07090185 CITY OF CUPERTINO
BU11,DING DIVISION PERMIT �� �TQ���� ' `
'— PERMIT NO.
BUfLDII6„ADI"fiOMESTEAD RD BLDG 29 #G PRO-CRAFT BUILDERS INC 07090185
G 2$41 U Yi PERMIT ISSUE DATE
OWNER'S NAME:
PROMETHEUS 761 MAFURY RD STE 50 09/28/2007
SANITARY NO. CONTROL NO.
.)NE:
BUILDING PERMTr INFO
ARCHITECT/ENGINEER: BALCONY DECK REPAIRS BLDG ELECT PLUMB MECH
p 0O LICENSED CONTRACTOR'S DECLARATION Job Description
V 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z,� with Section 70W)of Division 3 of the Business and Professions Code,and my license is
t y in full force and effect
r rn Z License s Lic•#
p DaterWb1 Contractor
ARCHrmcrs DECLA ATION
1 understand my plans shall be used as public records
)yU
y Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
jo O following reason.(Section 7031.5,Business and Professions Code:Any city or county
e which requires a permit to construct,alter,improve,demolish,or repair any structure
Z r prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation
=Q that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapicr 9 >
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L 3 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($500).
❑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.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 arc 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 Contraetoes 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.
❑[am exempt under See. B&P C for this reason
Owner Date
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 Code,for the performance of the work for which this permit is issued.
My Work rs Co pensation 1 rang carrier and� �� Policy1n-Policy
A� 4-5
Cartier. � Poliry No.:w S1
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 Cock,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
Ham+ I hereby affirm that there is a construction ending agency for the performance of
7 the work for which this permit is issued(Sec.3097,Civ.C.)
w A Lender's Name
2 Lender's Address
U 0 I certify that I have read this application and state that the above information is
0,1 cortcet.I agree to comply with all city and county ordinances and state laws relating to
v U building construction,and hereby authorize representatives of this city to enter upon the
W about-mentioned property for inspection purposes.
Fi L1. (Wer)agree to save,indemnify and keep harmless the City of Cupertino against
n,+rA liabilities,judgments,costs and expenses which may in any way accrue againstsaid City
U Z in consequence of the granting of this permit. Date
>-. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE GULA ONS Y/ 2 Wb7 Re-roofs
/ u
Signature of Applitant/Conuactor Date T of Roof
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 ;hall be inspected prior to any roofing material being installed.
❑Yes CfNo
W
If a roof i;installed without first obtaining an inspection,.I agree to remove
Will the applicant of future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes Iu
I 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 rnotcurrently have a tenant,that it is my responsibility a notify the occupant of the
tc
rcqu i hmustbc mftpn.or nissuanccofaCcrificatc rgZ dry 7 Signature of Applicant Date
All roof coverings to be Class "B"or better
Owner 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 .18
DATE ISSUED. . . . . . . : 09/28/2007
RECEIPT #. . . . . . . . . : BSC00002810
REFERENCE ID # . . . : 07C90185
SITE ADDRESS . . . . . : 20E00 HOMESTEAD RD BLDG 29 #G
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER PROMETHEUS
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST #150
CITY/STATE/ZIP . . . : SAN 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 . . . : SAlf JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 441-1301
FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BPERMFEE VALUATION 3, 100. 00 104 .76 0. 00 104 .76 0. 00
BPLANCHK PERMIT FEE 104 .76 139 :80 0. 00 139 . 80 0. 00
BSEISMICRE VALUATION 3, 100. 00 0..50 0. 00 0.50 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 245. 06 0. 00 245 .06 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 CUPERTINO 0`7 0 9 O I
_0UPEkT1N0 PERMIT APPLICATION FORM
e-orp, P, ID w"0 r%seL *- Coq sa#4L+
APN# .-� ( Date:
3,2(,06?as S 'f—.Z y—o-7
Building Address: Mailing Address (if different from building address):
v o `S EA n G
Owner's Name: Phone#:
E — l-l30►
Contractor: License#:
Ve_ 1 8,62-
Contact: .51•LL Phone: .30 ,1_-, Z 1 Cupertino Business License#:
Fax:
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job D ription:
Residential 154Le-01`J -pFG1e 9A19A10ZS Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 3 00
Occupancy Group:
Type of Construction: _ Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Ma
joI•❑
Quantity Fee ID We Description Fee Group
BAPPLOTHER Otner Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler 1 M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi EJUILIDJNG
BCONSTAXBQ Con. 'Tax for BQ Zone
BCONSTAXH Hotel and Motel BUIL
BCONSTAXR Const 3x—Resi/Mobile BUILDIN
BELEC 1000 Elec 500V<= l 000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec S-v cs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEI�1"INO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Con un. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW At:nos heric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Uldg Permit Fees BUILDING
BPFIXTURE Pb1g Fixture PLUMBING
BPGAS Ga: Piping System Fee PLUMBING
BPINTERCEP Inc Waste Interceptor PLUMBING
BPLANCHK :Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plate Check Re eat Fee BUILDING
BPREPIPE RE i e Of Fixtures PLUMBING
BPSEWAGE S ewa a Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM S torm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Writer Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C IJnits<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Romodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BR.EMHEAT H,;ater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Von-Res Appliance ELECTRICAL
BREMPOLE Pole/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
BREMR.ESAPP Remodel Res Appliance ELECTRICAL
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CITY OF C±UPERTINO
CUPEkTF PERMIT APPLICATION FORM
uanti 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 c cb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE .'seismic Fee Res BUILDING
BSPECIAL Special 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 Ele,.- Permit Issuance ELECTRICAL
MPERMFEE M.-chanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE PlumbingPermit Issue PLUMBING
- - -PPLBG -- Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Plannin :Long Range Residential PLANNING
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