08100059 CITY OF CUPERTINO
PERMIT a CM ,� �� *Rt I"NFIeOvhmR,'..M:M-etA �OtNk'rN
, ..BUILDING DWSION RAO
•4'.
BUILDING ADDRESS: PERMIT NO.
20800 HOMESTEAD RD TYPE 1A&1B NATIONAL CONSTRUCTION 08100059
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS 15319 CHATSWORTH ST 10/10/2008
NE: (818) 221-6057 SANITARY NO. CONTROL NO.
ARCHTIYCT/ENGINEER - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
app LICENSED CONTRACTOR'S DECLARATION
U 1 hereby,a0hm that I am licensed under proviso(of Chapter 9(commencing Job Description
with Section 7000)Of Division 5ofne Bum.and Prorcssiom Cade.and my license is TEMP POWER POLE & METER, 1 200AMP SVC
^�,,, in full rota and fN f�fs /j3e
j$Z License a _ C 1.1a..k (7
Data -�Z ant, 'Con r
❑W ARCItRE(TSATTON
1(ndmrnend my pima shall bu used as public me.,&
5yU
,t.1 Licensed Pro(utioml
Oat I am exempt
from
DECLARATION
'�0 0 1 hereby.(Seco that 1 1. acmpt Pram the Canlns Co :My c law for thC
o O following ream..amah,t 7 construct.
Business ISM Proimprove,
d.. i Cod,:Any city or county
K$ which rueful.a permit m cnmtrthe aper.Mprow,demorii I err mp,ir any structure
u¢y prior m its issuance,also requires the applicant for such permit m file a signed Chmmem
ERs< that(comeLcingwidSc�on7OD)afMtiotmorlhe Susinmrru,mxl,w(Ch c)or Sq.FC Floor Area $650 Valuation
(comen ongwiNSectaup,and ft Dilantin,oftheeged dProfessfans Cade)of
that io u 31.5 b any applicant
and de baso it the allcats Lk cmmptian a civil
violation of
no,me 7031.5 by any sed dont fm a Peud(t mubjttu the applicant m a civil pemLLy of
Inst more dean Ew hundred dallan(53110} 3 2 6 0 9 0 5 6 APNWIr$ber Occupancy Type
0 1,u ower of the p cepertY•or my employees with wags u theirmle eampecumme.
will do the work and On soucmm 13 notinandd or offered ror.We(Sec.7ou.Business Required Inspections
and Rofevsos,Cade The Comusetor's Liccrue Law does an,apply m an owner e ns of q p
property who Wilds m impmtes themon,and whodoessuch workloweadfor through his
own employees,provided that much Improvements are not tru, moRervM fee tile.B,
however.lie building or bnprovement is mid within one year of completion,the owner- _
builder wW ban the burden of proving that h did an,build or improve for purpose of
silk.).
0 1.u owner of the property w eacimively contracting with receded mnoscnrs m
consmsts the project(Sec.70x4.Business sad Profession Code:)The Coomxmh Li-
cmw taw does not apply to an owner of property who builds or improves themen,and
.1mmeoacts for such projects with a conuacmr(s)hewed pmauam to the Canoataofr
Liecue law.
I am exempt under See ,B&PC rorthis mama
Owner Man-
WORKERS
amWORKER'S COMPENSATION DECLARATION
1 beteby affirm muter peaty of perjury,one of the fallowing dodandoes
bsw and will maintain a Certificate of Consent in suf-insum for Worker's Compen-
radon.an provided for by Section 3700 of the Labor Code,for the Performance of We
work for which this pmnft is issued.
w and will maintain Wmiates Compensation Insurance,ss mquimd by section
3700 of the labor Code.for the perfmon.of the work for which this permit u issued '
CMayr 'Ccl Pes ,YTr4 catrsm'{•ISoryMI,yT�y a7rt:
srlta — ya Q?to 4 C77
CE IFICATE O•EXEMPTION FROMO ERS'
COMPENSATION INSURANCE
(This auction need mtbe completed 0th Permit ts focam hundred 00an(SIM)
or Waal
1 certify Nat to the inf...of the work for which thin permit is issued,l shell not
employ m,permn in any mmnee m as to become mbjen to the Worsen'Comperams.
Laws of Califumia.Data
Applicator
NOTICE TO APPLICANT:IL after making this Cartifiam of Exemption.you should
become subject m the W,heh Compensation provisiann of the labor Code,you must
.J O forthwith comply with such provisions sW
ons m this permit I h dmut ca revokcd
z0 CONSTRUCTION LENDING AGENCY
[� I toothy afmm that them is a construction lending agency for the performance of
LY.> the work fm which this permit Is iatad(Sce.3097,Civ.C.)
IG Q Lender's Name
L Address;
I-c does Addr
U 0 1 ms(y that I have mad this application end sum thm the above information u
ly corms 1 agree m comply with sl city and county ardinanas and rue Ian relating to
0 building construction,and hereby mthodm reprosentadw of this city m curer upon me
F 4 above-mentioned property for impaction purposes.
(We)agree to saw,indemnify and temp b trmoss the City of Cuperu o against
t'A liabilitiea,Judgments.costs and esPeaxa which may in my way masse against said City
U ,Z in consequence of the granting of this remail.
A I ANT UNDERSTANDS AND WILL C9-11 =_69-0f'
MPLY WITH NON-POINT Issued by: Date �� Gd'�l
S E REGULATIONS.
/�-/ -O Re-roofs
Signature of ApplicmVConuucmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliantm furu ebuilding occupant score or handle banrdous material
u dcfmcd by the Cupammm Municipal Code.Chapter 9.12,and the Health and Safety
Cnde,Section 25532(a)T
❑sen All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I agree to remove
Will r,'us me applicmt or (lure building occupant use equipment m devices which
Xdg
hair c,maminsnts u defined by the Bay Arta Air Quality Management all new materials for inspection.
n7
Dy. W
I have read the haardnus mmnials requirements underchapeard.95ofthe Califon
nia Health&Safety Cade,sections 25505,75533 and25534.1 undersand this ifthe building ��—
don Int c n0Y La's a uwm4 that It u my responsibility m notify the occupant of de
requi 'ch muse h met prior ho amu of a Ce,dru mof'cepancy. -
Signature of Applicant Date
ownertie.athorived eSt 7 Dow All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609056 .T1A&1B
DATE ISSUED. . . . . . . : 10/10/2008
RECEIPT # . . . . . . . . . : BS000006321
REFERENCE ID # . . . : 08100059
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD TYPE 1A&1B
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . : PROMETHEUS
ADDRESS 1900 S NORFOLK ST #150
CITY/STATE/ZIP . . . : SAN MATEO CA, CA 94403
RECEIVED FROM . . . . : EDWARD A GREGORY
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 15319 CHATSWORTH ST
CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345
TELEPHONE . . . . . . . . : (818) 221-6057
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --------- ---------- ---
1BSEISMICR VALUATION 650 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
1ERT<200 UNITS 1. 00 40 . 79 0 . 00 40.79 0 . 00
1TRAVDOC FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
------ ---------- ---------- ----------
TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- - -----
CREDIT CARD 122 . 87 MC
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- ---------------------------- -------- ----------- ----
402 TEMPORARY POWER
•
CITY OF CUPERTINO
TEMP POWER
• CUPEkTINO PERMIT APPLICATION FORM
APN # a U U S Date:
Lam_ /p- l0-2C �
Building Address-
<z L9
ddress:2D gds ////0Ale- .5 J/ WC/
Owner's Name: Phone #:
ToVMe 4eLs 6,s-v 9-3 3y�
Contractor: Phone1—
<`vKU� wV z(J Fax #:
Contact:._: Phone #:
,5d resp lel 9 sir
Contractor License #: 6 3 7 6
Cupertino Business License #: 2 z 3
Job Description:
. /— DOD /� �T sef✓�c t
Residential P51Commercial ❑
Valuation (cost of project): ��O Type of Construction: N/A
- 3
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp Power<200 E
(
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
/ 1BSEISMICR Seismic Residential B
/ ITRAVDOC Travel & Documentation B
Fee
CITY OF CUPERTINO
TEMP POWER
I OF
OF
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>lK Amps
IECT2001K Commercial Temp Power E
100-1K Am s
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
Revised 6/16/08 •
1
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