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07090060 CITY OF CUPERTINO BUILDING DIVISION PERMITRMTI�N: PERMIT NO. BUILI)(ti�IZD(tESHOMESTEAD RD BLDG 19 E PRO-CRAFT BUILDERS INC 07090060 G�J (J U PERMIT ISSUE DATE OWNER'S NAME: PROMETHEUS 761 MAEURY RD STE 50 09/14/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECTIENGINEER: DECK REPAIR — APT. BLDG ELECT PLUMB MECH w LICENSED CONTRACTOR'S DECLARATION p Job Description U F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and effe A A-6 7 v�Z License Class •8 t o Date — °Vz Contractor G m ARCHITECTS DECLARATION i aa < I understand my plans shall he used as public records ia.U 'a.� Licensed Professional O a OWNER-BUILDER DECLARATION �H n } 1 hereby affirm that I am exempt from the Contractors License Law for the jp o following 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 12- prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 ;>q.Ft.Floor Area t- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type 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 Required Inspections and Professions Code:The Contractors 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.). ❑I,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. ❑I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations. L]I hsve 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 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 Workers Compensation Insurance carrier and Policy number arc: Carrier. Policy No.:W 6 CERTIFICATJ 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 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 Q forthwith comply with such provisions or this permit shall be deemed revoked. Z , CONSTRUCTION LENDING AGENCY E r rA I hereby affirm that there is a construction lending agency for the performance of [Y> the work for which this permit is issued(Sec.3097,Civ.C.) Lia M Lender's Name 0Z Lenders Address U 0 I certify that I have read this application and state that the above information is (I, Hcorrect.I agree to comply with all city and county ordinances and state laws relating to U building construction.and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. a (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 U Z in consequence of the granting of this permit. Date lY U-•17 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by r SOURC�REGULANS �r�y-® Re-roofs Signature of Applicant/Contractor Dare T of R oof HAZARDOUS MATERIALS DISCLOSURE Type 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 roofs shall be inspected prior to any roofing material being installed. ❑Yes t vac+o i 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 rr aterials for inspection. District? ❑Yes Ir 1 have 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 Ute building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which mast be mel prior to i suan.of a Certificate of Ocanry. Signature of Applicant Date All roof coverings to be Class"B' or better Owner or authorized agent Datc 070 90 6 �o 0 a yh CITY OF CUPERTINO CITY Of PERMIT APPL]_CATION FORM CUPEkTINO CPN# ?o,� (P 0 9 os 0 Date: J 07 Building Address: Vlailin Address (if different from buil ing address): Owner's Name: Phone#: Qt v,-ti 13�r Contractor: License #: Contact: Phone: Cupertino Business License#: JLL Fax: yo -y/yl_ t3�� 2-8,139 Building Permit Info: Bldg 16 Elect ❑ F lumb ❑ Mech ❑ Job Description: VE e- P, Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 3,0&0 Occupancy Group: �=L Typ_e_of Construction: Please check this box if the project is a second-story addition: El roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID ]Tee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boilt;r> 500K to 1M Btu MECHANICAL BBOILER4 Boile-> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In(VOff/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC 1000 Eloc 600V <= 1 OOOA ELECTRICAL BELEC1001 E]ec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Lnergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF C'UPERTINO C1 of PERMIT APPLICATION FORM CUPEkTINO —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 In:,pection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE B Idg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plat Check Add Multi BUILDING BPLANCKREP Plait Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING - - - -BPS-TORM-- Storm/Rain Water - PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Inst�.11/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C'Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R emodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re:ocation of Furnace MECHANICAL BREMFURNOV Retro Furnace> IOK btu MECHANICAL BREMHEAT F-eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po_e/Platform Fixture ELECTRICAL BREMPOWER Powfr Device/Apparatus ELECTRICAL BREMRECEPT Rc ia, Switch & Outlets ELECTRICAL BREMRELOCA R-,location of Hood MECHANICAL BREMREPALT Rc pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF C'UPERTINO CUPE�T kTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING I BSEISMICRE k"Wismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T,,-mporary Power ELECTRICAL BTEMPPERM Tern-3orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Eusiness License BUILDING ELECTRIC E.lectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meeh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING -PPLBG--- -- Pllmbing-Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 )f3 CITY OF CUPERTINO 2 ITEMS OF 10 PERMI'' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bllc: Lot: APN . . . . . . . . . 32609056 .10 DATE ISSUED. . . . . . . : 09,114/2007 RECEIPT #. . . . . . . . . : BS0)00002647 REFERENCE ID # . . : 07090060 SITE ADDRESS 20;300 HOMESTEAD RD BLDG 19 E SUBDIVISION . . . . . . : CITY CU:?ERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : PROMETHEUS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : SAN MATEO CA, CA 94403 RECEIVED FROM . . . . : PROS-CRAFT BUILDERS CONTRACTOR . . . . . . . : BI=,L L. FEDOR-THURMAN LIC # 28938 COMPANY . . . . . . . . . . : PRS)-CRAFT BUILDERS INC ADDRESS . . . . . . . . . . : 76L MABURY RD STE 50 CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE . . . . . . . . : (4 )8) 441-1301 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BPERMFEE VALUATION 3, 800. 00 104 .76 0. 00 104 .76 0. 00 BSEISMICRE VALUATION 3, 800. 00 0.50 , 0. 00 0.50 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 105 .26 0. 00 105 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 569. 80 #10366 --------------- TOTAL RECEIPT 569 . 80 Community Development 10300 Torre Avenue ' T> Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# 0260 LD 076TM6o OWNER'S NAME: PRpwiE-MGyj PHONE #d0f — -3v GENERAL CONTRACTOR - C F= gt p FAX # - /30 I am not using any subcontractors: - i;nature Date Please check applicable subcontractors and co m)lete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 Owner/Contractor Signature Date