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09070056 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRlkSS: 20800 HOMESTEAD RD BLDG 55 CONTRACTOR:WEST BUILDERS,INC. PERMIT NO:09070056 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 LICENSED CONTRACTOR'S DECLARATION `' G� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Lic.# 19 Z fl-!`i, MECH[_ RESIDENTIAL COMMERCIAL r Contractor W6 Date 07,23.0,9 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:MULTI-UNIT ELECTRICAL PANEL UPGRADE, (commencing with Section 7000)of Division 3 of the Business&Professions HOUSE PANEL Code and that my license is in full force and effect. REPLACEMENT 1 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 Sq.Ft Floor Area: Valuation:$6500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32609056.655 Occupancyype: 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued bye Date: Signature Date d OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 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 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air permit is issued. 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 1 certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,1 Owner r a horized a er : become subject to the Worker's Compensation provisions of the Labor Code,1 must Date:7.2 3. forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. 1 agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address in Ty and keep harmless the City of Cupertino against liabilities,judgments, co.,. ..nd expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 120 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 32609056 .B55 DATE ISSUED. . . . . . . : 07/23/2009 RECEIPT # . . . . . . . . . : BS000008253 REFERENCE ID # . . . : 09070056 SITE ADDRESS . . . . . : 20800 HOMESTEAD RD BLDG 55 SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PRCMETHEUS ADDRESS . . . . . . . . . . : 20800 HOMESTEAD RD CITY/STATE/ZIP . . . : CUFERTINO, CA 95014 RECEIVED FROM . . . . : VIILA SERRA CONTRACTOR . . . . . . . : TOLD L. WHITLOCK LIC # 29961 COMPANY . . . . . . . . . . : WEBT BUILDERS, INC. ADDRESS . . . . . . . . . . : 16C8 4TH ST STE 120 CITY/STATE/ZIP . . . : BERKELEY, CA 94710 TELEPHONE . . . . . . . . : (510) 525-9378 FEE ID UNIT QUANTITY 7140UNT 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 CXPERTINO CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN# 32.(��905C�,� Date: ocl Building Address: 20$00 N�tn��S �ci�p C3�-►�c,.. 5� Mailing Address (if different from building address): Owner's Name: PLD Phone #: (,50—el 3 _ 3457 HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Contractor: W GST �� n�S �� Phone: S t 0 —-74(s —S p 3L-( Fax: 5l J T t-►L9 - 115 c> Contractor License#: �3 Z 5 3 9 5 Cupertino Business License #: 299 (91 Contact: -n` Phone: SI a --T`T 3 —O-7-70 Fax: 5�� -- -74U --533 Residential Commercial ❑ Job Description: M�xL t — u N �T �T-,�� ,�� FA-Nt E L— I-&P G Building Permit Info: Bldg ❑ Elect Ir Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B 51/ Valuation: $ S()0 — Square Footage: Project Size: 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.buijdjWeen.org Revised 02/05/09 CITY OF C'UPERTINO CUPEkTINO GENERAL BUILDING 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 1WINMEWSTR New Window-structural shear B wall/mason includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing;'ermit Fee P 1ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK 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) hourl -stared alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICR Seismic Residential B f 1BSEISMICO Seismic Commercial B A I TRAVDOC Travel & I>ocumentation B 1BUSLIC Business License B 5 of 5