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07100216 CITY OF CUPERTINO ' KUILDING �IVISION PERMIT ����� ��� ���������•' ' ,... ;•.. , .,...::<._ _ . _ . PERMIT NO. BUILD � r � a �$� .ss STEVENS CREEK BLVD #415 TBD — T� BE DETERMINED 07100216 • PERMIT LSSUE DATE .ER'S NAME: , PROMETHEUS REAL ESTATE GROUP 10/30/2007 SANITARY NO. CONTROL NO. PHONE: BUiLDING PERMIT iNFO ARCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH 0 0 0 0 ; o o LICENSED CONTRACTOR'S DECLARAT[ON JOb DeSCT1pC1011 '�'"' I hcrcb aff im �hat I am liccnscd undcr pmvisions oC Chaptcr 9(commcncing ' w iihSccdon7000)ofDivision3ofiheBusincssandProCcssionsCode.andmylice nscis REMODEL KITCHEN/BATH�W/D RETROFIT�DUCTLESS SPLIT � a a in full force and effect i�z LicenscCla�s [.�c.0 SYS HVAC RETROFIT� NO1�T—STRUCTURFIL • ^ p Da�c Con�ractar : F' � ARCHITECI'S DECLARA770N i a ta a I undcrstand my plans shall bc used as public reconis )aU ' w � Liccnsed Pmfcssional : � a OWNHR-BU(LDER DECLARA'CION � a� � hcrcby alTirm that 1 am excmpt frum �hc Con�ractors Liccnso Law for the . p o (ollowing rcason. (Secuon 7031.5, Business and Profccsions Cade: Any eiry ar wunty �^.�c, which rcquires a permit to conswc[, altcr, impmvc, dcmolish, or repair any suucture prior lo iLt issuance, alw requircs the applicant for such pertnit to file a s�gned s�alemem , FC. FIOOI' Are3 Valuation � z< that hc is liccnscd pucsuanl to thc provisions o[ thc Cnntractor's Liccnsc Law (Chap�cr 9 '�q $ 3 9 0 0 � t �(comm e n c i n g w i t h S c c t i on 7000) of Division 3 of �c Busincss and Profcssions Cadc) ur ,�, �.. �hat he is eumpt theiefrom and Ihe basis for the allcgcd exemption. Any violation oC OCCUP1IlC�/ Typ(: Sudon 703I.5 by arry applicant for a permit subjecu ihe applicant to a civil penalty of 3 6 9 010 2 6�`�� Number not more �han five hundred dollars (5500). ❑ I, as owncr o[ ttie property. a my employces with waga az their solc compensadon, will du the work and the seuctur is not intended or oftered fo: salc (Sec.7044. Busi�rcss Required Inspections and Professions Code: 'Che Contrecwrs Licenu Law does wt apply to an owner of propeny who builds or improves Wercon, and who daes such work himsel[ or thmugh his own emplayccs. pravidcd that such improvements are not iNended or ollered for sala 1[, howevu, the building or improvement is sold within one year oC compleuon, �he ownerv builder will have the bardcn oC proving Uiat he did no� build ar improvc for pu�pose of saleJ. ❑ I, u awner of tAe propeny, am exclusively convuting wiU� licensed rnnvactas to conswct the pmjea (Sec. 7044. Business and Profasions CadeJ The Contnctor's Li- ccnse Law docs aot applY w an owner of propeny who builds or improvrs �hereon. and , who convacts Cor sucd pmjecls with a comractoKs) licensed pursuant to ihe Canvutaf's License Law. t am uempt undu Sec. , B& P C for �his rcason .ner �� WORKER'S COMPENSATION DECLARA170N I hereby atTicm under penalty of perjury onc af the folbwing declaratiaas: ❑ 1 hsoe and will maimain a CertiGcate of Consent to selt-insure for Workcrs Canpen- sation, as pravided fa by Sation 3700 of the I.abor Code. for �he pc6orma�rcc o[ �hc work fo� which this permit is issucd. ❑ I have and will maintain Worker's Compensadon Insurance, as required by Sectian . 3700 oC the Labor Code. for Ne perCortnance o[ �he work for which this permit is issued. My Worker's Compensation Insueancc carricr and Poliry number a�c: Cartier. Poliry No.: CERTIFICATE OF EXEMPIION FROM WORKERS' , COMPENSATION INSURANCE ([his scctian necd not bc comple�cd if the permit is for onc hundred �Ilars (5100) , or Icss.) 1 certify thns in �hc performance af the work Cor which ihis pertnit is iuued. ! shall not employ any person in any manncr so as w bccomc subject to the Workcrs' Com{�ensauon Laws of California. Datc Applicant NOTICE TO APPLICANT: If, aftcr making �is Ccctilica�c of Ezemption, you slwuld become subject to the Worker's Compenstipon provisions of �he L.abor Code, you must � z forthwith comply with such provisions or this permi� shall bc dccmcd ccwkcd. z O CONSfRUC7'ION LENDING AGENCY F.-. I hc�cby a[firm that �here is a concwction Icnding agcncy lar �hc per[ormance o( - �� thc wurk far which this pertnit is issucd (Scc. 3097. Civ. C.) , W Q Lendcr's Nunc � � Lcnder's Address U � f cectity tha� I have read this application and sutc that thc above informaGon is w F cortcct. I agrce to comply with all city and county orJinances and state laws relating to � U building conswction, and hcccby authome rcpresentativcs of this city to cmcr upnn thc � W abovc-mcntioncd property [or inspccuon purFwses. a (Wc) agree to save, indcmni(y and kcep harmless ihe Cily of Cupertino against H � liabilitiu, judgmcn�s, cosLC and expenscs which may in any way accrue agains� said City U z in conuquence oC the granting of �his permiL D2Le � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIt�I' Issued by: SOURCE REGULATfONS. Re-roofs SignatureofApplicant/Conlractor �� T e of F'.00f HAZARDOUS MATERIALS DISCLOSURE YP �11 the applicant or futurc building occupant scorc or handlc ha•racdous mucrial lcfincd by ttec Cupertino Municipal Cade. C6ap�cr 9.12. and thc Hcalth and Safcty .,� Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. �y� ❑Nu . wIl �he applicant or fuwrc building occupant use equipmcnt ar devices which If a roof s installed without first obtaining an inspection, I agree to remove cmit harardous air contaminants u Jcfincd Ay the Bay Area Air Quality Managcmcnt all new n iaterials for inspec; Disuict? �ya ❑Nu I havc rexi the hazardcws matcrials requiremcn�s undcrCt�aptcr6.95 of �hc Califor- nia HcalUi & Safcry Codc, Scctirnu 25505, 25533 arul 25534. I undcrs�nd � if the 6uilding does no� curtently have a tenant, �hal it is my responsibili�y to notify the occupant af the rcyuircmcn�s which must 6c me� prior tu issuancc o[a Ccnifica�c of OccupuxY- S1gllatllTE Of A]�pI1C3fIL " 11 Date All roof coverings to be Class B or better Owncr or authori�cd agcn� �°� �� c�� �—� � _; � � s� CITY OF I�UPERTINO ��TM�F pERMIT APPL�ICATION FORM cuP�� i�vo APN # � 6 ,� Date: ,8�^02� �� ��3o--a�7 Building Address: Mailing Address (if different from building address): � D.38 S�r'L•�s crl [31., d ��.l iS Owner's Name: Phone #: p� �s C'e as, e�--�e- -.� � S 3-- 7/ o v Contractor: � License #: C�r`�b,� � �. w� �n.� '� y�7 `l' Contact: Phonet ?�' R— F Y� Cupertino Business License#: S-te�.� �.�,�, ��-�s;'�.�s Fa�ct�c6) � � 4 - io BuildingPermitlnfo: w r � Yrsf:t (c-;� �(3 `�.'S'r ��.c�� s e,n., .}-�� r- c�-.�r-o� :�_— r. �t S'-�v L vt�.ra-� Bldg (�" Elect �' Plumb 0� Mech �� Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: = Occupancy Group: � vO C'u<7 �^' Type of Co�ruction: Please check this 6ox if the project is a � second-stor addition: � Project Size: Standard l�' Large ❑ M� jor ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBOILERl Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boilf;r > 100K to SOOK Btu MECHANICAL BBOILER3 Boi�er> SOOK to 1M Btu MECHANICAL BBOILER4 Boil�;r > 1M to 1.75 M Btu MECHANICAL BBOILERS F�oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cc�n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Ccnstax — Resi/Mobile BUILDING BELEC 1000 E: ec 600V <= l 000A ELECTRICAL BELEC1001 E lec 600V > 1000A ELECTRICAL BELEC200 � Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD �nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING l of 3 CITY OF ��UPERTINO ��TM°F pERMIT APPI,ICATION FORM cu�E� i�o Quanti Fee ID Fee Descri tion Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Co�nm. Housing Mit. Fee BUILDING BNUCOMME rdew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHAIVICAL BNUCONIlVIP :�ew Comm Plumb PLiJMBING BOVERTIME I zspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLLTMBING BPCESSPOOL Cesspool PLLTMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS G��s Piping System Fee PLUMBING BPINTERCEP Ir d Waste Interce tor PLUMBING BPLANCHK Plan Check Fee BUILDING � BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Pl;in Check Repeat Fee BUII.,DING BPREPIPE F:e i e Of Fixtures PLUMBING BPSEWAGE Sewa e Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La��vn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT �.lt of Drain & Vent PLUMBING BPWATER Ins1 alUAlter Water Pi e PLUMBING BPWHEATER `Vater Heater/Vent PLUMBING BPWSVCS PZain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/ � Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY ;Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BR.EMFURN Rf;location of Furnace MECHANICAL BREMFURNOV Rel o Furnace > l OK btu MECHAIVICAL BREMHEAT :3eater Installation MECHANICAL BREMINHOOD Iz�stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rer.i Non-Res Appliance ELECTRICAL BREMPOLE Pc►le/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA F_elocation of Hood MECHANICAL BREMREPALT R�pair/Alter Heating MECHANICAL BREMRESAPP Reinodel Res Appliance ELECTRICAL � of 3 . ��� CITY OF �CUPERTINO ��TM°F pERMIT APPI.ICATION FORM CUPEI�TINO Quantity Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL BREMSIGNS Re�nodel Signs, Mar uee ELECTRICAL BREMTHEATR Tt►eatrical Lighting Fix ELECTRICAL BREMVENFAN V �nt Fan Sin le Duct MECHANICAL BREMVENSY5 �'entilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM S �ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSW1M Swimming Pool BUILDING BTEMP 'Cem orary Power ELECTRICAL BTEMPPERM Tern orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE E; ec Permit Issuance ELECTRICAL MPERMFEE P✓Iechanical sq. foot MECHANICAL MPERMITFEE M��ch Permit Issuance MECHANICAL / PPERMITFEE Pli:.mbin Permit�Issue PLUMBING PPLBG P.umbing Fee sq foot PLUMBING PLLONGRNGC Plannin;� LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planninl; Lon Ran e Residential PLANNING 3 of 3 CITY OF CUPERTINO 7 ITEMS OF 35 PERMI�' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN ......... 36�►01026.34 DATE ISSUED.......: 10,'30/2007 RECEIPT #.........: BS()00003124 REFERENCE ID # ...: 07'_00216 SITE ADDRESS .....: 20;�80 STEVENS CREEK BLVD #415 SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: PRC)METHEUS REAL ESTATE GROUP ADDRESS ..........: 19()0 S NORFOLK ST #150 CITY/STATE/ZIP ...: SATd MATEO, CA 94403 RECEIVED FROM ....: OR=:ON FINCL SVCS CONTR.ACTOR .......: TBI) - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBI) - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY fiMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- --•-------- ---------- ---------- ---------- BENERGY PERMIT FEE 104.76 50.28 0.00 50.28 0.00 BPERMFEE VALUATION 3,900.00 104.76 0.00 104.76 0.00 BREMACOVER NO UNITS 1.00 17.82 0.00 17.82 0.00 BSEISMICRE VALUATION 3,900.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 295.73 0.00 295.73 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1,478.65 MC --------------- TOTAL RECEIPT : 1,478.65 � ,, �.*,j... IU.iUU forre Avenue "��'� Cupe�tino CA 45014 C1TY Of Telephone (408) 777-322g � , i�Cn���n Fax (408) 777-;;33 U C 1` tJ Build�in De artment j JOB ADDRESS 20380 STEVENS CREEK BI�VD �. PERMIT #� � CUPERTINO, CA 95014 -��, ��� ((� 7 ��C� � � OWNER�S NAME:PROMETHEUS REAL ESTA'CE GROUP PHONE #( 91 6) 7 8 9- 84 8 4 GENERAL CONTRACTORsTEVE WHITESII)ES FAX #( 91 6) 789-1 0'51 I am not using any subcontractors: S::gnature Date Pleas� check a licable subcontractors and com lete the followin information: �- SUBCOI�TRACTOR BUSI1vESS NAME BUSINESS LICENSE # I Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Giazing x Heating SAN JOSE AIR ( 1 408 ) 286-�047 � Insulation ; Landscaping i Lathing , Masonry � Ornamental Sheet Metal ! Painting / Wallpaper I Paving � Plastering � Piumbing � Roofing ! Septic Tank ' Sheet Metal � Sheet Rock ! T� � z8 � � Owner/Contractor Signature Date