08050186 CITY OF CUPERTINO
BUILDING DIVISION PERMIT RC,ON T=RACT9(1R INIdRMA <IO1�I .
BUILDINGORFSS: PERMRNO.
2060 HOMESTEAD RD BLDG 13 WEST BUILDERS, INC. 08050186
E: PERMrr ISSUE DATE
PROMETHEUS 1608 4TH ST STE 120 07/09/2008
PHONE: SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHr1ECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
G LICENSED CONTRACTORS DECLARATION O O O O
Job Description
U 1 Wintry affirm that 1 w liavcd uMcr pmvisfou of L'hepus 9(commencing
Wi
wiNSationT01k1)o(Dividon3af NC Bmineu and Pmfcasiov Code,and myliccve is INSTALLATION OF EXTERIOR TEMPORARY PROPANE TANKS
in full fora Am affect.
j Z License Clea Lk.
^=
Own
I I �LjklhcHrrEcrS DECLARATION TEMPORARY UNDERGROUND PIPES.
< 1 undenund my plans"I W usd as;public acordat
s
i] Liccnsd Pmfeuional
5 OWNER-B empi f m win Contractors
0I 1 heahy affirm that 11. ,sump from dm Conaacmra Lkc My
taw for dm
00 following moon.(Saban TBT IS,Btmnets and Pmfesdov Cade:Any city Or county
m
which ayulres a permit ra cnnswet akar.improve,h fco tt i fi mash nay atructum
Soy that Wor i u soutcemi n c.Potsdam
rt to t e thmrishmas o for sucComm mit m bile a signal(Chaim,
l
pp < (comm ingwidpursuantmdepmviswmof.f ftB.ubr'slJtfe .(Cnepta9 Sq.Ft.Floor Area Valuation
Y�3 (commencing with Sa,lonTOW)of Division Sof the Budnessand Profesdav Cade)ur4000
e3 Net M is exrmp waafmm and the basin far the allcgcd exemption.Any viola u n of
Section 7031.3 by arty applicant for a prmdt subjects dm applicant N a civil panaltY ofA DIAL
ant mare man B.a hmmad dollar.(>asoot 3 2 6 0 9 0 5 6 . r Occupancy Type
❑1,an owner of the property,or my wploycu with wages u Nen sok compensation,
win do the work,and on strunum is not handed or mRwrrd for saw(Sec.70x4,Bud.
and Prefveloru Code:Tha Commutes Lkenm Lsw dao rot apply in an owmr of Required Inspections
propeny who builds or impales Nvwm w,d who does ouch wank himslf or through his
own employees,provided that such improvements art not intsndW or oRemd for saw.If.
however,the building or in Pmrn1wwL u sold within ane year of compkdon.the owner-
builder win turn,the bodies of proving that W did not bdld or improve for purpom of
saw.).
❑1,u awns of Ne progeny,em uclminly contracting with linrued a.numrs to
wmouct IN,project(Sec.7044,Bussom ss and Professions Code:)The Connors U.
cove law does not apply in an owner of property,who build.or improves Nemo..and.
who contracts for such projects with a convactor(s)licensed panuant N Ne ConuaeNh
Liars law.
I am exempt unM See ,B@P C for this mason
r Date
WORKER'S COMPENSATION DECLARATION
1 hereby aff ran under pna ty of perjury aro of Ne following decluatiav:
❑I haw and will m W.W.aCertifinmof Comm to slf-imua for Warkm's Compen.
swoon,u providedfor by Son..37M of Ile War Cade,forNe performance of Nc
wok for which this puma is housad.
0 I have and will mumain WmI a'.Compentatiom Istvan .as I quirad by Section
37M of we Labor Code far Na penam,ane of the wok far which Nis permit u owed. '
My Warka/.0 m ens tion lam ¢ and Policy nu-mbyer/art:
Cartier. Poliry No.: -f 7 Igo a
CER. CATEOFEX PILON FROM WORKERS'
COMPENSATION INSURANCE
(nossoNot rad natwcompkmd lithe permit Is forms:hundred dodws(SIM)
or Lest)
I asd[the,in Nc perfarch.of Na amk for which this panni,is issued,I dull no
employ any person in any manneran as to bwome subject to this Workere Compensation
Lam of California.Dau
APPOCIOL
NOTICE TO APPLICANT:If.allot making was Ceninnu of Exemption.you should
Within subject to the Worker's Camp.sadon pmAsiom of Ne Labor Coca you most
.JO faMwith Comply With such pmvidv aor Nnerm
pit Nall be dramrd an,kcd.
5,7 CONSTRUCTION LENDING AGENCY
I hereby dorm Nn,ft.a.cosstsunion lending agency far Ne pufwmarauf
> Ne wort far which this pnnn Is issued(Sec 3097.Civ.C.)
0 Landers Name .
M z Lander.Address
V O 1 artily Nat 1 haw rad tho application W sou door Na own infomtation i.
LL P corrin I agme to comply with.11 city and county ominencm end state was raising lo
0U vending construction.and bemby anNoire repaeswuninsof NU City ma=uDnn Ne
W dove-mentioned propsny for i opso.d n purposes
"d (We)stow in an,,indemnify and trap narmwm this City of Cuprtino a
h liabilitks judgments,costs end exparrins hich msY in any myaccrue egdv7 Cq
U z In conaw uana of has ng of Nu puma.
APPLICANT U D AND
AN'D_)W-Is,`rr].e%/(
65
Re-roofs
Slgnuum of Applinnr/Cenuacmr Data
HAZNtDOUS MATERIALS DISCLOSURE Type of Roof
WIII tire applicant ar fuwa Wildingoccupantman 2rtHes
hand, Health
hazardous
by Ne Capers.Municipal Coo,Cnapta 9.1;andand the IN and Safety.lk-RSection 25532(a7
❑res filto All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or futma wading occ.paat tam q.ipmat in dcdcas which If a roof is installed without first obtaining an inspection,I agree to remove
ami,hayamnv air comaminants w defined by Ne Bay Aro Air Quality Management all new materials for inspection.
Divrict7
❑Yes rifivo
I have aid the ha»mmu mvedanmquian.•.wAkr Clvphs G95 of the Califor.
not Hesl"S f.IYCodc.Sections 25503.25533 am125534.I andcnund Nuifina wilding
does ant cwrcntiy a¢ i,thatitb-�my�a�sP 0anfodty m aodry do oayew uof the
Qlaa
YrnLawhK
hand ..afQNpNey.
Signature of Applicant Date
owner or amthdvaa seat D,m All roof coverings to be Class's"or better
f)y
�CITY OF CUPERTINO
FURNACE/AC
CUPE1k1:1NO PERMIT APPLICATION FORM
APN # (P D 9 o �5 K :�
C�
Date:
Building Address:
$00 T"b 1-b 7,0 6
Owner's Name:
Phone #:
on
& 60 . q-31 . 3657
Contractor:
Phone #:Wp 403-7't&- 60-4/
WSJ a((,, bejQ3 //vc,
Fax #: 409. -�if(o . 503 -3
Contractor License #:
Cupertino Business License #:
$25 3y s
z.Flq& /
Contact:
Phone #: j;((). 612!. 7,55-3
06iil L- Vo W
Fax #: 0 . 5 SO . Z69�
Building Permit Into:
Elect ❑ Plumb Mech ❑
Residential Commercial
Job Description: +���� r g .e�'�� j �/ �✓O� Gt�l�t-L
For Residential Installations:
Attic ❑ I" floor Er� 2°d 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 Reg uired ❑
Cost of Project: Type of Construction (Usage Class):
f8� 000.0 6 1z11
Strapped On Platform Bonded 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.
.4rill.
CITY F
CUPEIQTINO
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.
1MCSUSHTR
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.
IBSEISMICO
Commercial Seismic
B
1MRRAA
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 appI permit.
1
CI F
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
1BPGAS
For each gas piping system of 5 or
more per outlet.
P
1BSEISMICR
Residential Seismic
B
1MECPLNCK
Mechanical Plan Check
M
1MFR=<100
Furnace Syst <=100k BTU install or
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
M
1 MFRN> 100
Furnace Syst > l 00k BTU install or
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
M
1 EPERMITFEE
Electric Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit
P
l
1 TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B
C
CI Of
CUPEIkTINO
CITY OF CUPERTINO
FURNACE/AC
FEE SCHEDULE
I
_I -
Quantity
Fee ID
Fee Description.
Fee
Group
Permit Type
AIR
CONDITIONING
FURN/AC
1 BCAIRHAN
Commercial A/C Units <= l0k 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
I PGASRES
Residential for ea gas piping system
of 1-4 Outlets
P
1 BPGAS
For each gas piping system of 5 or
more per outlet. Comm/Resid
P
1 BREMAIRHAN
Residential A/C units <= l0k 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
1TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B