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07100214 CITY OF CUPERTINO � ` ' BUILDiI'iC DIVISION PERMIT ������������������* ::: ,.::: , , : :: _. _._.. BUIL r� D ESS: PERMIT NO. GU�tS� STEVENS CREEK BLVD #408 TBD — PO BE DETERMINED 07100214 . NER'S NAME: � �� DA � PROMETHEUS REAL ESTATE GROUP 10/30/2007 PHONE: SANITARY NO. CONTROL NO. nRCHrrECr�NCrrrEEx: REMODE L K I TCHEN / BATH , W/ D BL�c B E��G PER p UMB MscH ' � � 0 0 � O p LICENSED CON7RACCOR'S DECLARATION ry _ _ � : R ., � ' � � TT � � _ ,,�, _ .,Iob Description v� 1 hcrcby affirm that I am liccnsed undcr provisions o[ Chap�cr 9(commcncing � z� with Sccdon 700U) of Division 3 of thc Business and Profcssions Cndc, snd my licensc is '� y in full Co�ce and c(fec� � 2 Licensc C1ass L�• � ' �, � Datc Contractor ARCHRECI'S DECLARATION � p�e e I undcruanJ my plans shall bc uscd as public records �yU ; �+. y Licensed Piufcuional n y � OWNER-BUILDER DECLARATION I hcrcby affirm tha� 1 am excmp� Gum �hc CoNractors Liccnse Law for tMc � p O Collowing rcason. (SccGon 7031.5, Business and Profcssians Cafc: Any city or county K,°, Pi which requires a pertnil to consuuc4 altcr. impmvc. dcmolish. or iepair any sWawc y Z� prior w i�s issuancc, also tcquims ihc applicant for such permit to file a signcd s�a�emen� £_ � that hc is licenscd pursuant ta thc pmvisiona of ihc Comractor's Liccnx Law (Chaptcr 9 Sq. Ft. Floor Area Valuation Y F- (commencing with Section 7000) of Division 3 of thc Business and Profcssions Codc) or y�� that he u exempt thcrcfrom and the buis [or the slleged exemption. Any violauon of Secdon 7031.5 by s�ry applicant for a permit subjecu ihe applicant to a civii penalty of ppN Number Oeeupaney Type not mo�e �han fiw hundred dollars (5500). ❑ I, u owner ot tt�e ptvperty. a my emptoycw with wages u their solc compensadon, will do thc work and ihe stcucwro u not intendcd or oRered for salc (Sec. 7044, Busir�ess Re uired Ins ections and Professiona Code: The ConuacWr's License Law doct not apply W an ownec of Q P property who builds a improves �hereon, and who das such wrork himself or through his own employces, providcd �hat such improvemen�s are not imm�ded ar oRered for sale. If, however, the building or improvement ia sold within one yeu oC completion, the ownu- builder will have the burden o[ proving �at he did not 6uild or impravc far purpose of saleJ. 0 I, as owner of the property, am aeciusively canuacting wilh licensed rnnuactors w construct the projea (Sec. 7044. Business and Professians Cade:) The Conuacmr's Li• cenu Iaw docs nol apply w an ownu of property who builds or impmves themon, snd , who contracts (or such projects wilh a convactor(s) licensed pursuant to the Convacror's License I.aw. I am exempt undu See. , B& P C for this rcason �aner Date WORKER'S COMPENSATTON DECLARAI'ION 1 hemby aftirm under penalty o[ perjury one of the following declarations: ❑ I hsae and will mainuin a Cenificam of Consent to self-insure for Workcfs Compen- sation, as providcd for by Section 3700 ot �he Iabor Code, for ihe pedormance ot ttrc work for which Ihis pemiit is issued. ❑ I havc and will maintain Workcfs Compcnsation Insurana, as myuired by Scctian 3700 of Ihe Labor Code, Cor the pedormance o[ the work for which this permi� is issued My Worker's Compensation Inwrance carticr and Poliry number arc: Cartier. Poliry No.: CER'17FICA7E OF EXEMP'1'fON FROM WORKERS' COMPENSATION INSURANCE ' (This sectian necd not bc completed it the permit is for onc hundred dollars (S I00) or leu) ' I cenify that in thc performancc of ihc work [or which �is permil is iuucd. I shall not employ any person in any manncr w az w bccome subject w ihe Workcrs' Compensa�on Laws of Califomia. Datc Applicant NOTICE TO APPLICANT: If, aftcr making �his Certi�ca�e of Excmption, you should become subject to the Worlcer's Compensation provisions of We Latwr Code. you muu � O faMwi�h compty with sueh provi�ions or this permit sha0 bc dccmcd awokcd. Z '"'' CONSCItUCf10N LENDING AGENCY (— ►�-� I hcrcby a(firm Uut �hcre is p consuucdnn Icnding agency Cor thc �crformancc of . a, . thc work for which ihis pertnit is iuued (Scc. 3097. Civ. C.) W� Q L.endcr's Namc ' � z L.cnder's Address V � [ certiCy iha� I have rcad Utis application and siatc ihst thc above informatiun is w� cortec� 1 agree w comply with all ci�y and counry ordinantts and state laws relaung to 0 U building conswctioo, and hacby amhori�t rcprcscmativcs of U�is city to cntcr upon ihc �� above-mcntio�d pioperty for inspcction purposes (Wc) agree ro save, indcmnify and kecp harmless We City of Cupenino against �� liabilitiu, judgmcn�t, costs and expenscs which may in any way accnie agains� said Ci�y V,'� in consequence oC thc granting oC this permit. Dat6 � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by. SOURCE REGUI.ATIONS. Re-roofs Signaturc of Applicant/Convacior Datc T of R oof HAZARDOUS MATERIALS DISCLOSURE J�]� Willlhc applicant or fuwrc building acupant uorc or handlc ha•rardous malcrial kfincd by lhe Cupenino Municipal Codc. Chaptcr 9.12, and �hc Hcalth and Safcty ,� .Scction25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs O No �11 thc applicant or fuw¢ building accupant usc cyuipmrnt or dcviccs which If a roof i� installed without first obtaining an inspection, I agree to remove emi� haiardous air contaminan�a at dcfincd Ay the Bay Arca Air Qualily Managcmem all new m aterials for inspection. District? ❑ Ycs ❑ Nu 1 havc rcacl the hvardous maicrials rcquiremcn�s unAcr Chap�cr 6.95 of �hc Califor- nia Hcalih & Safcty Codc. Scctiais 25505.25533 ancl 25534.1 undcrsund �hu if ihc building docs not curtcnQy havc a icnsn4 �hat it is my responsibiliry w nodfy Ux occupant of �hc rcyuiremcnls which muu bc mel prior to iuumcc af a Ccnifica�c of Occupanry. S Igll$tUTC Of APP� 1CSIlt Date Owncr or authoristd agcnt o,� All roof coverings to be Class ��8�� ar better CITY OF CUPERTINO 7 ITEMS OF 35 PERMI7' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 36��01026.32 DATE ISSUED.......: 10,'30/2007 RECEIPT #.........: BS(100003124 REFERENCE ID # ...: 07"_00214 SITE ADDRESS .....: 20:�80 STEVENS CREEK BLVD #408 SUBDIVISION ....... CITY .............. CU]�ERTINO IMPACT AREA ....... OWNER ............: PR()METHEUS REAL ESTATE GROUP ADDRESS ........ 19�)0 S NORFOLK ST #150 CITY/STATE/ZIP ...: SAId MATEO, CA 94403 RECEIVED FROM ....: OR:=ON FINCL SVCS • CONTRACTOR .......: TBI� - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBI� - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY .�MOUNT 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 R.ATE 1.00 4G.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 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 �. �� l ��� � � '� � CITY OF C'UPERTINO �+ �►� oF pERMIT APPL:[CATION FORM CUPEf�TINO APN # Date: �36Q�8��-02�,�� ��3o—a`7 Building Address: Mailing Address (if different from building address): � D38 o S � s crlt _ [3l d �`' `� o� Owner's Name: Phone #: P�ce�v.ne�n �s C'e c.� e��� �- .�, ,� S 3— 7/ o v Contractor: 9 License #: C�r` � � �. �.� ` � `�� �' Contact: PhoneC4c 7��– �Y� Cupertino Business License#: .S�Fe�� c..�.� ,-�eS;'d.c� s' Fax�-rt't 6) � �'r � — %O Building Permit Info: w/D r�Yof�t (L:� �a � `�'�'r i O�•c�rtQ.rs sPl;�-s�.,� e„., ,�-�L6 p. C �(�2-4rti°f ', �.— r� c►�/l S'-4v c�u.�'� Bldg C9� Elect �' ]'lumb C� Mech �� Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: c � Occupancy Group: -� Up � ( Type of Co�ruction: Please check this box if the project is a �—�. second-stor addition: � Project Size: Standard C'�� Laxge ❑ Major ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER �ther Appliances MECHANICAL BBOILERI Bciler <= 100,000 Btu MECHANICAL BBOILER2 Boile:r > 100K to SOOK Btu MECHANICAL BBOILER3 Boi: er > SOOK to 1M Btu MECHANICAL BBOILER4 Boilf;r > 1M to 1.75 M Btu MECHANICAL BBOILERS Eoiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Coinm/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 F,lec 600V > 1000A ELECTRICAL BELEC200 � Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BIJILDING BINVESTIGA Investigation fee BUILDING of 3 CITY OF ��UPERTINO �,noF pERMIT APPI,ICATION FORM CUPERTINO Quanti Fee ID Fee Descri tion Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Coinm. Housing Mit. Fee BUILDING BNUCOMME 1`dew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHAI�IICAL BNUCOMIVIP :Jew Comm Plumb PLUMBING BOVERTIME Iispection Overtime BLTILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLIJMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS G<<s Piping System Fee PLUMBING BPINTERCEP Ir.d Waste Interceptor PLLTMBING BPLANCHK Plan Check Fee BUILDING ' BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Pl,�n Check Repeat Fee BUII,DING BPREPIPE �:e i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La•Nn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT ��lt of Drain & Vent PLUMBING BPWATER Ins�:alVAlter Water Pi e PLUMBING BPWHEATER �Vater Heater/Vent PLUMBING BPWSVCS P�Iain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C' Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY �emodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN R�,location of Furnace MECHANICAL BREMFURNOV Re .o Furnace > l OK btu MECHANICAL BREMHEAT Eieater Installation MECHANICAL BREMINHOOD I�istallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rern Non-Res Appliance ELECTRICAL BREMPOLE P��le/Platform Fixture ELECTRICAL BREMPOWER Pov� er Device/A aratus ELECTRICAI, BREMRECEPT Rc �tl, Switch & Outlets ELECTRICAL BREMRELOCA F:elocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Re:nodel Res Ap liance ELECTRICAL :' of 3 CITY OF CUPERTINO �,naF pERMIT APPLICATION FORM CUPEI�TildO Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rm dl Signs Add Branch ELECTRICAL BREMSIGNS Reniodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vf nt Fan Sin le Duct MECHANICAL BREMVENSYS V entilation S stems MECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISMICOM Sf�ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL ��pecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP 7'em orary 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 MPERN�'EE T�echanical sq. foot MECHANICAL MPERMITFEE Mf�ch Permit Issuance MECHANICAL � PPERMITFEE Plumbin PermitIssue PLUMBING PPLBG Plumbing Fee sq foot PLLTMBING PLLONGRNGC Plannin�; LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin�; Lon Ran e Residential PLANNING = of 3 �r�"`f :, IU.iUU �forre Avenue - � Cupertino CA 95014 •� ~. Telephone (408) 777-3228 CI7Y OF Fax (408) 777-;333 �UPEI�TI�IO F uildi D e artment I JOB ADDRESS 20380 STEVENS CREEK BLVD �C PERMIT # , CUPERTINO, CA 95014 N� � p ��j�a �� OWNER�S NAME:PROMETHEUS REAL ESTA'I'E GROUP PHONE #( 91 6) 789-8484 GENERAL CONTRACTORsTEVE WHITESIL�ES FAX #( 91 6) 789-1 0'51 I am not using any subcontractors: Signature Date Pleas� check a licable subcontractors and com�lete the followin information: �- SUBCOI�TRACTOR BUSIrdESS NAME BUSINESS LICENSE # j Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linole�u.rn / Wood Glass / Glazing x Heating SAN JOSE AIR ( 1 408 ) 286-�047 � Insulation ; Landscaping � Lathing � Masonry � Ornamental Sheet Metal ! Painting / Wallpaper ! Paving � Plastering ) Plumbing � 1 Roofing �--- Septic Tank ' Sheet Metal � Sheet Rock � T' � z8 a - Owner/ Contractor Signature Date