07110172 CITY OF CUPERTINO ` `
�;::.:;, v c�rv�sioN PERMIT ��1����f��` I�(��'���k�: :
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PERMIT NO.
sui ��� vr ��B RE ��MESTEAD RD BLDG 38 #F PRO-CRAFT BUILDERS INC 07110172 .
OWNER'S NAME: PERMTTL�UEDATE
P R O METHE US 761 MABtfRY RD STE 50 � 11/30/2007
)NE: SANITARY NO. CONTROL NO.
(408) 4�1-1301
ARCHITECiBNGINEER: BU(LDING PERMiT INFO
BLDG EI.ECf PLUMB MECH
� � 0 0
� O p LICENSED CONTRACI'OR'S DECLARATION JOU DCSCi1pU0I1
;� V I hcrcby af(irtn that I am liccnscd undcr provisioas of Chaptcr 9(commencing
� aiW Sccuon 7000) ef Division 3 0( thc Bu�ness and Profcssions Cadc and my liccnsc is REMO DE L D E C K & DE C K RA I L I NG
°� y in futl force and eft �,
� z Licensc Class �• �
n F � Dalc - Conttaclar
� ' ARCHIl'ECI'S DECLA AT10N �
��< 1 understand my plans shall be used as public recorda
4
� w y Lic:cnsed P�ufcssional
� y � OWNER-BUILDER DECIARATION
I hercby alTirm ihat 1 am excmpt Gom ihc Camractor's Lieensc Law far the
� p O following icason. (Scction 7031.5, Business and Profcssiont Catc: Any city or county
K$� which rcquiccs s permit to conswct, aitcr, impmvc, dcmolish, or �epair sny swcwcc
'� Z y prior w i�s istuance, also �equires Wc applicant for such pertnit to file a signed statement
< that hc is liccnscd pursuant lo thc provisions oC thc Conuactor's Liccnsc Law (Chaptcr 9 3q. Ft. Floor Area � 3 5 O O Valuation
Y I z -� �(commencing with Scction 7000) of Division 3 of �hc Busincss and Profcssians Codc) or
y�� that he is eumpt thc�efrom and ihe besis for the allcgcd eumpdon. Any violauon ot
SecUon 7031.3 by airy applicant for a permit subjecu ihe applicant w a civil penalty of �-�.( Number Oceupancy Type
not more than five 6undred dollars (SS00� 3 2 6 0 9 0 ._i f>.
❑ I. u owner o[ ttie prnperty, a my employces with wages u their so� compensadon,
will do ihe work, u+d the sttuctwe is noi inrended or oftered for sale (Sec. 7044. Businesa Re uired Ins ections
�nd Professions Cade: The Canuacwrs License Law does not appty iu an owner of 9 p
property who builds or improves IMercon, and who does such work himself or Wough Au
own employces, provided �hat such improvementa ue not in�ended or olfered Cor sala If,
however, the building or impmvement ia sotd within one year o[ eompletion, the owner-
builder wiR luve the burdee of pmving ihu he did not buid or improvc for purpoae of
sakJ.
0 I, as aaner of the propeny, am aeclusively conuacting wi�h licenaed conuactors to
construct the project (Sec. 7044. Business and Professians Code:) 7'!ie Coauxwrs Li-
cense I�w docs not apply to an ownu of propeny w6o builds or improves �lieieon, and ,
who conuac�s tar such projects with a convutor(s) licenxd pursusnt w �he Convactors
Litense Law.
❑ I am exempt under Sec. . B& P C(or this rosson
Owner Date
WORKER'S COMPENSAT[ON DECLARA7'ION
1 heccby affirm under penalty of perjury one o[ �he follawing dalaraGons:
,J I hs.�e and will mainuin a Cenificate o( Consent to self-iasuee for Workcrs Compen-
sation, as providcd fa by Section 3700 af the Labor Code, frn the performarcc of the
work Cor which Ihis pertnit is issucd.
❑ I have and will maintain Worker's CompensaUan Insurana, as tcquired by Scction
3700 of ihc Labor Code, fw the pedormancc of the worlc (or which this permi� is issued.
My Workers Compenutian Insucance carricr and Poliry nu�q ����� li
cam«: RE�wa�D F �RE �oi�ey Na.: e ' �
CER17F7CA1E OF EXEMPITON FROM WORKERS'
COMPENSATION iNSURANCE '
(fhis sectian necd not bc completed if the permit is for onc hundred dollus (S I00)
or Icss.) '
I cenify Ihat in thc performancc of thc wark for which ihis permit is istuc4 I shsll not
employ any person in any manncr so u �o bccomc subject to the Worlcers' Compensation
Laws of Califomia. Datc
Applicanl -
NOTICE 7'O APPLICANT: If, aficr making �his CeniGca�c of Eucmption, you should
become subject w the Worlcer's Compensauon provisions of U�e Labor Code, you muu ,
. O foMwi�h comply with such provisions or this peanit shall bc dcemcd revokcd.
z ""' CONSTRUCf10N LENDING AGENCY
[- � I he�c6y sffirm Uut there is a conswction Iending agency for the perCwmance uf .
p�., � ihe work fur which this permit is iuued (Scc. 309'T, Civ. C.)
W Q Lendc�s Ntinc •
] z Lende�'s Addmss
V � I cenifY Ihat 1 havc read ihis application and sutc Uut Ihc above infartnatiun is
w� cortcct I a6rce w comply wiih alt city and county oNin�nces and sute Iaws relating a
0 U building consvuction, and hereby auihoria represenuuvcs of this city w cn�cr upon thc
� a aAovo-menGoned propcny (or inspecuon purposes.
(Wc) agree to save, indcmnify and keep hannless the City of Cupertino against
H � IiabiliUu, judgmcn�s, costs and expenses which may in any way accn�c againsl said City
() ,'� in consequence of tAc granting af this permi�
�+ APPLICANT UNDERSTANDS AND WILI. COMPLY WITH ALL NON-POINT Issued by; Date _�o-g�
SOU CE REGULATIONS.
�i�{�,�,�e�c�-'� l/-3�- Re-roofs /�/
SignawreofApplicanUContruwr �e� T ofRoof
HAZARDOUS MATERIALS DISCLOSURE }r�
Will the appliant or futwc building occupant starc or handle ha•rardous matcrial
u dcfincd by Uu Cupertino Municipai Cade. Chapt�r 9.12, and the Hesith and Safcty
c«� Section 25532(a)? � All roofs >hall be inspected prior to any roofing material being installed.
❑ Ycs
Will U�c applicant or fulure building occupant use equipmcnt ar devices which If a roof i; � installed without first obtaining an inspection, I agree to remove
.nil haiardous air conlaminanis az dcfincd by the Bay Area Air Quslily Management all nevv m aterials for inspection.
DISItICl7 � . .
❑ Yes
1 havc rcaJ the hvardaus materials requiremcn�s undcr Chaplcr 6.95 of Ihc Califor-
nia Hcalth & Safcty Codc. S�xtiions 25305, 25533 and 25534.1 undcrsmnd ihat iC Uu building
dces not currently havc a tenan4 ihat it is my responsibili�y w nodfy thc occupant of ihe
rcyuiremcn�s wnice must bc met prior w issuancc or a Ccnir�catc or ocwpancy. S1gIIShli2 Of APpI1C811t Date
.B-r�1,�� -�e-�" -���'�-- �� �'� All roof coverings to be Class "B" or better
Owncr or author'ved agcnt Datc '
�� ll O��l�
CITY OF (�UPERTINO
" ' ADDITIOl`�/REMODEL
CUPff�,TINO PERMIT APPLICATION FORM
APN# ��� Date: �/_ �_d�
Building Address:
2 2� �o o ,.,., �e ud � . f 3� �
Mailing Address (if different from building address):
Owner's Name: Phone # :
�o�� �z:� �" J�l U - J �{ - �v�,�J�
Contractor: Phone #:
e ty/— i�3� �
�r�- ���� ��; r �• _,� � F� #:
Contractor License #: � 3 3 8 2
Cupertino Business License #: 3��'�� ��� 1�J8
Contact: Phone #: o�— 2 2 - �"L-
� ' � � Fax #: G % Yl — % �� �'I
Building Permit Info:
Bldg. �� Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑
Job Description:
What is being added?
What is being remodeled? ��� � _�.�_- � c�u ��
Remodel Includes Re-Roof: Yes ❑ No [] If yes list number of squares
Remodel Includes Structural: Yes � No []
Square Footage:
Addition: Remodel: Garage:
Porc�: Deck: Other:
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N --3
Valuation: Please check this box if the project is a
��°"0 0 second-sto addition ❑
Green Building Check list must be completed and
� attached to the plans. Green Building Points Achieved:
***For Office Use Only***
Over-the-Counter ❑
CITY OF CUPERTINO
ADDITIOr�/REMODEL
CUPEt�TINO PERMIT APPLICATION FORM �
Quantity Fee ID Fee Descritp ion Fee Group Permit Type
1PATMOBF Atmospheric V�icuum P
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Dis osal Systeni
1PRSEWER Sewers P
1 BPSPRINK Lawn P
S rinklerBackflow
1BPWSVCS Main Water Service P
� BSEISMICRE SeismicResidential B
DECKS
/ 1DECKWOOD Deck (Wood) B
/ .
, 1DECKRAIL Deck Railing B
GARAGES
1GARDTW<=1K Wood Frame u� to B
1,000 SF
1GARDTM<=1K Masonry up to l,000 B
SF
PATIO'S OPEN
1PATIOWOOD Wood Frame u� to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1PATIOOTHER Other Frame up to 300 B
SF
PATIO'S CLOSED
1PATIOENCLW Enclosed Wood up to B
300 SF
1PATIOENCLM Enclosed Metal up to B
300 SF
1PATIOENCLO Other Enclosed Patio B
up to 300 SF
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIZ RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........ 32609056.22
DATE ISSUED.......: 11/30/2007
RECEIPT #.........: BSC00003367
REFERENCE ID # ...: 07110172
SITE ADDRESS .....: 20�00 HOMESTEAD RD BLDG 38 #F
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............. PRCMETHEUS
ADDRESS ..........: 19C0 S NORFOLK ST #150
CITY/STATE/ZIP ...: SAI� MATEO CA, CA 94403
RECEIVED FROM ....: PRC�-CRAFT BUILDERS
CONTRACTOR .......: BII�L L. FEDOR-THURNIAN LIC # 28938
COMPANY ..........: PRC�-CR.AFT BUILDERS INC
ADDRESS ..........: 76� MABURY RD STE 50
CITY/STATE/ZIP .. : SA1`f JOSE, CA 95133
TELEPHONE ........: (4(�8) 441
FEE ID UNIT QUANTITY �,MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1DECKRAIL EACH 1.00 428.00 0.00 428.00 0.00
1DECKWOOD EACH 1.00 428.00 0.00 428.00 0.00
BSEISMICRE VALUATION 3,500.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 856.50 0.00 856.50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 856.50 #1495
---------------
TOTAL RECEIPT : 856.50
Community Development
�� � � 10300 Torre Avenue
.�; ;fr.� ' Cupertino CA 95014
:Y . ' �.
�;�:: Telephone (408) 777-3228
C1TY OF Fax (408) 777-3333
�UPERTINO
Buildi:n De artment
JOB ADDRESS: PERMIT #
1. � fs� b�;�e ' d� d 3�`� ��7 l/ o l"7 Z
OWNER'S NAME: rz�•rv�2-t'���5" PHONE # `fG(/-/ 3�/
GENERAL CONTRACTOR: Pra - c' �` G� C� �dp,��• FAX #
I am not using any subcontractors: �-r'�'` - �� - � � �� --�� -D �
Si;;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIrTESS NAME BUSINESS LICENSE #
Cabinets & Mill�vork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lativng
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�,.�;L, � ��� - ��r�- -
Owner/Contractor Signature Date