material
afrned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
,fe,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ° 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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 have read the hazardous materials requirements u pier 6.95 of the Califor-
nia Health&Safety Code,Sec' 25505,2 3 and 25 un .il that if the building
does not currently have a.te" t that it' myres t •to notify the occupant of the Date
requirements whic s met prio issuance ficate of Oce°panty. Signature Of Applicant
All roof coverings to be Class"B" or better
Owppr nrcd agent Date