07100215 CIT� OF CUPERTINO ' > ` ` ' '
su►�.�ir�e nrv�s�oN PERMIT ��1��E�G'��R ����ATI�N: :
, , :. .
PERMIT NO.
BUILD � CREEK BLVD # 111 TBD 70 BE DETERM3NED 0 710 0 215 .
r$
.dER'S NAME: PERMIT LSSUE DATE
PROMETHEUS REAL ESTATE GROUP � 10/30/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGiNEER: BUILDING PERMR INFO
BLDG ELEG7 PLUMH MECH
� 0 � 0
i p � LICENSED CONTRACl'OR'S DECLARATION JOb DOSCTIPC10l]
� v� I hcreby afGrm that I am liccnud unJcr provisions a( Chaptcr 9(commencing
; z� wiih Secdon 7o�U) of Division 3 of ine Business and Professians Code, and my Iicense is REMODEL K I TCHEN / BATH � W/ D RETROF I T, DUC TLE S S S PL I T
� a a � full Corce and cClccL
>�z LicenscClazs [.ic.x SYS HVAC RETROFIT� NON—STRUCTUR.AL
: F p Da�c Conuacwr
� ARCHITECi'S DECLARATION
i a a 1 undcrstanJ my plans shall bc uscd as public recorcls
)yV
' LL. F' Licenscd Prufcssional
� y � OWNER-BUILDER DECLARA'f10N
>' 1 hcrcby at7rm thnt 1 am excmpt trum Wc Cantrac[or's Liccnsc Law for thc
� p o foUowing rcuon. (Sccuon 7031.5. Busincss and Profcssions Codc: Any city or county
�,°, � which requires a pertnit w conswct, altcr, improvc, dcmalish, or repair any structure
� Z} pnor to ils issuancc, alsu rcquircs ihc applicant Cor such permit ta filc a signcd s�a�cmcnt
;= o tha� 6e is licenscd pursuan� to ihc pmvisions of thc Contractur's Lic�cnsc Law (Chaptcr 9 Sq. Ft. Floor Area $ 3 9 0 0 Valuation
� t– $ (commencing with Scction 7000) of Division 3 oC thc Busincss and Profcssions Codc) or
,, �., that he is exempt themfrom and the basis [or the altegcd eumpdon. Any violaUon of
Section 7031.5 by arry applicant tor a pertnit subjccts the applicant to a civil pcnalty of p Number Oceupancy Type
not more than fivc hundccd dollars (5500). 3 6 9 01- � 2 6.��
❑[, as owner o( Uu property. ar my cmployces with wages az their sote compensadon,
wiU do thc work. and �hc awcfurc is not intenGcd or offeced lorsatc (Sec. 7044, Business Re uired Ins CCt10i1S
and Pro[essions Code: The Canuactor's License Law does not apply in an owner of Q p
prapeny wha 6uilds or improves thereon, and who das such work himulf or Uvough his
own employces, providcd that such improvemen�s are not in�ended or ot(eecd Cor sala IC,
however, ihe building or impcovement is sold within one year of compktion, the owneo-
builder will have the burden of proving that he did nat build or improvc for pmpose of
sale.).
❑ I, as uwner o( Ne property, am ezciusively convacting with licensed rnntractors to
construct the projett (Scc. 7044. Eusiness and Rofessions Cade:) The Coa�actor's Li-
ccnse Law docs not apply to an owner of property who builds or improves thereon, and ,
who conuacls for such p�ojects with a contractor(s) licensed pursuant to �he Convactar's
License Law.
1 am tacempt under Sec. , B& P C for this reason
_ .uner Date _. .
WORKER'S COMPENSATION DECLARATION
I hereby �rm under penalty of perjury onc o! the following declarations:
❑ 1 hs.�e and wilt maintain a Ccrtificatc of Conscnt to self-insure tor Workcts Compen-
sation, as providcd for by Sation 3700 of the labor Code, for the performancc at thc
work for which Ihis permit is issucd.
❑ I have and will maintain Worker's Compensauon Insurance, as icquimd by Section
3700 oC We Labor Codc, for thc performance of the work far which this pecmit is issued.
My Worke�s CompensaGon Insurance camer and Policy number aze:
Carrier: Poliry No.:
CERTIFICATE OP EXEMPf[ON FROM WORKERS'
COMPENSATION INSURANCE
('This scctian necd not be completed if the permit is foronc hundred dallars (SI00)
or Icss.) �
1 certify thxt in thc performancc of thc work for which ihis permit is issucd, 1 shall not �
employ any person in any manner so az ta bccomc subjcct �o thc Workcrs' Campensation
Laws oC Califomia. Datc
Applicant
NOTICE TO APPLICANT: If, aftcr making Ihis CcniGca�c of Excmptian, you should
become subject to thc Worker's Compcnsation provisions of thc LaAor Codc, you must
� O farthwi�h comply wi�h such provisions or this pccmil shall bc dccmcd ccwkcd.
z """ CONStRUCf10N LENDING AGENCY
[� ►�-+ 1 hereby amrm Uiat ihere is a consuuctinn Icnding agency for tAc per[urtnance o( _
a� �hc work fur which this permit is iuucd (Scc. 3097, Civ. C.)
�1 Q Lendcr's Namc '
a z L.ender's Address
U � 1 ccni(Y that I have rcad this application and siatc thu thc abovc informatiun is
w � cortcc� I agree to comply with all city and county ordinances and sute laws rclating �o
0 U building conswction, and hcrcby authoriu rcprescnta�ivcs of �his city to cnter upon lhc
�� abovc-mcmioncd properly for inspcction purposes.
(Wc) agree to sare, indcmmi(y and kccp harmlcss ihc Ci�y of Cupertino against '—"
H � liabilitiu, judgmcnts, costs and czpenscs which may in any way accruc agains� said City
U z in consequcnce oC Ihe granung of �his permit. Date
� APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by
SOURCE REGULATIONS.
Re-roofs
Signature af App�icanUContracwr �a� Type of R oof
HAZARDOUS MA7ERIALS D[SCLOSURE
�11 thc applicant or futurc building occupant srorc or handlc harardous matcrial
lefined by thc Cupenino Municipal Codc. Chaptcr 9.12, and �hc Hcatth and Safety
..x1c. Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs O No .
Will ihc applicant or [uturc building occupant usc cyuipment or dcvices which If a roof i� installed without first obtaining an inspection, I agree to remove
emit harardous air contaminants az defincd hy �he Bay Area Air Quality Managemcnt all new m aterials for inspec*ion.
Disvict?
❑ Ycs ❑ No
t havc reacl the hazardcws ma�crials rcquiremen�s undcrChaptcr 6.95 of the CaliCor-
nia Hcal�h & Safcry Codc, Scctimts 255U5.25533 and 25534. I undcrstand that i(thc building
docs not curtently havc a �cnan4 �at i� is my responsibility to nouCy thc occupant of �hc
rcyuiremcn�s which mus� bc met prior to issuancc of a Ccnificatc of Occupancy. SlgilatUie Of APpI1C8Rt Date
pa« - All roof coverings to be Class "B" or better
Owncr or au�horizcd agcnt
�,. ,/... IU.iUU �Corre Avenue
"�'� Cupertino CA 95014
Telephone (408) 777-3228
CI7Y Of Fax (408) 777-;;33
CUPE�TI�10
Buildi�n De artment
j JOB ADDRESS 20380 STEVENS CREEK BLV PERMIT #
� CUPERTINO, CA 95014 _., � � � Q� � ��(�
, `
OWNER�S NAME:PROMETHEUS REAL ESTA`.CE GROUP PHONE #( 91 6) 7 8 9- 8 4 8 4
GENERAL CONTRACTORsTEVE WHITESII)ES FAX #(91 6) 789-1 0'S1
I am not using any subcontractors:
S:.gnature Date
Pleas� check a licable subcontractors and com lete the followin information
�- SUBCON'TRACTOR BUSI2JES5 NAME BUSINESS LICENSE #
I Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
x Heating SAN JOSE AIR (1408)286—�047
� Insulation
; Landscaping
i Lathing
� Masonry
� Ornamental Sheet Metal
! Painting / Wallpaper
': Paving
� Plastering
) Plumbing
1 Roofing
� Septic Tank
' Sheet Metal
� Sheet Rock
! T�
� z8 �
� Owner/ Contractor Signature Date
CITY OF CUPERTINO
7 ITEMS OF 35 PERMI7' RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: B1}:: Lot:
APN ......... 36� 01026.33
DATE ISSUED.......: 10�30/2007
RECEIPT #.........: BS(i00003124
REFERENCE ID # ...: 07].00215
SITE ADDRESS .....: 20;�80 STEVENS CREEK BLVD #111
SUBDIVISION .......
CITY .............. CUI'ERTINO
IMPACT AREA .......
OWNER ............: PRC)METHEUS REAL ESTATE GROUP
ADDRESS ..........: 19()0 5 NORFOLK ST #150
CITY/STATE/ZIP ...: SAPd MATEO, CA 94403
RECEIVED FROM ....: OR:=ON FINCL SVCS
CONTRACTOR .......: TBI) - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBI) - TO BE DETERMINED
ADDRESS ...........
CITY/STATE/ZIP ...: ,
TELEPHONE .........
FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BENERGY PERMIT FEE 104.76 50.28 0.00 50.28 0.00
BPERMFEE VALUATION 3,900.00 104.76 0.00 104.76 0.00
BREMACOVER NO LTNITS 1.00 17.82 0.00 17.82 0.00
BSEISMICRE VALUATION 3,900.00 0.50 0.00 0.50 0.00
EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 295.73 0.00 295.73 0.00
�
0�������
� . ���� CITY OF (:UPERTINO
CuP��T�NO PE�IT APPLICATION FORM
APN # � � Date:
�3 6c�_ � � � 0 2 � � ,3 `�j � �3 -a -�
Building Address: Mailing Addres�(if different from building address):
��_38 S�r��.s CY-1<_ (3t.• d �i
Owner's Name: Phone #:
P��n�� �s C'� �s. e��� �-� � S 3-- 7/ o �
Contractor: 9 License #:
C�r'��� � � ��� ` � `�� �'
Contact: Phonet 7& �— �t(� Cupertino Business License#:
.S�e�.� c��i � Fax:L�-c'c6) � �4 — io
Building Permit Info: w r� Yof;t 1L;�1nQ,n ra (3 `-�.'�'r � O�•c��s' sP�;� en-,
,�-��6 p. � �(�2-hr � . — r� � ��l S'-4v L �'�-�'�
Bldg [� Elect C�� ?lumb 0� Mech ��
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: �' Occupancy Group:
.� UO C• �� �
Type of Co�ruction: Please check this box if t� project is a
� second-stor addition:
Project Size: Standard � Large ❑ Major ❑
Quanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER Other A liances MECHANICAL
BBOILERI Bc iler <= 100,000 Btu MECHANICAL
BBOILER2 Boilf:r > 100K to SOOK Btu MECHAI�IICAL
BBOILER3 Boi .er > SOOK to 1M Btu MECHANICAL
BBOILER4 Boil�;r > 1M to 1.75 M Btu MECHANICAL
BBOILERS F�oiler > 1.75M Btu MECHAI�TICAL
BCONSTAX Construction T� BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Cc�n. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Ccnstax — Resi/Mobile BUILDING
BELEC 1000 E.ec 600V <= l 000A ELECTRICAL
BELEC1001 F�lec 600V > 1000A ELECTRICAL
BELEC200 ' Ele�� Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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� CITY �F CUPERTINO
�►noF pERMIT APPLICATION FORM
CUPfI�Tif'�i0
Quanti Fee ID Fee Descri tion Fee Grou
BMISCELL ]vliscellaneous Fee BUILDING
BMITIGATC Conun. Housing Mit. Fee BUILDING
BNUCOMME T�ew Comm Electric ELECTRICAL
BNUCOMMM Ne��v Comm Mechanical MECHANICAL
BNUCONIMP �1ew Comm Plumb PLLJMBING
BOVERTIME IJispection Overtime BUILDING
BPBACKFLOW A� mospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLLTMBING
BPERMFEE 61d Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING '
BPLANCKADD Pl;�n Check Add Multi BUILDING
BPLANCKREP Pl��n Check Repeat Fee BUII,DING
BPREPIPE F:e i e Of Fixtures PLUMBING
BPSEWAGE Sewa e Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK La�vn S rinkler/Backflo PLLTMBING
BPSTORM 3tornrnlRain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT �.lt of Drain & Vent PLUMBING
BPWATER Ins1 a1VAlter Water Pi e PLUMBING
BPWHEATER ��ater Heater/Vent PLUMBING
BPWSVCS T'Iain Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/� Unit > 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY :2emodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Rr,location of Furnace MECHANICAL
BREMFURNOV Re o Furnace > l OK btu MECHANICAL
BREMHEAT �ieater Installation MECHANICAL
BREMINHOOD Ii�stallation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNR.APP Rern Non-Res Appliance ELECTRICAL
BREMPOLE P��le/Platform Fixture ELECTRICAL
BREMPOWER Pov� er Device/A aratus ELECTRICAL
BREMRECEPT Rc itl, Switch & Outlets ELECTRICAL
BREMRELOCA �:elocation of Hood MECHANICAL
BREMREPALT R epair/Alter Heating MECHANICAL
BREMRESAPP Re�nodel Res Appliance ELECTRICAL
:' of 3
� � � s CITY OF ��UPERTIND
CUPfI�T11�0 PERMIT APPI,ICA'TION FORIVI
Quantity Fee ID Fee Descri tion Fee Grou
BREMSIGNAD Rs�idl Signs Add Branch ELECTRICAL
BREMSIGNS Reinodel Signs, Marquee ELECTRICAL
BREMTHEATR Tr eatrical Lighting Fix ELECTRICAL
BREMVENFAN V�,nt Fan Sin le Duct MECHANICAL
BREMVENSYS `�entilation S stems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM S��ismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP rCem orary Power . ELECTRICAL
BTEMPPERM Ter.n orar Bld Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE El ec Permit Issuance ELECTRICAL
MPERIV�EE l✓Iechanical sq. foot MECHAIVICAL
MPERMITFEE M��ch Permit Issuance MECHANICAL
� PPERMITFEE P1L.mbin Permit�Issue PLUMBING
PPLBG P_umbing Fee sq foot PLLTMBING
PLLONGRNGC Plannin;7 LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planninl; Lon Ran e Residential PLANNING
_ of 3