07090195 CITY OF CUPERTINO
BUIL)3ttrvi;DIVISION PERMITOR�NC} MtTIOk :
-- PERMIT NO.
BUILI�jI•j(i�RD,[tES�OMESTEAD RD BLDG 34 #E PRO—CRAFT BUILDERS INC 07090195
L�J �J(J PERMIT ISSUE DATE
OWNER'S NAME:
PROMETHEUS 761 MABJRY RD STE 50 09/28/2007
SANITARY NO. CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BALCONY DECK REPAIRS BLDG ELECT PLUMB MECH
p o LICENSED CONTRACTOR'S DECLARATION Job Description
U C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencingZ m with Section 7000)of Division 3 of the Business and Professions Code,and my license is
t y in full force and effect 8�3$�Z
t ? License CI Lic.N
Contractor ^�
F w Date �S
m RCHI7ECCS DECLA ON
i�< l understand my plans shall he used as public records
)aU
U.ti Licensed Professional
y OWNER-BUILDER DECLARATION
s I hereby affirm that 1 am exempt from the Contractor's License Law for the
p 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
y prior to its issuance,also requires the applicant Cor such permit to file a signed stalrmentFt.Floor Area Valuation
a that he is licensed pursuant to the provisions
of the Contractor's License Law(Chapter 9 q
ll--• (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 APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500).
[11,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not 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 are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,die 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 Contractors 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.
❑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:
J 1 have and will maintain a Certificate of Consent to self-insum 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 Workers Compensation I`�`' cc carrier and Polity nu be
Cartier.�a i 4�C�t�l e:C-Policy No
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.1 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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
R:> the work for which this permit is issued(See.3097,Civ.C.)
W Q Lender's Name
ate
. Z Lenders Address
U 0 1 certify that I have read this application and state that the above information is
corset.I agree to comply with all city and county ordinances and state laws relating to
rJ building construction,and hereby authorize representatives of this city to enter upon the
U
Uabove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
HCA 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
►-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
S 0 U R9EPEGUTIONS.
_ L Re-roofs
Signature of Applicant/Contractor Dare Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as dcftncd by the Cupertino MuniciplCode.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 N0
If a roof i;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 materials for inspection.
District?
❑Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty 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
requiret whic must Ix met pq to issuance of a Ccnificay�O� per.,� Signature of Applicant Date
Y' �SD�are All roof coverings to be Class"B"or better
Owner or authorized agent
CITY OF �UPERTINO
3 ITEMS OF 30 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32609056 .21
DATE ISSUED. . . . . . . : 09/28/2007
RECEIPT #. . . . . . . . . . BS000002810
REFERENCE ID # . . . : 07090195
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD BLDG 34 #E
SUBDIVISION
CITY CUFERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . PRCMETHEUS
ADDRESS . . . . . . . . . . : 19CO S NORFOLK ST #150
CITY/STATE/ZIP . . . : SAID MATEO CA, CA 94403
RECEIVED FROM . . . . : PRC-CRAFT BUILDERS
CONTRACTOR . . . . . . . : BILL L. FEDOR-THURMAN LIC # 28938
COMPANY . . . . . . . . . . : PRC-CRAFT BUILDERS INC
ADDRESS . . . . . . . . . . : 761 MABURY RD STE 50
CITY/STATE/ZIP . . . : SAT JOSE, CA 95133
TELEPHONE . . . . . . . . : (4C8) 441-1301
FEE ID UNIT QUANTITY IMOUNT 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 C'UPERTINO �,7 ° �1 G 19 S
CUP EWTINO PERMIT APPLICATION FORM
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APN# e-opt, p, R iroWOVO r%-,C GASa.4L+
(P G q oZ Date: z y-0-7
Building Address: Mailing Address (if different from building address):
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Owner's Name: Phone#:
Contractor: License#:
d _ C2 F+ R L4 iL LR ,e- (v
Contact: 'S i•LL Phone: o q_, Z ICupertino Business License#:
Fax: _ ' --:?9q39-
Building
:? 38_Building Permit Info: If
Bldg Elect ❑ Plumb ❑ Mech ❑
Job D ription:
Residential 9L Ga rel �EG1� r=P� ��5 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: �o 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 Av liances 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/ uasi TT
ING :
BCONSTAXB Con. 'rax for B Zone
BCONSTAXH Hotel and Motel BUIL
BCONSTAXR Consux—Resi/Mobile BUILDIN
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA investigation fee BUILDING
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CITY OF C UPERTINO
CUPEt�TINO PERMIT APPLICATION FORM
Nuantity Fee ID Fee Descri tion 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 S►;b Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL ST ecial Inspection BUILDING
BSWrM 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 Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mectt Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning L ong Range Residential PLANNING
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