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08050185CITY OF CUPERTINO BUILDING DIVISIONPLt' �' p R 7 � 0AW �� .BUILDING ADDRESS: PERMIT NO. 20800 HOMESTEAD RD BLDG 7 WEST BUILDERS, INC. 08050185 OW PERMIT ISSUE DATE PROMETHEUS 1608 4TH ST STE 120 07/09/2008 PHONE: SANITARY NO. CONTROL NO. (510) 525-9378 ARCHTTBCTIENGiNEER: BURRING PERMrriNFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I bachy afLrm that I am licensed under provisions of Chapter 9 (commencing whit Section700o)ofDivision3oftheBusinessandProfcssionaCode,and myIke=is INSTALLATION OF EXTERIOR TEMPORARY PROPANE TANKS in full four and effect. �as39.S License Class L ic.. , & u rgL— Date yCRc�� RAJ,IT� TEMPORARY UNDERGROUND PIPES. 1 undmatand my plans shall be used as public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following mown. (Section 70313, Business and Professions Code: Any city m county which requims a permit to construct, altar, improve. demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement be is licensed to the of the contractor's license Law (Chapter 9 Sq. Ft. Floor Area Valuation this pmatrant provisions (comencing with Section 7000) of Division 3 of the Business and Professions Code) or m $4000 . that he is exempt therefrom and the basis for the alleged exemption. Any violation of l liter Occupancy Tjlpe Section 7031.5 by any applicant for a permit subjects,the applicant to a civil penalty of not more duo five hem b d dollars (S-500) 32609065 ❑ L as owner of the property, or my employees wild wages as their sole compensadon, Required Inspections will do the work. and the structure is not intended or offered for sale (Sec 7044, Business and Professions Cade The Contnctmrs License Law does not apply to an owner of property wbo builds or improves theroon, and who does such wort himself or through his own employees, provided that such improvements am not intended or offered for sale. If. however, the building or improvement is sold within one year of completion. the oamer- bu ilder will have the burden of proving that he did not build or Improve for pwyose of sale.). ❑ L u owner of the property. an exclusively eonuacting with licensed conowtors to construct site project (Sec 7044, Business and Professions Code:) The Contractor's U. . cense Law does not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's [.Ieemae Law. ❑ I am exempt under Sec B R P C for this reason Owner Due WORKER'S COMPENSATION DECLARATION 1 hereby air— under penalty of perjury, one of the following declarations ❑ 1 have and will maintain a certificate of Consent to seer-insaR for workers Camper- station, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the wort for which this permit is issued My Worker's Cmn ansa . Insurance carrier and Policy number am: 1107- Carrier Polity No.: �� f, 5?e,2 1107- CEIlTIFICATE CERTIFICATEOF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for oac hundred dollars (S i0o) or leas.) I Certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any mammy so as to become Subject to the Worms' Compensatoo Laws of California. Dau Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this pesmit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Addrnsa I certify that 1 have road this application and state that the above information is ' correct. I agree to comply with all city and county ordinances and stato laws relating to building convection, and hereby authorise repre=tatves of this city to cater upon the above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of CUPWMo Against liabilities, jodgmanta. costa and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS D WILL COMP Y illi ALL NON-POINT Issued by: Date sovRCEREcuLAnolvs. Re-roofs Signature of Applicam/Contractdr Dam HAZARDOUS MATERIALS nfsctosuRE 'Ijrpe of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code. Section s25s3z(.)? Yes No All 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 revere building Occupant use equipment or devices which emit hayardoes air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑ Yes )Q No I have mad the w7mdo,s materials requbemcros under Quptcr 6.95 of the Califor- nia Health R Safety Code, Sections 75505, 25533 and 25534.1 understand tha irthe building does not currently have a trnam4 char it' tcsponu it to notry the occupant or the requirements which must be met prior scam qLpccupancy- Signature of Applicant Date t Da All roof coverings to be Class ';q" or better Owner or authorimd agent aR0 5 ()I kb CITY OF CUPERTINO a - FURNACE/AC CUPE1k11N0 PERMIT APPLICATION FORM APN# D o (P 5^ 6-7 1 fk A Date: 5,zz-08 Building Address: Zvo N� i2b LrjC7 -rn��-z Owner's Name: Phone #: To &60-9-31- 3&57 Contractor: Phone #: W6511—AWL-66(a 10 C, Fax #:4607✓' -;S Contractor License #: Cupertino Susiness License #: Contact: Phone #: GJ 0 Na L Jaw Fax #: 5 1z • 5;,C,0. we Building PermA Info: Elect ❑ Plumb Mech ❑ Residential V1 Commercial Job Description: 4a4/(kc, L For Residential Installations: Attic ❑ I" floor � 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): 4000 -co I? - Strapped On Platform El Bonded 0 New Location Replacement Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or. P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1 BSEISMICO Commercial Seismic B 1 MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed.wall htr, or floor mounted unit heater. 1MRAPPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install & not incl in an appl permit. ZIF CUPEkTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of 1-4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. P 1 BSEISMICR Residential Seismic B TI 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type fumace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h M 1MFRN>100 Furnace Syst> 100k BTU install or relocate ea forced-air/gravity type fumace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h M 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M / 1 PPERMITFEE Plumbing Permit P / 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B CUPERINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1BCAIRHAN Commercial A/C Units <= IOk CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System 1-4 outlets P 1PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P 1BREMAIRHAN Residential A/C units <= lOk CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B