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08050206CITY OF CUPERTINO �77"^"�T 17" 1 'TR�y�v - '�y sr 's� T�a,gY BUILDING DIVISION PERNUT g+'v T.el`*,LII"' ♦'h" RII�1 ORMAT 01V. RCONTR:AC BUILDING ADDRESS: PERMIT NO. 20800 HOMESTEAD RD TYPE WEST BUI ' NAME: - PERMIT ISSUE DATE PHONE: 4:609 4TH SEP STE 1-29 _iWrhfA O. CONTROL N0. (510) 525-9378 ARCHTIECTIENGINEER: BUILDING PERMIT INFO BLDO ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I brachy wyou than 1 w licensed under provisions of Chapter 9 (commencing with Section 70mB of Division Sof Ne Business and Professions Code. and my license is in full force ameffect. DEFERRED SUBMITTAL OF M/E/P'S,ORIG#0712.0212—NO License❑ns La.0 Dan condain, - SANITARY REQUIREMENTS. ARCHITECTS DECLARATION 1 understand my plans shall bc used as Public records Licensed Professional OWNER -BUILDER DECLARATION I hereby aline that l an ucmpt from the C.mracle's ucense Law for the ' following reason. (Section 7031.5, Business and Profesdons Coda: My city Or county which requires a Permit m construct. ager. hnpmv, demnluh, m mpasr any strunum prim m its issuance, also require the applieam for such permit N file asils ed tummmt Sq. Ft. Floor Area Valuation mu he is licensed purntanl m the provisions of the Comrmmrb Lime Low(chapter9 (commencing with Section 70.0) of Division S of rhe Business and Proresions Codo) or 0 0 0 $1000 Nu u uNe he ccom tbuefrom and basis for the alleged emmptim. Any violadun of APN Number Occupancy Type Section 7031.5 by any Applicator (m a pmmit objects the applicant m a civil penalty of tool mom Nan five hundred dollars ($300). 32609056 T2 & 2 A 1,nownm oldie propmy, err mY wplaycu with wagesss lkv ole compensadm, Required Inspections will do Newark. and Nesmctum is not intended moRered rortale(See. 7014. Business and Pro(nUom Cade The CanoacNrs Liens Law does WE apply m an owmc of q P pmpeny who buildaarimp e. Herron, dwho do such wort himself.' Waugh his .wncmployres, pmvided that such improvements we not intended moQered fmsale, If. however. me building m'unprovemmt is mid within arc year of ampletim. the owser- builder wig have Ile bardr+t .f proving that he did Out Wild or improve Ins purpose of sale) Q 1, u sones of IM pope", am exclusively contracting with licensed conommn in construct Ne project (Sec. 7014, Business and Professions Code:) The Costracmra U. costs Law dens out apply In an emor of propmy who builds, or improves thereon, and, who contracts for such pro) with a eonuacmr(a) licensed pursuant m the, Convacmes License Law. ❑lam Pt .B&PCfo Nis teams Date - tayom IrCOMPIENSATIONDSCLARATI,N 1 hereby aQ r pevlly o! perjury arc o(dr (olbwing denlantiasa (m Wartera Comprn of Co vent to too, ❑ Ilextie anilide for provided for by Sttdon 3700 of dm lanae code. (m die performance .f the aadm, for by Section37M r ooh for which this; permit is issued. 1 have and will maintain Workers Compensation ImmLIW. a required by Sccuon 3700 of the lanae Code. to, Ne perfarmatee of Ne wort for which this permit Is Issued ' My Waiters Coropesmtim lnwuntt carrier and Poll, momma, am: camm Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thu urian need no, W complmnd if the penom ofmonehmtAed dalmot ($100) or tont) I cenic. that le the perfmma N the work for which Nu permit u issued. L ,hall nm employany Appliexns TO L ng Nu Certificate Exemption you Mould m becomeecomty the W. SCompevalionermit provisional of themed rCode you most becomes foMwiN comply with ncM1 provisions m Nu pemnir shall be deemed rooked. ) CONSTRUCTION LENDING AGENCY I hereby M. that Nem is a covwctimt lending agency for Ne performance of ' the weals for which this permit is issued (sec. 3097, Civ. C) Unders Name LOOAddress 1 conify that 1 have read Nis sppliudan and sum five do above information is atra.T. I agrne in amply with all city and county ordinarues and sum laws miming In Wilding construction. and hereby •uNmice repmseau im of this city to cndr upon dm aWve-menti.ned property for insiamdm Pmgwes (We) agree to sam, indemnify and kap harmless the City of Cupertino agalnsl liabilities judgmenu, casts and expenses which may in my way accrue agWmLsaid City v in covegmnee of the grat of or th It. APPLICANT UNDERSEA S WILL COMPLY WITH ALL NON MINT 1' Issued by: Date SOURf; � Re -roofs I�I7�j• I� Signature a/�ZADOUSMATERIAISDISCLOSUREMATERIALS T Dia Type of Roof Will the appliant.r future Wilding occupaslnom or handle lusemmns mamdal &fl.d by the Cupertino Municipal Code. Chapter 9.17 and the Health and Safety .section zss3zp)7 yrs ❑KNo 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 octupam use, equipment or devices which emit hevardnm air conumivnu as defined by me Bay Am. Air Quality Management all new materials for inspection. Diavict7 Yu `-'t u �-I'' I have mull the ha Moue mamriatsmgvvements under Clupme595 of me Califon. nialicud"SafmyCode. Sccti 25503.25533and M34.IurdumaMNnirdm Wilding dens net curtrndy have a II u my nnsponsiMlilY m nodry de.eeupanl of Ne Iwo issuanceoaCmtif ofOc Signature of Applicant Date 16 e . All roof coverings to be Class 'Aa' or better owner ath dagen4 ons a CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD TYPE 2 & 2A CONTRACTOR: WEST BUILDERS, PERMIT NO: 08050206 INC. OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED: 11/24/2008 OWNER'S PHONE: BERKELEY, CA 94710 PHONE NO: (510) 525-9378 ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMINFO: BLDG ELECT PLUMB PERMIT License Class Lic. # r r r MECH RESIDENTIAL COMMERCIAL Contractor Date i hereby affirm that i am licensed under the provisions of Chapter 9 JOB DESCRIPTION: DEFERRED SUBMITTAL OF (commencing with Section 7000) of Division 3 of the Business & Professions M/E/P'S,ORIG#07120212-NO Code and that my license is in full force and effect. SANITARY REQUIREMENTS. 9/14/9 RE -OPEN PER BE;REVISION OF ELECTRICLA 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $1000 performance of the work for which this permit is issued. i have and will maintain Worker's Compensation insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32609056.72&2A Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that i have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. i agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: i hereby affirm that i am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). i have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. i will i hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 1 store or handle hazardous i have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should i use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and i have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Workers Compensation laws of California. if, after making this certificate of exemption,) CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, i must i hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the i understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date ffl'' CI OF CUPEkTiNO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # Date: Original Permit #: O$b5b2olQ Building Address: 2DIBOO 2-(3 Ty p 2.Pr Mailing Address (if different from building address): Owner's Name: Phone #: (.50-931-31q57 ?(w Iv. rT"e� N --s M t 1- G Contractor: Phone: 1O 7 73 - o7 7a t -�-r- r�►-� ► `r� Fax: yp� - 7q (9 - 5-0,33 Contractor License #: 62-539E, Cupertino Business License #: 2q q Contact: Phone: S t a --77 3 -0 -770 Fax: Building Permit Info: Bldg;K Elect ❑ Plumb ❑ Mech ❑ Residential © Commercial Job Description: Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B ❑ Valuation (cost of project): N GLi4A G' Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildit reen.or Revised 01/07/09 .» ;l CITY OF XN11DEFER-P ED RIA V IS Y- E EF ,x/111 Af'PLRATIC)N, T:) FLNi oso5 0,2-6(p D ginal P-= -#'- ®-7 rL CZl -Z— Building Building AddrLss. 7,uB0® "M t5srE b I Mailing Address (if different from building address): Owner's Name: Phone #: Contractor: Phone: 408 , 7442 503 Fax: q0b. %41iQ. 5033 Contractor License #: l37' 39 5 Cupertino Business License k 74KO 1 Contact: L Phone: 610 817—, Z653 �V`N(7. Fax: 5107 • ,550 • Z&81 Building Permit Info: Bldg ❑ Elect Plumb [[]� Mech Residential ❑ Commercial ❑ Job Description- , �e fre � 5a f3tk iTr)9Z �F MC -P s Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 2 ►�� 1-A, 1-B ❑ 11i 1 l 1/V -A ❑ 11i 111 ; ; Project Size: Standard Large Major Valuation (cost of project): Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index, Points Achieved: For help, contact Build it Green at www.builditgreen.org CUPEkTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1REVCOMNEW Revision Commercial New B 1* 1REVCOMTI Revision Tenant Improvement B 1* TI 1REVSFDWL Revision SFDWL B 1R3SFDW 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R-3 Inspection B 1* L/ 1DEFPLNCK Deferred Submittal not R-3 Plan Check B 1* OR 1* TI 1DEFR3PLNCK Deferred submittal R-3 Plan Chk B 1R3SFDW 1R3SFDADD 1R3SFDREM 2 of 3