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09070086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 79 CONTRACTOR:WEST BUILDERS,INC. PERMIT NO:09070086 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 3S S BUILDING PERMIT INFO: BLDG ELECT 1� PLUMB License Class C_ Lic.# MECH r— RESIDENTIAL COMMERCIAL r Contractor l-3 R 11 Date 71Z3 19 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 iq,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 CPN Number:32609056.B79 Occupancy Type: ,f I certify that 1 have read this application and state that the above information is 1 correct. 1 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:-Z Signature _ Date OWNER-BUILDER DECLARATION RE-ROOFS: kII roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that 1 am exempt from the Contractor's License Law for one of nstalled without first obtaining an inspection,I agree to remove all new materials for the following two reasons: nspection. 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) 1,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 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. ,•ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by :;afety 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 I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 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 1lealth&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,I )w rerl author d gent: become subject to the Worker's Compensation provisions of the Labor Code,I must _ Date:-7/-3LP-O 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 1 certify that 1 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 it ify and keep harmless the City of Cupertino against liabilities,judgments, co 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 1 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 . . . . . . . . : 32E09056 .B79 DATE ISSUED. . . . . . . : 0723/2009 RECEIPT #. . . . . . . . . BS( 00008253 REFERENCE ID # . . . : 09( 70086 SITE ADDRESS . . . . . : 20E00 HOMESTEAD RD BLDG 79 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 WEST BUILDERS, INC. ADDRESS 1608 4TH ST STE 120 CITY/STATE/ZIP . . . : BER'KELEY, CA 94710 TELEPHONE . . . . . . . . : (53.0) 525-9378 FEE ID UNIT QUANTITY I,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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 3, 064 . 80 #9204 --------------- TOTAL RECEIPT 3, 064 . 80 CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPIJICATION FORM APN# Date: , C-)C� 3ZG0905U Building Address: `=- -79X Mailing Address (if different from building address) Owner's Name: PLO Phone#: G 5 p_G 3 I 3 y Fj7 HOA: (Exterior work only) Yes ❑ No If yes,provide letter from HOA Contractor: Phone: S t ——jc.{6 _S p 3y Fax: 51 J — -7�►19 - `jo33 Contractor License#: 67-5S95 -Cupertino Business License #: 299 (9 Contact: -�` �� Phone: S10 --1'73 —O-7-7U Fax: ) 74U —Sc�33 Residential Commercial ❑ Job Description: M VEL t u N k.r Z��-�� ,�� epr-t t�E1. "P G fes- 01Z Building Permit Info: Bldg ❑ Elect 2� 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: / _ Square Footage: Project Size: Express ❑ Standard ❑ Largt ❑ \,,I j o r ❑ Green Building: Please complete relevant portioi of the Green Building/LEED Checklist& attach it to the application or if applicatile, include in plan set& the sheet index. Points Achieved: For help,contact Build it Green at www.buildit reen.or Revised 02/05/09 CITY OF C'UPERTINO LUPE O 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 >tucco application 1 WINREP Replacement windows/sliding glass B door ea 8 windows 1WINMEWSTR New Window-structural shear B wall/mason includes plan ck fee I IEPERMITFEE Electrical Permit Fee E l . 1 MPER 41TFEE Mechanica 1 Permit Fee M IPPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alor.e 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 -stand alone IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic RE sidential B f IBSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5