08050208CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD TYPE 3
CONTRACTOR: WEST BUILDERS, INC.
PERMIT NO: 08050208
OWNER'S NAME: PROMETHEUS
1608 4TH ST STE 120
DATE ISSUED: 11/24/2008
OWNER'S PHONE: 6509313657
BERKELEY, CA 94710
PHONE NO: (510) 525-9378
❑ LICENSED CONTRACTOR'S DECLARATION
r F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class lr_ Lic. # 625395
MECII F RESIDENTIAL F COMMERCIAL �
Contractor L.J R-r Date k7 - ' — GT
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: DEFERRED SUBMITTAL OF
(commencing with Section 7000) of Division 3 of the Business & Professions
M/E/P'S,ORIG#07120212-NO
Code and that my license is in full force and effect.
SANITARY REQUIREMENTS
9/14/9 RE -OPEN PER BE;REV OF ELECTRICAL SERVICE
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Workers
Compensation, 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 provided for by
Sq. Ft Floor Area:
Valuation: $1000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 32609056.TYP3
Occupancy Type:
I 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 building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Z: ' p Zv • (�
��
Issuefby _` Date/o- Z-6—of
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify. that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code-, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
Owner•. authorrzci agent:
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18•
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTIN771
O'
a a h.gry. 1 a; t
BUILDING DIVISION PERMIT`S
.�'��'r
BUILDING ADDRESS:
PERMIT NO.
20800 HOMESTEAD RD TYPE 3
WEST BUILDER
OWNER'S NAME:
PERMIT ISSUE DATE
PHONE
A CONTROL NO.
(510) 525-9378
ARCHI'fECr/ENGINEER
BUILDING PERMIT I4F0
BLDG ELECT PLUMB MECH
a o a o
LICENSED CONTRACTORS DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
DEFERRED SUBMITTAL OF M/E/P' S, ORIG#07120212-NO
License Class _
Dale-c�onus saor
SANITARY REQUIREMENTS
ARCHITECTS DECLARA7ON
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
which require a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance. also requires the applicant for such permit to rile a signed statement
Sq. Ft. Floor Area
Valuation
that be Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Codc) or
that he is exempt therefroni and the basis for the alleged exemption Any violation of
10 0 0
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the appliant to a civil penalty of
not more than rive hundred dollars (S500).
32609056 . TY P 3
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
win do the work and the Structure is not intended or Offered for sale (Set. 7044, Business
and Professions Code: The Conu=Loes License Law does not apply to tit owner of
properlywho builds or improves thereon, and who does such wort himself or tlfmagh his
own employees provided that such improvements are not Interhded or offered for sale If,
however, the building or improvement Is sold within one you of completion, the owner -
builder will have the burden of proving that he did not build or Improve for purpose of
z
1, as owner of the property, am exclusively contracting with licensed contrutora to
conatmn the project (Sec. 7044. Business and Professions Code:) The Contractor's u.
tense Law does not apply to an owner of property who builds or improves thereon, and .
who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law.
❑ lam - and r St , B & P C f ir this
/
Owner Due
MPENSATION DECI.4RATION
1 hereby afrtrm under penalty of perjury one or the following declarations:
❑ 1 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 or the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation lasurncc, as requited by Section
3700 of the Labor Cade, for the performance of the work for which this permit Is issued.
My Worker's Compensation ma.•-nct artier and Policy number am:
Carrier. Policy No.:
CEKMCATE OP EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (Sloo)
or Less)
I certify that In the performance of the work for which this permit is issued, 1 shall no
employ any person in any manners as 10 bccoma subject o the Workers' Compenution
Laws of Californiay8 e
Appli
NOTICE To APPLIC g this Caro r arc of mptonr you should
become subject to the Workers pcnsdtion previsions of the Labor Code, you mast
forthwith comply with such provisions or this permit shall be dcurred mvoked.
CONSTRUCTION LENDING AGENCY
I hereby allure that there is a construction lending agency for the Performance of
'
the work for which this permit 0 issued (Sec. 3097, Civ. C)
Lendcfs Name
,
Lenders Address
1 certify that I have read this application and state that the above information Is
correct. 1 agree to comply with all city and county onfnnanas and state laws relating to
building construction. and hereby authoriSn representatives of this city to enter upon the
above -mentioned Property for inspection pmpaaes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities judgments costs and expenses which may In any way acme against said City
in consequence or the ung of this permit.
rrH ALL N
APPLI U A S AND WILL COMPLY ON -POINT
r
` -
Issued by: Date
S CIS
DR
V1_41
Re -roofs
Type Of Roof
Sigma of or Data
US MATERIALS DISCL SURE
WIH the appy t or future building occupant store or handle haurdous material
as dcfuhcd by the Cupertino Municipal Code, Chapter 9.12. and the Halth and Safety
Code, Section 25532(a)7
❑ Yes
All roofs shall be inspected prior to any roofing material being installed.
�No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the apPli=L 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.
Dlstrict7
❑Yes CpNo
1 have cad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health Sc Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currently ha ■ tenarht. that Rig my risibility to notify the occupant Of the
mqu tsw ' h ct prior to' of a ' n to or
Signature of Applicant Date
.
All roof coverings to be Class '1 " or better
.
Owner or au ariz a en Dater