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07080125 CITY OF CUPERTINO �pq�y�A�ym BUILDING DIVISION Lli1WY11 _ PERMIT NO. IBuILDt�1�apRlssRODRIGUES UNIT F DEVERA CONSTRUCTION INC. 07080125 G 11 t5 PERMIT ISSUE DATE OWNER'S NAME: PROMETHEUS REAL ESTATE 941—D BERRY SANITARY NO. CONTROL NO. E: (408) 44_--9598 BUILDING PERMIT INFO TECT BLDG ELECT PLUMB MECH ARCHI /ENGINEER: o a o z LICENSED CONTRACTOR'S DECLARATION Job Description O I hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPAIR ]'IRE DAMAGE INCLUDING SHEETROCK, in full force and effect.' Lic # ELECTRICAL z License CI Date Contractor ARCHITECTSDctor T OUTLETS AND GEEING WIRING UPPER KITCHEN CABINET, J I understand my plans shall fie used as public records PAINT =i U F' Licensed professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve.demolish,or repair any structure )~t.Floor Area Valuation N prior it)its issuance.also requires the applicant for such permit to Glc a signed statement r. that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 tq $8700 m (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Number Occupancy Type Section 7031.5 by any,applicant for a permit subjects the applicant to a civil penalty of 3690300 3 . V G not more than five hundred dollars($500). 0 1,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 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 lC, 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.). 0 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 Contractors License Law. B&P C for this reason 0 1 am exempt under Sec Owner Date WORKFJt'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure Cor Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance oC the work Cor which this permit is issued. ❑i have and will maintain Workers Compensation Insurance.as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wo er' o pensation Insuranc crier and Policy number are:ar Q e! Carrier.( Policy No.dQ D 0 18"'7�7��d CERTIFICATE OF MP'I•ION 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 as to become subject to the Workeri Compensation Laws of California.Dale 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 Z forthwith comply with such provisions or this Permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY r--r 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.) a Q Lender's Name Lender's Address �z Q 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 U building conswction.and hereby authorize representatives of this city to enter upon the y about-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against y liabilities,judgments,costs and expenses which may in any way accrue against said City Date Zin consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PO Issued by: SOURCE REGULATI d 1 Re-roof: Signature of Applicant/Conuactor Da T e of Roof HAZARDOUS MATERIALS DISCLOSURE YP 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 Safety Code,Section 25532(a)? All roof 3 shall be inspected prior to any roofing material being installed. OYes 4A+O— 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 under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 undcrstmd that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant or the Date rcquiremcntsw mus m no,to' uan ofaCertifrcateofOccupancy. Signatu-eofApplicant ' All roof coverings to be Class"B" or better Date Owner or authori-rcd agent Community Development 10300 Torre Avenue i Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Buildinar De artment JOB ADDRESS: _ PERMIT # OWNER'S NAME: PHONE # div GENERAL CONTRACTOR r FAX # i?�C_I am not using any subcontractors: Signature Da Please check applicable subcontractors and comn:)lete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing IIectrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile D to Owner/Contractor Signature CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: B11:: Lot: APN 36003008 .02 DATE ISSUED. . . . . . . : 08,'14/2007 RECEIPT #. . . . . . . . . : BS000002370 REFERENCE ID # 07080125 SITE ADDRESS 20)80 RODRIGUES UNIT F SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PRJMETHEUS REAL ESTATE ADDRESS 20080 RODRIGUES AVE UNIT F CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DEVERA CONSTR CONTRACTOR . . . . . . . : HENRY DEVERA LIC # 24605 COMPANY . . . . . . . . . . : DEVERA CONSTRUCTION INC. ADDRESS . . . . . . . . . . : 941-D BERRYESSA RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE . . . . . . . . : (408) 441-9598 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- BENERGY PERMIT FEE 158.76 76 .20 0. 00 76 .20 0. 00 BPERMFEE VALUATION 8,700. 00 158 .76 0. 00 158 .76 0. 00 BREMFIXT NO. FIXTURES 2 . 00 2 .40 0. 00 2 .40 0. 00 BREMRECEPT NO. OUTLETS 2 .00 2 .40 0. 00 2 .40 0. 00 BSEISMICRE VALUATION 8,700. 00 0.90 0. 00 0 .90 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 MPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 ----- -0. 00 - --------- ---------- ---------- - TOTAL PERMIT 317 .40 0. 00 317 .40 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------- CHECK 317 .40 20418 --------------- TOTAL RECEIPT 317 .40 CITY OF C UPERTINO ��nQF PERMIT APPLICATION FORM CUPEkTINO PN # Date: Building Address: P►failing Address (if different from building address): a Oner's Name: Phone#: Ow Contract or: License : V%ra r�� c , 1 — — — ontact: __— Phoi e:q 9l3't3s-I t Cupertino Business License#: N1) Fax:�0$- 1 4 7� L 0 Building Permit Info: Bldg Elect 1� Plumb ❑ Mech,9 Job Descriptio '�"�"' o - �� '-�s e a !is L A �0 Residential Commercial El Sq.Ft. Floor Area. Sq-Ft.: Cost of Project: C) Occupancy roup: r Type of ConstructnPlease check this box if the project is a second-story addition: ro'Ject Size: Standard Large ❑ Major El Quantity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BBOILERI Bo ler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boil-,r> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX 1-onstruction 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 of 3