08050139CITY OF CUPERTINO�
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BUILDING DIVISION PERNIIT
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BUILDING ADDRESS:
PERMIT NO.
2.0800 HOMESTEAD RD
WEST BUILDERS, INC.
08050139
OWNER'S NAME:
PERMIT ISSUE DATE
VSII A CALIFORNIA LTD
1608 4TH ST STE 120
08/15/2008
PHONED n M717= cru r n
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHI'IECT/F.NGBNEER:
BUILDING PERMIT1NFo
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions Of Chapter 9 (commencing
with S=Licm 7000) of Division 3of dic Business and ProlessionsCodc,ad my license is
TEMPORARY LAUNDRY FACILITY MODULAR STRUCTURES
Imnfull force and effect R � LS �pl Jr
(HOUSING TEMP LAUNDRY FACILITIES)
Dam W-
Contractor
CHrIECPS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
'
I hereby affirm that 1 am exempt from the contractor's License Law for tie
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to conslrucL alter. improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to fate a signed statement
Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the
Section 7000) Division 3 of the Business and Professions Code) or
$5000
(commencing with of
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
,�px Number
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects he applicant to a civil penalty of
not more than five hundred dollars (S500).
f�)jL
32609056..
❑ L as owner of the property, or my employees with wages as their sok compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code The Contractors License Law does not apply to an Owner of
property who builds or Improves thereon, and who does such wort himself or thmagh his
own employces, provided that such improvements are not intended or offered for sale If.
bwever. the building or improvement is sold within one year of completion. the owner -
builder will have the burden of proving that he did not bold or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licmed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Coutractoes Li -
ewe Law does not apply to an owner of property who builds or improves thereon. and.
.
who contracts for such projects with a contract r(s) licensed pursuant m the Contractors
License Law-
❑ 1 am exempt under Sec . B do P C for his mason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury aria of the following declarations:
❑ 1 have and will maintain a CeniGnte of Consent to self-inwm for Wakefs Compaa-
sadon, as provided for by Section 3700 of the Labor Code, for he performance of he
work for which this permit is issued
❑ 1 have and will maintain Worker's Compensation insurance, as inquired by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued
My WorkersCompensation Insurance carry and Policy number
TtonJt Policy vY `��7
Carrico �N�%�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need root be completed if the permit Is for one hundred dollars ($101F)
or less.)
I certify that In the performance of the work for which this permit is issued. I shall WE
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making his Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this peanit shall be deemed revoked.
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that dent is a conrtrrrction lending agency for he performance of
the work for which this permit is issued (Sar. 3097, Civ. C)
Lendees Name
Lenders Address
j I certify that I have read this application and sum that the above information is
coned I agree to comply with all city and county onfinatacs and state Laws relating to
building construction, and hereby authorize reprc=tauves of this city to eater upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
l liabilities, judgments, costs and expenses which may In any way accrue against raid City
S
in consequents of the grand g of his permit
APPLICANT ND S AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date Q
sou GU
—
Re -roofs ��--�
Si A °=US MATERIALS DISCLOSURE Date,Sof
Roof
Will the appl' t or future building occupant store or handle hazardous material
as d -fined by the Cupertino Municipal Code. Chapter 9.12, and he Health and Safety
Code. Section 25532(a)7All
❑Yes o
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant rpant use equipment or deviceswhich
emit hazardous air contaminants as defined by the Bay Arca Air Quality Manag=cnt
all new materials for inspection.
Diauict7
❑Yea VINE
1 have read the hasardmu materials requirements under Chapter 6.95 of the Califor-
nia Health do Safety Code, Seaiw 25505.25533 and 25534.1 understand that if the building
dna not aurently have taunt, that Itis my responsibility to notify the occupant of de
regn m be prior m' ora of Occupancy.
Signature of Applicant Date
All roof coverings to be Class in'' or better
Owner .
orwth t Dam
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SUE -
CITY Of
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN #
Date:
Building Address:
a,5O T�i4 P< -b
41k4 ✓ �
Mailing Address (if different from building address):
Owner's Name: Vn I I P, -C & ( f4 -ft 14 Lr,6 ,
Phone #:
&.5o. q31.7,&57
Contractor: Lt) CkS IN e .
Phone: S (D . S ZS • g 3 78
Fax:
Contractor License #: 66Z-53Cl S
Cupertino Business License #:
Contact: � � L v ` ^- _
Phone: sf ,9
Fax:
Residential Commercial
Job Description: _ _ /
��,/
kV"PK::5 lr�frv,
Is the project in the Wildland- Urban Interface Fire Are ?Yes
❑ No ❑
Building Permit Info:
—/
Bldg ❑ Elect Plumb Mech L�
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-lHR [I11, 111, 1V V -N
Square Footage:
Project Size: Standard Lar e ❑ Major ❑
Green Building: Please complete relevant portion 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.builditgreen.org
I sllm-'�-
CITY of
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1BTEMPPER
Temporary Building Permit (good for
B
30 days)
1 BBOILER 1
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3
Installation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1 MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour)
1 MEETING 1 HR
Application Meeting
B
m J�
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
lACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
1 ACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1 CHIMNEY
Chimney
B
1 CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
1 FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
1 FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
1 FLAGPOL>20
Flag pole (over 20 ft in height)
B
1 MODUSTRU
Modular Structures
B
FOUNDATIONS
.1 FOUNDREP
Foundation Repair
B
1PILECAST
Pile Foundation Cast in place concrete
B
1 PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete)
B
3 of 5
CITY OF
CUPERJINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
Standard (up to 50 ft)
B
1 RETSTN
1RETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSP10
Special Design, over 10' high (up to
50')
B
1RETCRB<
Gravity/Crib Wall, 0-10'high (up to
50 ft)
B
1 RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft
B
SIDING
1 SIDESTBK
Siding, Stone & Brick Veneer
(interior/exterior)
B
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<10 SF
Skylight less than 10 sf
B
1 SKYL>10SF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4 of 5
S;�,
CITY OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee)
B
1 EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1 PLMBLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
r
1
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
1 TRAVDOC
Travel & Documentation
B
1 BUSLIC
Business License
B
5 of 5
JOB ADRESS: 20800 Homestead Road PERMIT # 7 13 1/�l
OWNER: Prometheus PHONE: 408.746.5033
G.C. WEST Builders, Inc FAX: 408.746.5034
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets and Millwork
N/A
Cement Finishing
Mega
29410
Electrical
MEC
30339
Excavation
Robert Enz
30190
Fencing
N/A
Flooring: Carpeting
N/A
Linoleum / Wood
N/A
Glass / Glazing
N/A
Heating
N/A
Insulation
N/A
Landscaping
N/A
Lathing
N/A
Masonry
N/A
Ornamental Sheet Metal
N/A
TIM
Painting / Wallpaper
Nor Cal
Paving
N/A
Plastering
N/A
Plumbing
Can Am Plumbing
23336
Roofing
N/A
Septic Tank
N/A
Sheet Metal
N/A
Sheet Rock
N/A
Tile
N/A