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10010093 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159S BLANEY CONTRACTOR:BKB CONSTRUCTION,LP PERMIT NO: 10010093 OWNER'S NAME: PROMETHEUS REAL ESTATE GROUP 2812 TRINITY SQUARE DR STE 110 DATE ISSUED:01/20/2010 4ER'S PHONE: 5106779855 CARROLLTON,TX 75006 PHONE NO:(972)478-2255 ❑ LICENSED CONTRACTOR'S DECLARATION _ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractors CSS 3'T Date Z -:7 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE ROTED 4X10 BEAM WITH ALL AS LIKE (commencing with Section 7000)of Division 3 of the Business&Professions MATERIAL. Code and that my license is in full force and effect. UPON CITY INSPECTION,INSPECTOR MAY REQUEST STRUCTURAL ENGINEER DETAIL 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 permit is issued. Sq.Ft Floor Area: Valuation:$2300 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36903008.SB Occupancy Type: 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 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 granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. -- _ Sigfl' Date/ ZG�' / Issued by: `� Date_.- V OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All 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, installed 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, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 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 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 Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. j Ow au ' d agent: r Date:loop— .- c.. APPLICANT CERTIFICATION f CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is j correct.I agree to comply with all city and county ordinances and state laws relating I hereb ffirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name i- -nify and keep harmless the City of Cupertino against liabilities,judgments, :end expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all - oint source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.1 I understand my plans shall be used as public records. Signatur !.� Date Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36903008 .SB DATE ISSUED. . . . . . . : 01/20/2010 RECEIPT # . . . . . . . . . : BS000009594 REFERENCE ID # . . . : 10010093 SITE ADDRESS . . . . . : 10159 S BLANEY SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PROMETHEUS REAL ESTATE GROUP ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE 150 CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 RECEIVED FROM . . . . : LEONARD TAYLOR CONTRACTOR . . . . . . . : BRYAN G BROWN LIC # 29820 COMPANY . . . . . . . . . . : BKB CONSTRUCTION, LP ADDRESS . . . . . . . . . . : 2812 TRINITY SQUARE DR STE 110 CITY/STATE/ZIP . . . : CARROLLTON, TX 75006 TELEPHONE . . . . . . . . : (972) 478-2255 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 300 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 21300 . 00 0 . 50 0 . 00 0 .50 0 . 00 lINSPCRT HOURS 1 . 00 253 . 00 0 . 00 253 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 296 . 50 0 . 00 296 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 296 . 50 AMEX --------------- TOTAL RECEIPT 296 . 50 01/20/2010 15:54 FAX 9724781277 41002'004 c)c� 3i CITY OF CUPERTMO CUPEkTINO CMNERAL BUILDING PERMIT APPLICATION FORM APN# Date:oo � S Building Address: ' e e� �:kcvp ailing Address (if different frorn 64ilding address): Are Hazardous materials being Mod as part of this project? Yes No HOA: xterior work only Yes lata Yf ves rovide letter from HOA OWner's Name: Phone#: 4?�•'1 ►.,," if 0 0\ Q. Contractor: Phone; Pax: -1 -1-t C9 a-I n Contractor License#: $9 4 S-!t Cupertino Business License#. Contact:� ,.— =Phonc:14 05- g 5(Q� Ca. �� 1 „csidential Comm Job Description. n mak- imp `k Building Pe1mit info: - f Bldg Electiplumb C� Mech 11 Type of Construction(U-sage Class) Occupancy Type: 1-A 1-B II/IIYi'Vi V-A i YII B, TV-HT1 -B Valuation: , i Square Footage: 'ect She, rens Stan Large, Nia`or Green Building:Please complete portion of the Green Bunding�EED Checklist& attach it to the appllcati or if applicable,include in plan set the sheet index. Points Achieved. For helv.contact Build it Green 4t www.build r Revised 07/14/09 i® 3� � va t��.g60s9 Z0:90 0t0z/z0!t0 . CITY OF CUPERTINO WnOF GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E r 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone �+ 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Business License B J- P C R F 5 of 5 01/20/2010 15:55 FAX 9724782277 4003/004 I i RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. Project address. Contact person. Phone. - S Fax. Lit — i Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: •� Garage. TOTAL: ' Are there at least two 10 foot by 20 ftot clear spaces inside the gars N 1s privacy protection planting require for+doe project? Build it Green Total Points On what floor(s)is work being done?I rx>,r%C\- ~ ' boa Brief description of work. L � o ;,f,4 . ,. , 20 7 -N Cade editions:2407 CBC0-N)2"tepa, �' Q ,��'�s �"i'' ) 2407 CFC N)� 007 bI rTy- (Yr7?JGi—/6 i s1cNE Effective 1/1/08 This set of plans vo �;i)"lt,,,,tl.ws MUST be kept on the lot),jt ,ill tww', Ind it is Wnlaw ful to make any change,)�;r alterations on ><3me without wry en pee r)issic ri from the Podding Departn ent (:ity ;f('upertino. The stamping of this��fan �nrj specific atic;rts SHAI L NOT be held to v)errrut or to be an aper caval of the violati«r):A ar)y I>rovision of Arn City `;tete Law. i r V ` �. BMW Plan Review Process Woik Book Pa a 4-Revised 9/05/08 Za 3svd t,9 TU-95059 Zt7 90 0 TOZ/ZO/TO ,. Community Development { 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT # /22/sLa-u� G � 01 %'D OWNER'S NAME: PHONE GENERAL CONTRACTOR: �' �z -• FAX # I am not using any subcontract j 2 -&/ Signature Date Please check a m licable subcontractors d colete the following information: 21 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