09070084 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 76 CONTRACTOR:WEST BUILDERS,INC. PERMIT NO:09070084
OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED:07/23/2009
( -:R'S PHONE: 6509313457 BERKELEY,CA 94710 PHONE NO:(510)525-9378
I� LICENSED CONTRACTOR'S DECLARATION
c BUILDING PERMIT INFO: BLDG ELECT PLUMB�
License Class Lie.# �Z 35
t MECH I— '
RESIDENTIAL frCOMMERCIAL�
Contractor Date 0
I 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. ?EPLACEMENT
I 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 ;q,Ft Floor Area: Valuation:$6500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
CPN Number:32609056.1376 Occupanc Type:
APPLICANT CERTIFICATION
I 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
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 b Date:
fT
Signature /ham Date a3 V
OWNER-BUILDER DECLARATION RE-ROOFS:
111 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 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)
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
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 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. :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 iafety 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 ikdditionally,should I use equipment or devices which emit hazardous air
permit is issued. :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
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,I Dwne•or u thorize4 aat nt:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION 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 lor which this permit is issued(Sec.3097,Civ C.)
correct. I 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 tify and keep harmless the City of Cupertino against liabilities,judgments,
cc- ,and 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 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 .B76
DATE ISSUED. . . . . . . : 07/23/2009
RECEIPT #. . . . . . . . . BS000008253
REFERENCE ID # . . . : 09070084
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD BLDG 76
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PRCMETHEUS
ADDRESS 20800 HOMESTEAD RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : VILLA SERRA
CONTRACTOR . . . . . . . : TOLD L. WHITLOCK LIC # 29961
COMPANY . . . . . . . . . . : WEST BUILDERS, INC.
ADDRESS 16C8 4TH ST STE 120
CITY/STATE/ZIP . . . : BERKELEY, CA 94710
TELEPHONE (510) 525-9378
FEE ID UNIT QUANTITY PMOUNT 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
APN# Date: 1 OR
3 2(00 9 05(.Q —
Building Address: 2-0(600 ST � (3u)u -0- 7Q
Mailing Address (if different from building address):
Owner's Name: Phone#: _013, 34 57
HOA: (Exterior work only) Yes ❑ No
If yes, provide letter from HOA
Contractor: Phone: S t LO —-7t.(6 _5 p 3y
Fax: 5l`� — -7yL-9 - `Sc>
Contractor License #: 2 5 3 5
Cupertino Business License #: 299 (9 f
Contact: 7Phone: Sl o --1 Z 3 -0-7-70
Fax: ?'- U —!&LD 3 3
Residential Commercial ❑
Job Description: /VL V�� i u N ►T �T-�—� �,�� por til�c l� �P G �/�c�c
Building Permit Info:
BIdg ❑ Elect 2f 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: $ 500 — Square Footage:
Project Size: Express ❑ Standard El Large ❑ tilajor El
Green Building: Please complete relevant portior. 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.buiWjj&-een.org
Revised 02/05/09
CITY OF C'UPERTINO
�uPENO GENERAL BUILDING APPLICATION
FEE SC EIEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Ap)lications (up to 400 sf) B
additional Stucco ap lication
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1WINMEWSTR New Window-structural shear B
wall/mason includes plan ck fee
/ 1 EPERMITFEE Electrical Permit Fee E
l 1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand AlorLe 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
J 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
/ TYPES
1 1BSEISMICR Seismic Residential B
f
1BSEISMICO Seismic Commercial B
A 1TRAVDOC Travel & Documentation B
1BUSLIC Business License B
5 )f 5