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09070177 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD CONTRACTOR:NATIONAL PERMIT NO:09070177 CONSTRUCTION RENTALS n"'NER'S NAME: PROMETHEUS 15319 CHATSWORTH ST DATE ISSUED:07/27/2009 (�,,NER'S PHONE: 6509313400 PIISSION HILLS,CA 91345 PHONE NO:(818)221-6057 ❑ LICENSED CONTRACTOR'S DECLARATION f BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Clot GI'3, Ogl Lic.# (Pel (LVO MECH f— RESIDENTIAL f— COMMERCIAL� Contractor 1 hereby affirm that I am licensed under the provisions of Chapter 9 OB DESCRIPTION:TEMP POWER POLE FOR LAUNDRY FACILITIES (commencing with Section 7000)of Division 3 of the Business&Professions &2 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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. Sq,Ft Floor Area: Valuation:$22537 1 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. CPN Number:32609056.ALL Occupancy Type: APPLICANT CERTIFICATION 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 ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 D YS FROM L CALLED INSPECTION. 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 ssued by / " ' � Date: 9.18. —� 7 - W i Si- .,tore Date -1 o Z —� RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed. If a roof is nstalled without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of nspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, :;ignature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. iafety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by %dditionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 'ontaminants as defined by the Bay Area Air Quality Management District 1 will naintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 1 certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Worker's ;3�rrrgi�ef auihorized aeent: q Compensation laws of California. If,after making this certificate of exemption,I --Tn --_--- Date: 2 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. CONSTRUCTION LENDING AGENCY .hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address lit e above mentioned property for inspection purposes.(We)agree to save in,- ify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature _ Date CITY OF C"_UPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 326 )9056 .ALL DATE ISSUED. . . . . . . : 07/27/2009 RECEIPT # . • . . • • • • • : BS030008279 REFERENCE ID # . . . : 09070177 SITE ADDRESS . . . . . : 20800 HOMESTEAD RD SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PRCMETHEUS ADDRESS . . . . . . . . . . : 19C0 SOUTH NORFOLK ST #150 CITY/STATE/ZIP . . . : SAT MATEO, CA 94403 RECEIVED FROM . . . . : NATIONAL CONST RENT CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537 COMPANY . . . . . . . . . . : NA".TONAL CONSTRUCTION RENTALS ADDRESS : 15:19 CHATSWORTH ST CITY/STATE/ZIP . . . : MI:3SION HILLS, CA 91345 TELEPHONE . . . . . . . . : (8:_8) 221-6057 FEE ID UNIT QUANTITY ;MOUNT PD-TO-DT THIS REC- --NEW-BAL- ---------- ------ --------- --------- - --------- --- 1 . 00 0 • 1BCBSC---- ---- - VALUATION 22 , 537 .00 1 . 00 0 .00 2 .30 0 .00 00 1 1BSEISMICR VALUATION 22 , 53 .00 2 .30 0 .00 .00 42 . 00 0 .00 42 . 00 0 .00 lEPERMITFE FLAT RATE 1 lERT<200 UNITS 2 . 00 84 . 00 0 . 00 84 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 ------ -- -- TOTAL PERMIT 171 .30 0 . 00 171 .30 0 . 00 METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER ----------------- CHECK 171 .30 #001610 --------------- TOTAL RECEIPT 171 .30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------------------- 402 TEMPORARY POWER O yo -7 -7 CITY OF CIJPERTINO TEMP POWER CITY F PERMIT APPLICATION FORM CUPER Date: -7 Z�7 v APN # a q 0 Building Address: y Phone#: Owner's Name: phone Contractor: rrJJ Fax#: w 1 Phone#: Contact: Contractor License#: (,`�� 10 v 1 2 Cu ertino Business License#: A Job Description* ,5 L ems- Comm erclal ❑ Residential ;© of Construction:N/A Type Valuation cost of project) Fee Group Permit Type Fee ID Fee Descri,allon 1REAP14 Quantity E Res. Temp Power>1K IERT>1K Amps E Res. Temp Power<200 IERT<200 Ams E Z Res. Teml)Power 200-1K IE 001K Amps E IEPERMITFE Electric F ermit Issuance E IELCPLNCK Electric flan Check B ALL PERMIT Cal Bld€; Standards TYPES IB BSC Commission Fee B EISMICR Seismic Residential 1BS B IT DOC Travel &Documentation Fee 1 Revised 01/07/09 fo Villa Ser a A at#r ents , - D � '_..PHASE it „HASH 1 .W_E S T E .. x.....::: ... -- .. -r Mobilization Erbft- - , .. .F _. ., t� ._. -�. n • . Y 1 I t • rr h ! 200$ - - stu�c r eta rt D . A t _ Q� p it _ u a I kk ee t entryfm vmnc Y N �f t � I ! -.New Building Location 1-4 1 i AREA 1 ,,: April Construction Commences L _11 ( _ ti L { `1 en f f zr. 1 /� t= ay ..,.. OA � O � t Se.5 Zwao� yp.r.n•o`� E tt r w ,.. `7 1 < It iz rr ar c^ 11 d t _ 4 {,i � .:; Y.... ,• ! 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' p n 'L 2dok, z vu��- f�rtaP 0 60 r �{ Z At, oJt-4e,44 WtP` Z Pao,,Sona e� $o P, Lao Yo� ..�.n ..f..nA—PPO loo $tot 1- 4fi Ikl► ��Scannu Jam©k�� 240�1. loop �vR y�3oJ k ?�o AIPAP a _r'\ ZP.Ub• - .: _;, N� T g4 1� � - 11oi} Sib M' 2 P•G�- �jcl+ P�►c. buy CA"he1 �roe� Rs _ Gs h p NOR FH BAY START DATE PE RMS SERVICES FOR ALL YOL`R PERMIT NEEDS ScSve Time and More I Let Us Do The Leg Work! PROJECT/JOB# CONTRACTOR: .��� CITY JOB ADDRESS CROSS STREET CITY TY Or COUN (CHECK ONE) #OF STORYES an USE OF BUILDING #U1�1ITS�„ VALUATION S is TIM"A POOL OR SPA ON PROPERTY" YES-7 INTO_______ POST ON JOB SITE:YY -S�, NO �Wk 3q C) pud Ow1,MKS NAME Prc m e'� cV5 x Y ►� M[��-e ZIP - ADDRESS N - NATIONAL (:ONSTRUCION RENTALS SUBCONTRACTOR: ZIP.: 94577 ADDRESS: 1300 Business Centex Dr. CITY: San Leandro FAX: (510) 563-4081 CONTACT: Christine pHO (510) 563-4040 EXPYRES: 04/30/201.0 STATE LYCENSE# 687160 CLASS: C10,C13,D31 'WOItI�ER'S COMP'#TRJUB44246B 89108 CONIPANY: .Mp,� j;�$PROP. EXPIRES: 12/31!2009 PRODUCTS TO BE INSTALLED � cep i SUgDiVISION# LOT#_ PARCEL# BUILDING PERMIT# �`1 1 a 0 l u �-- PERMIT SERVICES, INC. 528-7663 (707) 527-7727 - (E00) 627-3764 • Fax(707) permltservices.com 2635 Cleveland Avenue,Suite 6 • Santa Rosa,CA 95403 www.