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07090176 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � � R �IQ ' PERMIT NO. BUILDFN 89YbEshOMESTEAD RD BLDG 26 #B PRO-CP_zXT BUILDERS INC 07090176 G U Z5 v v t1 PERMIT ISSUE DATE OWNER'S NAME: PROMETHEUS 761 MABURY RD STE 50 09/28/2007 SANITARY NO. CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITEC(ENGINEER: BALCONY' DECK REPAIRS BLDG ELECT PLUMB MECH p Q LICENSED CONTRACTOR'S DECLARATION Job Description V C I 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 C and my license is r y in full force and effect. Licenso Class Lic. t e Dam Contractor e5 AR HITECI S DEC RA ON i a< I understand my plans shall he used as public records )yU U.In Licensed Professional o a OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's 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 a"y 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 iq.Ft.Floor Area F (commencing with Section 701X))of Division 3 of the Business and Professions Code)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number 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,Busineu Required Inspections and Professions Code:The Contractor's 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 sah:J. Q 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 U- cense Law docs 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. ❑1 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: ❑I have 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. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Cc&.for the performance of the work for which this permit is issued. My WorkCo ensation I`'�u carrier and Policy number are; Carrier: OPolicy No.: LQ1A 3,51612 CERTIFICATE 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 manncr 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 ,J. 0forthwith comply with such provisions or this permit shall be deemed revoked. z 2 CONSTRUCTION LENDING AGENCY (~"Cn I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(See.3097,Civ.C-) W ALender's Name a Z Lender's Address U 0 1 certify that I have read this application and state that the above information is ci rrect.I agree to comply with all city and county ordinances and"rate laws relating to Jbuilding construction,and hereby authorise representatives of this city to enter upon the above-mcntiuncd property for inspccuon 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 ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE GUL ONS. / �_,& 21't7 Re-roofs Signature of Applicant/Contractor Date Type of F.00f 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 Codc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. E]Yes No W If a roof s 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 n laterials for inspection. District? E]Yes Q1416 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 the building does not currently have a tenant,that it is my responsibility to notify the occupant of the xquiremen ic6must be in riorto" uattceofaCertificate fPC ancyy Signature of Applicant Date Owner or authorized agent All roof coverings to be Class"B"or better Date CITY OF CUPERTINO 3 ITEMS OF 30 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 32(,09056 .15 DATE ISSUED. . . . . . . : 0928/2007 RECEIPT #. . . . . . . . . : BS(100002810 REFERENCE ID # . . . : 07090176 SITE ADDRESS . . . . . : 20E�00 HOMESTEAD RD BLDG 26 #B SUBDIVISION . . . . . . CITY . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER PROMETHEUS ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST #150 CITY/STATE/ZIP . . . : SAi1 MATEO CA, CA 94403 RECEIVED FROM . . . . : PRO-CRAFT BUILDERS CONTRACTOR BILL L. FEDOR-THURMAN LIC # 28938 COMPANY PRO-CRAFT BUILDERS INC ADDRESS 76 MABURY RD STE 50 CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE (408) 441-1301 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 83 . 16 83 .16 0. 00 83 .16 0. 00 BPLANCHK PERMIT FEE 83 . 16 110.98 0. 00 110.98 0. 00 BSEISMICRE VALUATION 3, 100. 00 0.50 0. 00 0.50 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 194 . 64 0. 00 194 . 64 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 CITY OF ( PERTINO 7 ©�C ' -X C(JPEt�TINO PERMIT APPLICATION FORM APN# Date: Building Address: Mailing Address (if different from building address): d 0M1 _SJ i:A V RA -�)Ic Owner's Name: Phone#: E - Contractor: License#: Contact: .3 I'LL Phone: 30 q Z 1 Cupertino Business License#: • Fax: _ / -:W38_ Building Permit Info: Bldg Elect ❑ P lumb ❑ Mech ❑ Job D scription: Residential �r�LGo,�I �FGt� �Z�P►4i�35 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 100 Occupancy Group: Type of Construction: _ __ Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler 1M to 1.75 M Btu MECHANICAL BBOILER5 Boi ler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasiUILD ING : BCONSTAXBQ Con. Tax for B Zone BCONSTAXH Hertel and Motel BUIL BCONSTAXR Constax -Resi/Mobile BUILDIN BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Secs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA In%esti ation fee BUILDING 1 of. jP CITY OF (: CITY OF CvUPERTINO CUPEi�TINO PERMIT APPLICATION FORM Quantity I Fee ID Fee Description Fee Group BREMSIGNAD Rmdl 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 Scb Specific Plan BUILDING BSEISMICOM _ Seismic Commercial _ ___BUILDING BSEISMICRE (seismic Fee Res BUILDING BSPECIAL S)ecial Inspection BUILDING BSWIM owimming Pool BUILDING BTEMP T(!mporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS '.emp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mecli Permit Issuance MECHANICAL PPERMITFEE Pluiribing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planningl,R Comme/Multi-Fam PLANNING PLLONGRNGR Planning ong Range Residential PLANNING 3 of 3