07090177 CITE.'OF CUPERTINO
BUILLIING DIVI'ION PERMIT
PERMIT NO.
BUILIT6AL)OP.ESS:.OMESTEAD RD BLDG 28 #B PRO—CRI,FT BUILDERS INC 07090177
G V�S L1�J Y1 PERMIT ISSUE DATE
OWNER'S NAME:
PROMETHEUS 761 MADURY RD STE 50 09/28/2007
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BALCON" DECK REPAIRS BLDG ELECT PLUMB MECH
!Wz0 LICENSED CONTRACTOR'S DECLARATION Job Description
i u.15 I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z uJ with Section 7000)of Division 3 of the Business and Professions Code,and my license is
�
H in full force and effect 3 r
r v�z License C Lrc'# tV t ves
p Datc Contractor
f to RCHITECTS DECLA TION
a-a
< 1 understand my plans shall be used as public records
)aV
U.� Licensed Professional
O a OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p OC following reason.(Section 7031.5,Business and Professions Code:Any city or county
[i 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 ;;q Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's Intense Law(Chapter 9
t= (commencing with Section 7000)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
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(E5W).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended oroffered for sale(Sec.70",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.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors U.
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:
❑1 have and will maintain a Certificate of Consent to self-insure for Workers compen-
sation,as provided for by Section 3710 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 Code,for the performance of the work for which this permit is issued.
M Worker's Csatin carrier and Policy number are: ��f��
Carrier. 2 wE Policy No.: LAYO
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 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 Cade,you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z"' CONSTRUCTION LENDING AGENCY
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.)
W A Lender's Name
0 z Lender's Address
U 0 1 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
p Jbuilding construction,and hereby authorise representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
(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 2 in consequence of the granting of this permit Date
�. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE�ULA NS.
,C�o Re-roofs
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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 016o
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,.1 agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
C3 Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safely 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 whi h must be m prior ' trance oCa Certifies Signature of Applicant Date
All roof coverings to be Class"B"or better
Owne or authorized agent Date
CITY OF CUPERTINO
3 ITEMS OF 30 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN 32E09056 .16
DATE ISSUED. . . . . . . : 0928/2007
RECEIPT #. . . . . . . . . : BSC00002810
REFERENCE ID # . . . : 07C90177
SITE ADDRESS . . . . . : 20E00 HOMESTEAD RD BLDG 28 #B
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST #150
CITY/STATE/ZIP . . . : SAf MATEO CA, CA 94403
RECEIVED FROM . . . . : PRC)-CRAFT BUILDERS
CONTRACTOR . . . . . . . : BILL L. FEDOR-THURMAN LIC # 28938
COMPANY . . . . . . . . . . : PRC)-CRAFT BUILDERS INC
ADDRESS . . . . . . . . . . : 76:_ MABURY RD STE 50
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 441-1301
FEE ID UNIT QUANTITY 2�MOUNT 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 2, 349 .76 #10462
---------------
TOTAL RECEIPT 2, 349 .76
CITY OF ��UPERTINO Cl 0°�
10,
Ci1PER,TINO PERMIT APPLICATION FORM
APN# e:
Dat
gyp• I � f-Zy—o-7
Building Address: Mailing Address (if different from building address):
0 om —S+tA a�
Owner's Name: Phone#:
E U 5
Contractor: License #:
PP,0 6 F-f- t L O R� !e-
6 2
Contact: 16 —
1 L L Phone: 3,) qZ i Cupertino Business License#:
• Fax: _ / _^.? 38_
Building Permit Info:
Bldg Elect ❑ P lumb ❑ Mech ❑
Job D scription: .
Residential LGd,nl �FG1� ��PA�i�S Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 3 I o0 Occupancy Group:
J
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..er> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi JNG
BCONSTAXBQ Con. Tax for BQ Zone
BCONSTAXH Hotel 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
�- CITY OF ('UPERTINO
CUPERTiNo PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BMISCELL miscellaneous Fee BUILDING
BMITIGATC Corr.m. Housing Mit. Fee BUILDING
BNUCOMME N,;w Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME In 3pection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum _ PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE E ldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Pi ing System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK flan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plar. Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
-- BPSTORM Siorm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT All of Drain & Vent PLUMBING
BPWATER Insta I/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS M<<in Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C IJnits <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Hoater Installation MECHANICAL
BREMINHOOD Insi:allation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem-Non-Res Appliance ELECTRICAL
BREMPOLE Polc:/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Re ocation of Hood MECHANICAL
BREMREPALT Rer air/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 o:73
~ CITY OF C'UPERTINO
CUPEf�TiNO PERMIT APPLICATION FORM
uanti Fee ID ]Fee Description Fee Group
BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL
BREMSIGNS Rem Adel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Seb Specific Plan BUILDING
BSEISMICOM Sekmic Commercial _BUILDING
BSEISMICRE c eismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Tcmporary TemporaryPower ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mecli Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plwnbing Fee sq foot PLUMBING
PLLONGRNGC PlanninglA Comme/Multi-Fam PLANNING
PLLONGRNGR Planning ong Range Residential PLANNING
3of3