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07100213 CITY OF CUPERTINO ° � ` ' BiJ[LJiNG CIIVISION PERMIT ��������� ���������� ' , . ,.. . _; _ PERMIT NO. BU(LD �� .v �3 c �� sss STEVENS CREEK BLVD #217 TBD 'IO BE DETERM3NED 07100213 . PERMIT LSSUE DATE ,JER'S NAME: PROMETHEUS REAL ESTATE GROUP � 10/30/2007 SANITARY NO. CONTROL NO. PHONE: BUILDING PERMIT [NFO ARCHTCECT/ENGINEER: HLDG ELECT PLUMB MECH � � � � i p p LICENSED CONTRACfOR'S DECLARATION JOb DeSCflpt1011 ; V� I hercby aff�n that [ am licenscd undcr provisions af Chaptcr 9(commcncing c z� wiih Sccuon 7400) of Division 3 of ihc Busincss and Profcssiuns Codc and m �icc�sc is REMODE L K I TC H EN / BATH � W/ D RETRO F I T� DUC T L E S S S P L I T � e a in NII foree and cffect ;�? �;��„�ci�S �;�.� SYS HVPC RETROFIT, NON—STRUCTURAL ; E, �p Datc Conuaclor �?� ARCHITECI'S DECLARATION i a s I undcrstand my plans shall bc uscd as public rccords >aU ' �+. �"' Licenud Prufcssional • � a OWNER-BUILDER DECLARATION j Q� � nc�cny air,� that 1 am cxcmpt Crom ihc Contracrors Liccnsc Law [or thc : p o (ollowing mason. (Secdon 7(131.5, Business and Profcssions Codc: Any ei�y or coumy �,°, � which rcquires a pcmiit to conswc� altcr, impravc, dcmalish, or repair any suucwrc ? Z y �', pnor to ils issuancc, also rcquires thc applicant (or such pertnit to filc a signed statcmcnt Valuation � s< tha� hc is IiccnscJ pursuant ta thc provisions o( ihc Convacmr's Li��cnsc Law (Chaptcr 9 Sq. Ft. Floor Area $ 3 9 0 0 � t- $(commencing wi�h Scction 7000) of Division 3 ot lhc Busincss and Profcssinns Cadc) or 4�... U�at he is ezempt themtrom and the basis Cor the aticgcd eumption. Any violation of Section 7031.5 by any applicant Cor a permit subjec�s ihe applicant to a civil pcnalty o[ 3 6 9 010 � 6 A�� Number Oeeupaney Type not morc than fivc hundred dollars (5500). • ❑ I, as owner o[ the propcny, w my employces with wages as their solc compensauon, wili do thc wocic, and the stiuctme is r.at intendcd or offered for salc (Sec.70b4, Business Require�' Inspections and Professions Cade: The Contrxwrs License Law docs no[ apply to an ownw of property who 6uilds or impcoves �hereon, and who daes such work himseltor ttuough his own employccs, providcd that such improvements are not intended or of(eced for sala If, however, the building or improvement is soid within one year oC complction, ihe owrrcr- builder will have We burden oC proving �at he did not build or improvc for puryose o( salc.). � 1, as awner of the property, am ezclusively conlraaing wi�h Gcensed convactors a constntct the projen (Sec. 7044. Businas and Professions Cade:) The Conlracmr's Li- � ccnse [aw docs not apply io an owner o[ propeny who builds or impmves �hereon, and , who comracts Cor such projec�s with a comractor(s) licensed pursuant to the Contrutor's r.icense [.aw. ' am ezcmpt undu Sec. . B& P C for Ihis mason ,,.vner Date _. . WORKER'S COMPENSAT[ON DECLARATION I hercby �rm under penalty of perjury one of �he following declaraGons: ❑ i hsye and will maintain a Ccrtificatc of Consent to ulf-insure for Workcis Compen- sation, as providcd for by Section 3700 of che Labor Code, for the perfarmancc ot �he work tor which U�is pertnit is issucd. ❑ I havc and will maintain Workcr's Compensation Insurance, as tcyuircd 6y Scccion 3700 oC the Labor Code. Cor the performance oC the work for which this pecmit is issued. My Worker's Compensadon Insurancc caRicr and Poliry numbcr arc: Carrier: Pa���Y Na•� CERTIF[CA'C6 OF EXEMFI70N FROM WORKERS' COMPENSA'f10N INSURANCE (This scction nced rrot bc completcd if the permit is for onc hundred dollazs (5100) or Icss.) T cenify that in the performancc of thc work Cor which Ihis permit is issucd, 1 shall not employ any person in any manncr so u to bccomc subject to �he Workcrs' Compcnsation L,aws of Califomia. Datc Applicant NOTICE TO APPLICANT: lf, af�cr making �his Ccrtificaic of Excmption, you should become subjcct a thc Workcr's Compensauon provisions of ihc Labor Codc, you must � O farthwilh comply with sueh provisions oi lhis permil shall bc dcemcd revolccd. Z "" CONStRUCT10N LENDING AGENCY Fr � 1 hcrcby alfirm ihat thcre is a consuuction Icnding agcncy Cor thc perfortnance oC . p�., � �hc wurk fur which �his pertnit is issucd (Scc. 3097, Civ. C.) W Q Lendcr's Narnc � � z L,cnder's Addrcss U � 1 ccrtily Ihat I have rcad this applieation and sutc �hat thc above infortnatiun is w ►-a corrcct. 1 agrce to comply wiU� all city and county ordinances and suk laws relating to rJ U building conswction, and hcreby authori�e rcprescntativcs of Nis city to cn�cr upon lhc � W aM1ove-mcneiuncd pmperry (or inspecuon purposes. a (Wc) agrce to save, indcmni(y and kecp harmlcss thc City of Cupertino against H � liabiliues, judgmen�s, costs and expenses which may in any way acecue against said City V z in consequcncc oC thc granting aC Nis permit. Date �+ APPLICANT UNDERS'CANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signaturc o(ApplicanUContnctor �a� T e of F.00f HAZARDOUS MATERIALS DISCLOSURE YP Will ihc applicant w fuuuc building occupantstorc or handlc ha•rardous malcrial kfincd by lhe Cupertino Municipal Codc. Ct�ap�er 9.12, and tho Health and Safety _.,� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs O No WiII thc applicant or futurc building attupant usc cyuipmcn� or dcviccs which If a roof s installed without first obtaining an inspection, I agree to remove - emit harardous air coniaminants az �icfincd by thc Bay Arca Air Quality Managcmcnt all new n iaterials for inspec*ion. o�s����� ❑ Ycs ❑ Nu I havc rcui the haiardous ma�erials rcquiremcnts undcrChaptcr6.95 of �hc Cali[or- nia Hcalih & Safcry Cadc. Scctians 25505, 25533 and 25534. I undcrstand ihat if �hc building docs not curtcnUy havc a mnan4 �at it is my responsibility to noufy thc occupant of ihc rcyuircmcn�s which must bc me� prior w issuancc of a Ccnificatc of Occupanry. Signature of Applicant Date All roof coverings to be Class "B" or better Owncr or authorizcd agen� 0a� r CITY OF CUPERTINO 7 ITEMS OF 35 PERMI'[' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN ......... 36'�01026.31 DATE ISSUED.......: 10�30/2007 RECEIPT #:........: BS�)00003124 REFERENCE ID # ...: 07:L00213 SITE ADDRESS .....: 20.380 STEVENS CREEK BLVD #217 SUBDIVISION ....... CITY .............. CU:?ERTINO IMPACT AREA ....... OWNER ............: PR��METHEUS REAL ESTATE GROUP ADDRESS ..........: 19)0 S NORFOLK ST #150 CITY/STATE/ZIP ...: SA71 MATEO, CA 94403 RECEIVED FROM ....: ORCON FINCL SVCS CONTRACTOR .......: TB:� - TO BE DETERMINED LIC # 00096 COMPANY ..........: TB:� - TO BE DETERMINED ADDRESS .........:. CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY .�'IOUNT 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 RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 295:73 0.00 295.73 0.00 k ��11 � �._� CITY OF CUPERTINO J ���� �F pERMIT APPL ICATION FORM cuP�� i►vo APN # . �.�, � � � O 2 � � � � Date: � r3o _� `7 Building Address: Mailing Address (if different from building address): � 038 S�'�.ns C�rlt� [31.. d� 2� � Owner's Name: Phone #: P�� C'� �. ez��� -� � S 3— 7/ o v Contractor: � License #: C�r`►b� � � w� �n.� '� `�� �7' Contact: PhoneC ?�-�— �tf� Cupertino Business License#: ��I- �.�.h �-��s; •�.�s F���c 6) � � 4 - io BuildingPermitlnfo: w/D r�Yof:t k-►�'-��n �(� ��raJ-�� O�.c,��-rs sPl;t��,,. e „., .�.�<6 A c re-�rv f', -� _— r�,rt S'-iv-., c..�r,�-� Bldg L�Y Elect C�� Plumb �� Mech C�' Job bescription: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 1 Occupancy Group: � C'uJ Q ( v� Type of Con�ruction: Please check this box if th 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 BBOILERI Bc�iler <= 100,000 Btu MECHANICAL BBOILERZ 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 MECHA1vICAL BCONSTAX Construction Tax BLTILDING BCONSTAX In d/Off/Comm/Quasi BUILDING BCONSTAXBQ Cc�n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Ccnstax — Resi/Mobile BUILDIN� BELEC 1000 E ec 600V <= 1 OOOA ELECTRICAL BELEC1001 F,lec 600V > 1000A ELECTRICAL BELEC200 � Ele�� Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD .��nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING : of 3 CITY �F CUPERTINO c�noF pERMIT APPLICATIDN FORM CUPERTII�IC) Quanti Fee ID Fee Descri tion Fee Grou BMISCELL ]vliscellaneous Fee BUILDING BMITIGATC Cor.vn. Housing Mit. Fee BUILDING BNUCOMME I� Comm Electric ELECTRICAL BNUCOMMM Ne��v Comm Mechanical MECHANICAL BNUCOMNIP �1ew Comm Plumb PLLTMBING BOVERTIME Iiispection Overtime BUILDING BPBACKFLOW A� mospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interce tor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Pl,in Check Add Multi BUILDING BPLANCKREP Pl�n Check Repeat Fee BLTILDING BPREPIPE P.e i e Of Fixtures PLUMBING BPSEWAGE Sewa e Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La�vn SprinklerBackflo PLUMBING BPSTORM �3torm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT �.lt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pi e PLUMBING BPWHEATER VJater Heater/Vent PLUMBING BPWSVCS l�7ain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/�� Unit > 10,000 cfin MECHAIVICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY ]Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Rf:location of Furnace MECHANICAL BREMFURNOV Re] o Furnace > l OK btu MECHANICAL BREMHEAT �3eater Installation MECHANICAL BRENIINHDOD Ir.stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREn7NRAPP 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 Repair/Alter Heating MECHANICAL BREMRESAPP Reinodel Res Appliance ELECTRICAL � of 3 � � � CITY OF t�UPERTINO ��na� PERMIT APPLICATION FORM CUPEf�Tll�+l0 Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rn: dl Signs Add Branch ELECTRICAL BREMSIGNS Rer.lodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN VE:nt Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Sf�ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL �3 eciallnspection BITILDING BSWIM Swimming Pool BLTILDING BTEMP 7'em orar Power ELECTRICAL BTEMPPERM Teni ora Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE A7echanical sq. foot MECHANICAL MPERMITF`EE Mf�ch Permit Issuance MECHANICAL � PPERNIITFEE Plumbin Permit-Issue PLUMBING PPLBG Plumbing Fee sq foot PLLJMBING PLLONGRNGC Plannin ; LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin€; Lon Ran e Residential PLANNING ? of 3 lUjUU'forre Avenue �"`� � Cupertino CA 95014 >.�:'�, �.,-' � Telephone (408) 777-3228 ClTY Of Fax (408) 777-3333 '; U PEf�Tl1�0 Buildi.n De artmenf i JOB ADDRESS 20380 STEVENS CREEK BLVD PERMIT # , CUPERTINO, CA 9501 4•- ��P" ( �..( � � Q�j �� � OWNER�S NA1V�:PROMETHEUS REAL ESTA7'E GROUP PHONE #( 91 6) 789-8484 � GENERAL CONTRACTORsTEVE WHITESII►ES FAX #( 91 6) 789-1 0`51 I am not using any subcontractors: Si gnature Date Pleas� check a licable subcontractors and com lete the followin information �- SUBCOI�TRACT�R BUSIrJESS NAME BUSINESS: LICENSE # I Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linolezun / Wood Glass / Glazing X Heating SAN JOSE AIR (1408)286—�047 � Insulation ; Landscaping � Lathing � Masonry � Ornamental Sheet Metal ! Painting / Wallpaper ! Paving { Piastering � Plumbing 1 Roofing � Septic Tank ' Sheet Metal � Sheet Rock � T' � z8 a Owner/ Contractor Signature Date