11030047 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLING RD CONTRACTOR:WEST BUILDERS,INC. PERMIT NO: 11030047
OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED:03/10/2011
G'""ER'S PHONE: 6509313457 BERKELEY,CA 94710 PHONE NO:(510)525-9378
LICENSED CONTRACTOR'S DECLARATIONF
0Z`�� 15: BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# C5, 7
I MECH F RESIDENTIAL F COMMERCIAL
Contractor ( `-��\x3( l �
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CARPORT-REPLACE POST AND FOOTING IN-KIND FOR
EXISTING CARPORTS,FOOTING LOCATIONS SHOW IN RED
(commencing with Section 7000)of Division 3 of the Business&Professions
ON A0.9 ATTACHED
Code and that my license is in full force and effect.
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 Worker's
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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$10000
permit is issued.
APPLICANT CERTIFICATION APN Number:32609056.00 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 sqprce regulations per the Cupertino Municipal Code,Section
9.18.
` Issued by: l' `���f�
- i Date:J
Signature Date a�
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of 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
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
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.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall 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 O ger er`a+ h ri er j w
forthwith comply with such provisions or this permit shall be deemed revoked. Date: 1
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
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
and expenses which may accrue against said City in consequence of the
Ing of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10870 n.stelling rd DATE: 03/10/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $10,000
rPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Building is PENTAMATION 1 GENRES
USE: Multi-Family Dwelling >3 Stories Q Yes (F) No I PERMIT TYPE:
WORK repair post and footing for exisiting carports shown in red on A0.9. attached.
SCOPE
L L
_j
T-1 L
NOTE. These fivs are based on the prelindnary in ormation available and are only an estimate. Contact the Dept for addn'1 info,
FEE ITEMS (Pee Resolution 09-051 L ff. 1.;'10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 L�_J # Foundation Repair
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $0.00
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-0 Reg. 0 OT 0.01 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: Q Yes (F) No $0.00 0
Work Without Permit? Q Yes E) No $0.00
Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure
i
Strony- Motion Fee: IBSEISMICR $1.00 3.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $378.00 1INSPMIS Standard Inspections
SUBTOTALS; $2.00 $378.00 TOTAL FEE $380.00
Revised: 01/15/2011
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609056 . 00
DATE ISSUED. . . . . . . : 03/10/2011
RECEIPT #. . . . . . . . . : BS000012874
REFERENCE ID # . . . : 11030047
SITE ADDRESS . . . . . : 10870 N STELLING RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS
ADDRESS . . . . . . . . . . : 1900 SOUTH NORFOLK ST #150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
RECEIVED FROM . . . . : MIKE E DUCOTE
CONTRACTOR . . . . . . . : TODD L. WHITLOCK LIC # 29961
COMPANY WEST BUILDERS, INC.
ADDRESS . 1608 4TH ST STE 120
CITY/STATE/ZIP . . . : BERKELEY, CA 94710
TELEPHONE (510) 525-9378
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 000 . 00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1FOUNDREPA EACH 1 . 00 760 . 00 0 .00 760 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 762 . 00 0 . 00 762 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 762 . 00 VISA
---------------
TOTAL RECEIPT 762 . 00
OF ��
CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
IXPTW �v 'l0 til• ►�l� ?��TIN►� �SU1
Mailing Address (if different from building address):
Qmlboo �.- � . � a
Are Hazardous Materials being used as part of this project? Yes Ll No
HOA: (Exterior work only) Yes ❑ No [Y If yes, provide letter from HOA
If Residential.is house an Eichler? Yes ❑ No If yes, needs planning approval.
Owner's Name: Phone #-
v�S G50 -- 931 -S44q%-..
Contractor: Phone: HCS--7J 46_Sa S4
Wr i Lcez S Fax: 44 0 a— 7i4 b — 5S
Contractor License#: $Z15 515
Cupertino Business License #:
Contact: ` Phone:
Fax/e-mail: ' ckeovN(a 6w i IAL4JAP-St-:1 W1+
Residential Commercial
Job Description:
. ?.EPLAC& c +�►-+►r� � ►.l-1r.�µb e �X�ST u� t,A�oef a--S
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Building Permit Info:
Bldg U Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B
Valuation: Square Footage:
S �O%Z) o lir
Project Size: Counter 5n Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 12/06/10
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HOHBACH-LEWIN, INC. PAGE:
Ilf (�srRUCT/U�-RAL ENGINEERS PROJECT NO:
SUBJECT: V I `l 1 L?j `l-C.� Y DATE: 2 I
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRA C O / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# v QY 77
OWNER'S NAME: PHONE # 6JO Z f (�
GENERAL CONTRACTOR: > � kAe4 S BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses worki gin the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: Vc:' � ,T�(
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date