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09070070 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 64 CONTRACTOR:WEST BUILDERS,INC. PERMIT NO:09070070 OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED:07/23/2009 t ER'S PHONE: 6509313457 BERKELEY,CA 94710 PHONE NO:(510)525-9378 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Lic.# 39 t Contractor 460fl Dale 7 Z3•d S MECH RESIDENTIAL COMMERCIAL 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 IOUSE PANEL Code and that my license is in full force and effect. ZEPLACEMENT 1 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by 3q,Ft Floor Area: Valuation:$6500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION \PN Number:32609056.664 Occupancy Type: I certify that 1 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 by Date: Signature • Date �• 23. �, '��`� OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of i istalled without first obtaining an inspection,I agree to remove all new materials for the following two reasons: i ispection. I,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, ignature 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 declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's 1 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. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I 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 /Aditionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall I lealth&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 O er r authori d ent: become subject to the Worker's Compensation provisions of the Labor Code,I must _ Date: 7 Z?• 417 forthwith comply with such provisions or this permit shall be deemed revoked. 10 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 abovz information is for which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating t ender'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 t ender's Address it ify and keep harmless the City of Cupertino against liabilities,judgments, cw ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION 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 .B64 DATE ISSUED. . . . . . . : 07/23/2009 RECEIPT #. . . . . . . . . BSC00008253 REFERENCE ID # . . . : 09C70070 SITE ADDRESS . . . . . : 20E00 HOMESTEAD RD BLDG 64 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PRCMETHEUS ADDRESS 20E00 HOMESTEAD RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : VIILA SERRA CONTRACTOR . . . . . . . : TODD L. WHITLOCK LIC # 29961 COMPANY WEFT BUILDERS, INC. ADDRESS 16C8 4TH ST STE 120 CITY/STATE/ZIP . . . : BEF.KELEY, CA 94710 TELEPHONE . . . . . . . . : (510) 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 CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM D�D LYS APN# 32 foo 9050 &� Date: 1 Oct Building Address: 20?)0o 64 Mailing Address (if different from building address): Owner's Name: Phone #: to5 p_et 3 k — 3L4 57 HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Contractor: Phone: S t —-T4(s —5 p 3y Vel GST r3v��VVtrL.-S Fax: 51 J -7,-x uo - `<jc> Contractor License#: 045,395 Cupertino Business License #: 299 (9 Contact: Tj` \ Phone: Sk 0 --173 ^0-7-70 Fax: 7LAU —Sc�33 Residential Commercial ❑ Job Description: M V&Lt u �T- ��-�� ,�� (�cr 1��c 1, P G, r- -p c AE p-`OLA-S'C Building Permit Info: Bldg ❑ Elect Zr Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V•B Valuation: ! O — 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.buildilgl-een.org Revised 02/05/09 CITY OF C'UPERTINO CUTE o GENERAL BUILDING APPLICATION FEE SC=HEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1WINREP Replacement windows/sliding glass B door ea 8 windows 1 WINMEWSTR New Window-structural shear B wall/mason includes plan ck fee 1 IEPERMITFEE Electrical Permit Fee E IMPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK 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) stared alone l 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B f 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1 BUSLIC Business License B 5 of 5