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09070047 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 37 CONTRACTOR:WEST BUILDERS,INC. PERMIT NO:09070047 OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED:07/23/2009 ER'S PHONE: 6509313457 BERKELEY,CA 94710 PHONE NO:(510)525-9378 I LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# Z5315 MECH I— RESIDENTIAL rt--"COMMERCIAL r Contractot �� Date 7'7_3 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ELECTRICAL PANEL UPGRADE,HOUSE PANEL (commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT 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:$6500 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. APN Number:32609056.637 Occupancy Type: APPLICANT CERTIFICATION 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 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 DAYS FROM LAST 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 Issued by Date: 9.18. Signature Date 23•cX1 RE-ROOFS: d OWNER-BUILDER DECLARATION 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 all new materials for 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature 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: I 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. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,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 contaminants as defined by the Bay Area Air Quality Management District I will maintain 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,I shall not employ any person in any manner so as to become subject to the Worker's Owne20r thor' a gent: Compensation laws of California. If,after making this certificate of exemption,I Date: �• 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 I 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.) 1 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 upon the above mentioned property for inspection purposes.(We)agree to save i mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION c(., ,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 CUPERTINO 5 ITEMS OF 50 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 32E09056 .B37 DATE ISSUED. . . . . . . : 07/23/2009 RECEIPT # . . . . . . . . . : BSC00008251 REFERENCE ID # . . . : 09C70047 SITE ADDRESS . . . . . : 20E00 HOMESTEAD RD BLDG 37 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PROMETHEUS ADDRESS 20E00 HOMESTEAD RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : VILLA SERRA CONTRACTOR . . . . . . . : TODD L. WHITLOCK LIC # 29961 COMPANY . . . . . . . . . . : WE&T BUILDERS, INC. ADDRESS 16C8 4TH ST STE 120 CITY/STATE/ZIP . . . : BEF.KELEY, CA 94710 TELEPHONE (530) 525-9378 FEE ID UNIT QUANTITY 7,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 500 . 00 0 . 70 0 . 00 0 . 70 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 127 . 70 0 . 00 127 . 70 0 . 00 CITY OF CUPERTINO CUPEIZTINO GENERA L BUILDING PERMIT APPLICATION FORM � I DST APN# 32.60905Ix • ,837 Date: —1 ` - Dcl Building Address: N ��4 2pQ,od i-aD rv��5� 37 Mailing Address (if different from building address): Owner's Name: Phone #: (0 5 p_ej 31 .- 3 4 57 HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Contractor: W GST HiV n_S io�L Phone: S t o _-714 —S c,3y Fax: Contractor License Cupertino Business License #: 299 b Contact: -�` �� Phone: Sl 0 --7-73 -0-7-70 Fax: 714U —SO 3 3 Residential Commercial ❑ Job Description: M L-1-t u N %_r r�Arcx Building Permit Info: Bldg ❑ Elect Z� Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V•B Valuation: $ 5()O — Square Footage: Project Size: Express ❑ Standard ❑ Lame ❑ %Ia or ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checkl`iis `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 i-een.or Revised 02/05/09 CITY OF C:UPERTINO CUPEkTT NO GENERAL BUILD[NG APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Ap)lications (up to 400 sf) B additional Stucco application 1 WINREP Replacemc nt windows/sliding glass B door ea 8 windows 1 WINMEWSTR New Window-structural shear B wall/mason includes plan ck fee 1 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanica 1 Permit Fee M 1 PPERMITFEE Plumbing 'ermit Fee P I ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P I STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourl -stand alone j 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT / TYPES / IBSEISMICR Seismic Rcsidential B IBSEISMICO Seismic Commercial B A 1TRAVDOC Travel & Documentation B 1 BUSLIC Business License B 5 of 5