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07090066 CITY OF CUPERTINO BUILDING DIVISION PERMIT —' PERMIT NO. BUILD} d25 A1��ES$.:-OMESTEAD RD BLDG 22 PRO-CRI FT BUILDERS INC 07090066 G�J j� PERMIT ISSUE DATE OW NE A E: PROMETHEUS 761 MAI3URY RD STE 50 09/14/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: DECK REPAIR BLDG ELECT PLUMB MECH o a 0 0 p O LICENSED CONTRACTOR'S DECLARATION Job Description v C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing :z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is t y in full force and effect t Z License Class� Lam•ri O Date a 7 Contractor �= ARCHITECT'S DECLARATION i ce< l understand my plans shall be used as public records )yU ' U.H Licensed Professional O< OWNER-BUILDER DECLARATION j< 1 hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Calc:Any city or county $ which requires a permit to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;)q.Ft.Floor Area G F G (commencing with Section 7000)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 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). ❑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 Required Inspections 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.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 Contractor's 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 License law. C3 I am exempt under Sec. B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: (]1 have and will maintain a Certificate of Consent to self-insure for Worker's 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,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier. Policy No.: !'5-040q CERTIFICAT F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis 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 Codc,you must ,J Q forthwith comply with such provisions or this permit shall be deemed revoked. Z' CONSTRUCTION LENDING AGENCY [^'i ►�-� I hereby affirm that there is a construction lending agency for the performance of C>!. the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is CL." corrccL 1 agree to comply with all city and county ordinances and state laws relating to O building construction.and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rFr liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date SOURCE REGULATIONS 6_t., . ye o4i- b'-' 12 Re-roofs Signature of Applicant/Contractor Dai Type Of Roof HAZARDOUS MATERIALS DISCLOSURE 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 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 Ju I have read Ute hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must bemet pn to issuance of a certificate of Occupamy. Signature of Applicant Date Owner or authorized agent Date 1-1 All roof coverings to be Class"B"or better CITY OF CUPERTINO 2 ITEMS OF 10 PERMIP RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 32509056.12 DATE ISSUED. . . . . . . : 09/14/2007 RECEIPT #. . . . . . . . . . BS)00002647 REFERENCE ID # . . . : 0790066 SITE ADDRESS . . . . . : 20300 HOMESTEAD RD BLDG 22 #EF SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . PROMETHEUS ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : SAV MATEO CA, CA 94403 RECEIVED FROM . . . . : PRD-CRAFT BUILDERS CONTRACTOR . . . . . . . : BIuL L. FEDOR-THURMAN LIC # 28938 COMPANY . . . . . . . . . . : PR)-CRAFT BUILDERS INC ADDRESS 761 MABURY RD STE 50 CITY/STATE/ZIP . . . : SAV JOSE, CA 95133 TELEPHONE . . . . . . . . : (4)8) 441-1301 FEE ID UNIT QUANTITY .MOUNT 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 070 c/ CITY OF C'UPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO '-PN" 32- �D 6 q O(o• ) 2— Date: -- 0 7 Building Address: Mailing Address (if different from building address): z�Soc, N�►��.s - t,C) (3\ Wiz. 6-1 F & Owner's N me: hone#: 1 fLr�rvZ IsEQ= , (91- 04bB) gL41 - \3c1 Co tractor: License #: t� - c. ,Q 6,\3,u-, 8 33662 Contact: I l Phone:Ncf) 3c?- 27-1Z- Cupertino Business License#: Fax:CH06) 'Lly I -1301 -Z.6136 Building Permit Info: Bldg g Elect ❑ Plumb ❑ Mech ❑ Job Description: Vcc 2t�pr,%2 6p+. Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 3,goo - Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: El _Aroject Size: Standard ❑ Large ❑ Major❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bo:ler<= 100,000 Btu MECHANICAL BBOILER2 Boile--> 100K to 500K Btu MECHANICAL BBOILER3 Boit-,r> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In(VOff/Comm/Quasi BUILDING BCONSTAXBQ Cosi. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax -Resi/Mobile BUILDING BELEC 1000 Eloc 600V<= 1000A ELECTRICAL BELEC1001 E:.ec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO 11 lor CUPEkTiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Corrm. Housing Mit. Fee BUILDING BNUCOMME N-1w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP 1\ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW At. Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Ga,;Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plat Check Repeat Fee BUILDING BPREPIPE R.-pipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lamm S rinklerBackflo PLUMBING ---BPS-TOR:M- Storm/Rain Water - PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstsdUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS M ain 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 Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD In itallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rerr Non-Res Appliance ELECTRICAL BREMPOLE Po le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc J, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF C"UPERTINO aYO PERMIT APPLICATION FORM - CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmill Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Veat Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD ;)cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S pecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC :electrical sq foot ELECTRICAL EPERMITFEE Elvc Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meeh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Pbimbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -4UPEI�TINO Building Department JOB ADDRESS: PERMIT # O 70 $0,9 C,6 Z(r8"oc 6 OWNER'S NAME: oma+k a�u PHONE # /7V/- /30 I GENERAL CONTRACTOR: FAX # - icy G I am not using any subcontractors: Sigmature 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