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07090186 CITE'OF CU NO BUIL^.NG DIN ISION PERMIT PERTI �� � PERMIT NO. BUILL�(NG�f)pRES$:.OMESTEAD RD BLDG 29 #H PRO-CRFFT BUILDERS INC 07090186 (J �J(J t1 PERMIT ISSUE DATE OWNER'S NAME: PROMETHEUS 761 MAFURY RD STE 50 09/28/2007 SANITARY NO. CONTROL NO. )NE: BUILDING PERMIT INFO ARCHrrECf/ENGINEER: BALCOM DECK REPAIRS BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description V(: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 70(10)of Division 3 of the Business and Professions Codc,and my license is t=y in fullCorce and effect. !/L7 t Z t License C Ciocn CITECI'S.D# CDate oVAIONMO=�E� i a l understand my plans shall be used as public records >yU U.ti Licensed Professional y OWNER-BUILDER DECLARATION } I 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 e which requires a permit to construct,alter,improve,demolish.or repair any structure prior m its issuance,also requires the applicant for such permit to rile a signed statement Valuation PP r g ;;q.Ft.Floor Area < that he is licensed pursuant t to the provisions of the Contractor's(rccnsc Law(Chapter 9 e H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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(5500). ❑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.704t,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 Contractor's License Law. ❑1 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 Workces 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 Workces Compensation fhsursyee carrier and Policy num�er are: r Cartier: C)C7V V+ t'j it CPolicy No.: J CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued,)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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY E" I hereby affirm that there is a concoction lending agency for the performance of (�.7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name a z L.cndees Address U 0 1 certify that I have read this application and state that the above information is 1-4 correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned properly for inspection purposes. Ll. (We)agree to save,indemnify and keep harmless the City of Cupertino against HCjl liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date �r? 'tom) ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOUR EGA TIONS. 7/37 6107 Re-roofs Signature of Applicant/Contractor Dare 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 shall be inspected prior to any roofing material being installed. ❑Yes No 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 fr aterials for inspection. District? ❑Yes o 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the rcquiremqWwhich must be m t prior t 'ssuance of a Ccrtiricatc of c upanFyO7 Signature of Applicant Date 1- r�_ 2/ 8' 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 32609056.19 DATE ISSUED. . . . . . . : 09/28/2007 RECEIPT #. . . . . . . . . : BS000002810 REFERENCE ID # . . . : 07090186 SITE ADDRESS 20800 HOMESTEAD RD BLDG 29 #H SUBDIVISION . . . . . . CITY CUFERTINO IMPACT AREA OWNER PROMETHEUS ADDRESS . . . . . . . . . . : 19CO S NORFOLK ST #150 CITY/STATE/ZIP . . . : SAID MATEO CA, CA 94403 RECEIVED FROM . . . . : PRC-CRAFT BUILDERS CONTRACTOR . . . . . . . : BIIL L. FEDOR-THURMAN LIC # 28938 COMPANY . . . . . . . . . . : PRC-CRAFT BUILDERS INC ADDRESS . . . . . . . . . . : 761 MABURY RD STE 50 CITY/STATE/ZIP . . . : SAY JOSE, CA 95133 TELEPHONE . . . . . . . . : (4C8) 441-1301 FEE ID UNIT QUANTITY I.MOUNT 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 114W I CITY OF C'UPERTINO -70q CtJPEI�TINO PERMIT APPLICATION FORM Corti, P Rtflu>v61o ,RC- .t- G#q.5tAA APN#5� (0 D q O�_ I p` ' 9 Date: f z y-o-7 Building Address: l Mailing Address (if different from building address): � d om .S+tAo (� Owner's Name: J Phone#: E a 5 YJQ&- l-130 Contractor: License#: O - C 9338'(07, Contact: 6 l•LL Phone: ��, �_;� -Z I Cupertino Business License#: Fax: 38_ Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job D scription: Residential �r�L G©r�1 FG 1l g EP A vr?S 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-sto addition: ❑ Project Size: Standard ❑ Large ❑ Majo:- 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 BUILDING' BELEC1000 Elec 500V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Secs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA investigation fee BUILDING 1 ON CITY OF C UPERTINO CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID lee Description Fee Group BMISCELL 1V:iscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N,-,w Comm Plumb PLUMBING BOVERTIME In: ection Overtime BUILDING BPBACKFLOW Atnios heric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Ilan Check Fee BUILDING BPLANCKADD Plar. Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE S,,-wage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawii S rinkler/Backflo PLUMBING -- - BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT All of Drain &Vent PLUMBING BPWATER InstalI/Alter Water Pie PLUMBING BPWHEATER Witter Heater/Vent PLUMBING BPWSVCS Mein Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C LJnits <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Rcinodel Busways ELECTRICAL BREMFIXT L.ghting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC )\disc 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 BREMRESAPP Remodel Res Appliance ELECTRICAL 2 oF3 CITY OF C'UPERTINO LUPEI�TINO PERMIT APPL[CATION FORM FQ-uantity I Fee ID lice 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 Scb S ecific Plan BUILDING BSEISMICOM Sei mic Commercial BUILDING BSEISMICRE seismic Fee Res BUILDING BSPECIAL S-)ecialInspection 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 Elea; Permit Issuance ELECTRICAL MPERMFEE Mochanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning]LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning l-,on Range Residential PLANNING 3 o'3