09080109 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 63 CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09080109
WNER'S NAME: PROMETHEUS
DATE ISSUED:08/12/2009
ER'S PHONE: 6509313457
_ PHONE NO:
❑ // LicLICENSED CONTRACTOR'S DECLARATION
License Class C�� /(, Q�O��� BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
.#
MECH RESIDENTIAL COMMERCIAL
Contractor � w`�0 C.�l�('�el�jate —� Z —09
1 hereby affirm that I am licensed under the provisions of Chapter 9 IOB DESCRIPTION:GROUND MOUNTED UL LISTED POWER SUPPLY
(commencing with Section 7000)of Division 3 of the Business&Professions JdITH 1 20AMP
Code and that my license is in full force and effect, ARCUIT&METER/DISCONNECT FOR COMCAST;MUSCIO
1 hereby affirm under penalty of perjury one of the following two declarations: ;LECTRIC PD FOR BUS LIC
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided f'or 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
permit is issued. c q.Ft Floor Area: Valuation:$1000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is �.PN Number:32609056.663 Occupancy Type:
correct. 1 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. (V1'e)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
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
with all non-poin e�gulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Datev r' Z l:sued by: Date:
Q OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: A I roofs shall be inspected prior to any roofing material being installed. If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, in stalled without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, in;pection.
Business&Professions Code) Si,nature of Applicant:
1,as owner of the property,am exclusively contracting with licensed contractors to Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
1 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 tabor Code,for the performance of the work for which this Sa'ety 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
1 certify that in the performance of the work for which this permit is issued,I shall colitaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Ile tlth&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Califomia. If,after making this certificate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,1 must O-o mer orized agent: �t
forthwith comply with such provisions or this permit shall be deemed revoked. — Date: �2 d91
APPLICANT CERTIFICATION / CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and state that the above information is ►hereby affirm that there is a construction lending agency
correct. I agree to comply with all city and county ordinances and state laws relatingo bency for the performance of work's
to building construction,and hereby authorize representatives of this cit to enter for der's this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Ler der's Name
iit ify and keep harmless the City of Cupertino against liabilities,judgments, Ler der's Address
cis, .nd 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 un ierstand my plans shall be used as public records.
I Signature_________ Date
Licensed Professional
y
a of 09
1S- 0-0CITY OF (;UPERTINO
CUPEkTINO GENERAL, BUILDING
PERMIT APPLICATION FORM
APN#� � / „ � �� . � � Date: � � 12-
Building
2-Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No Jil
HOA: Exterior work only) Yes No ❑ If 3,99, prW"4Aie-r from HOA 6-1 1..C, +M}'mal
Owner's Name: � ` �/ � 2/ Phone t 5
Contractori� � Phone: �d -?��` _ G 6
Fax:
Contractor License#: 36,t*-�05�
Cupertino Business License#:
Contact Phone* -
—v-1�.{ 5; � Fax: (o ?l�y__ � -16 69
Residential El Commercial
Job Description: � PJ a,-J f*--i3 Fr)GJ?-'O- /P
�7-- S/� P/S C46Aam ' -
Building Permit Info:
Bldg ❑ Elect I2/11" F lumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B 0--- (2 — 2,
Valuation: Square Footage:
Project Size: Express �tandardE] 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.builditgreen.or
Revised 07/14/09
a : CITY OF CUPERTINO
an of GENERAL BUILDING APPLICATION
CUPEf�TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Desc ription Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacemont windows/sliding glass B
door (ea F windows)
1 WINMEWSTR New Winslow-structural shear B
wall/maso (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
l ELCPLNCK Stand Alo-le Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alo 1e Mechanical Pln Ck(hrly) M
1 PLMBLNCK Stand Alo ae Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard flan Check(when no EMP) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg;Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &:documentation B
1BUSLIC Business license B
/ 122rP0 w
of 5
INPUT Resources EnerM' IAOiHealth
M.Indoor Air Quality and Finishes
1.UsetIrlNo-YOC Paird IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes IAQ/Health pts y=yes 0
3.Use Lowft VOC Adhesives ;I IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses I IAQ/Health pts y=yes 0
7.Seal all Pattidaboard or MDF f IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish f Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
. 1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Floo"Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor I Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 2 Resource pts y=yes 0
. 1 1 1
Total Points Available: 1401 130 57
Total Points Project Received:1 01 01 0
rogslgr ibuildingguidelines/remodelers/greenpointsfinal2.12.D4prolected.xls
Community Development
` 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
„UPEkTINO
BuildinIg De artment
JOB ADDRESS: PERMIT # o 0 C7
OWNER'S NAME: PHONE # 61-56r 351 3(oU
GENERAL CONTRACTOR: Gtt,6151-fe 0 FAX #
I am not using any subcontractors:
SiEnature Date
Please check applicable subcontractors and comF lete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date