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08050198CITY OF CUPERTINO BUILDING PERMIT 101. BUILDING ADDRESS: 20800 HOMESTEAD RD TYPE IA&1B CONTRACTOR: WEST BUILDERS, PERMIT NO: 08050198 INC. OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED: 11/24/2008 OWNER'S PHONE: 6509313657 BERKELEY, CA 94710 PHONE NO: (510) 525-9378 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # r r r MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: DEFERRED SUBMITTAL OF (commencing with Section 7000) of Division 3 of the Business & Professions M/E/P'S,ORIG#07120212-NO Code and that my license is in full force and effect. SANITARY REQUIREMENTS. 9/14/9 RE -OPEN PER BE; REVISE ELECTRICAL SERVICE I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $1000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32609056.T1 A&1 B Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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 all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 1 store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY f CUPEkTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # Date: Original Permit #: o8O5019%l Building Address: 2,D8 oo CL_(3 'l q ?C I* 1 A� Mailing Address (if different from building address): Owner's Name: Phone #: &_50-931-34,57 �t� o �v. 2 C 4-k G c•�-S m k K. G OL. c. oT c Contractor: Phone: 6 1 D - 773 - 07 70 t..)'��T 2��•� c.� c2 -S Fax: Hoe) - 7y (9 - 5-033 Contractor License #: 62-539r;, Cupertino Business License #: 2 Cl Cl to l Contact: Phone: S i D -- 7 7 3 -0-770 _Dkv10- Fax: 4D e ` 7y U - 5033 Building Permit Info: Bldg X Elect []� Plumb ❑ Mech ❑ Residential Commercial ❑ Job Description: ( l l w -� ` -I i2�„• �<� �lQ.[�-v ,,� i'C r� i C i �s • 'C� �� �:C_ 1 `5 ` 11l`W v S Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B ❑ II/IIUV-A ❑ II/III B, IV -HT, V -B 0� Valuation (cost of project):;�,� W RIO Project Size: Express ❑ Standard ❑ Large ❑ 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.buildit reen.or Revised 01/07/09 BUILDING DIVISION PERMIT OWNER'S NAME: ARCHITECT/ENGINEER: O p LICENSED CONTRACTOR'S DECLARATION ulI hereby affirm that I am li¢ under provisions of Chapter 9 (commencing with Section 71100) of Dividoa 3 of the Business and Professions Code, and my license is H in full force and effect. Ll z License Clea Lk:. g F Date Contractor ARCHnECPS DECLARATION < I mukrsund my plus shall be used as public records yU C t; Licensed Professional y 3 OWNER -BUILDER DECLARATION i I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following mason. (Section 70313, Business and Professions Code: Any city or county Pi which requires a permit to construct. alta, improve, demolish, or repair any structure prior to its issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70313 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (SS00). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law don not apply to an owner of property who builds orimprwa thereon, and who does such work himself or tkough his own employees, provided that such improvements are not intended oroQered for rale If, however, the building or improvement is sold within one yea of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property. am exclusively -contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Cmoactor's 13- ccne Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a conuactor(s) licensed pursuant to the Contractor's Lice= Law. ❑ I am exempt under Sec B & P C for this reason (510) 525-93 PERMtI- NU. nancini PERMIT ISSUE DATE A CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description DEFERRED SUBMITTAL OF M/E/P'S,ORIG#07120212-NO SANITARY REQUIREMENTS. Ft. Floor Area Valuation APN Number Occupancy Type 326O9O56.T1A&1B Required Inspections Owner Date WORKER'S COMPENSATION DECLARATION I hereby drum under penalty of perjury one of the following declarations ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compe t- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Workers Compensation Insurance. as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My Workers Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EcEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit ger forone hundred dollars (SI00) or less.) 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workcrs' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provision of the Labor Code, you must 7 0 forthwith comply with such provisions or this peonit shall be deemed revoked. CONSTRUCTION LENDING AGENCY r r --r I hereby affirm that there is a construction lending agency for the performance: of Ili > the work for which this permit is issued (Sec 3097, Civ. C) Q Len dces Namc Z Lendda Address J . C) 1 certify that I have rad this application and state that the above Information is correct I agree to comply with all city and County ordinances and state laws relating to building construction, and hereby authorize reprtsentadves of this city to enter upon the Lia above-mentioned property for inspection purposes. y fy (We) agree to save, indcrostify and keep harmless the City of Cupertino against ..,i y liabilities, judgments. toss and expenses which may In any way scene against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: SOURCE REGULATIONS. Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant sore or handle hazardous material as deftned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code. Section 25532(a)7 [3 Yes C] No Will the applicant or future building occupant use equipment or devices which cmlt hazardous air contaminants as damned by the Bay Area Air Quality Management Dlsuict7 ❑Yes No I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code. Secdons 25505.25533 and 25534.1 understand that if the building don notcurendy have a tenant. that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Ccrtifiate of Occupancy. Owner or authorizzd agent Date Re -roofs Type of Roof Date 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 all new materials for inspection. Signature of Applicant Date . All roof coverings to be Class'}" or better C tlf, Y1- (if Ci 0 FEAR I 1NN1 0 CITY Of C�?EkTir-0 RE ✓ISIO 1DEFERRED 00509? A, ""/(_.�)I z� �/� o • 1�-l.� t ^oro -: nal Paan;- #° ®-7 12 Cr&l Z Building Address. 7,0B00 "VVL 1iS` e" +b J,-,,- T� '77 Mailing Address (if different from building address): Owner's Name: Phone #: Contractor: Phone: 408 , -7442 5 p3 ,11.t� S ZiVe • Fax: qDS. _74P. 5(733 Contractor License #: f37,5 3cj rj Cupertino Business License #: PIC)& � Contact: L �Dkrl(7 Phone: 610. 81 Z , S Z Fax: 5/(D • ,550 • �8 Building Permit Info: Bldg ❑ Elect Plumb Mech Residential ❑ Commercial Job Description* ))efreRZb s1413nk1 -it-eL OF MCPs Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B ❑ 11 /1 11 /V-A ❑ 11'111 Project Size: Standard L Large ❑ Major Valuation (cost of project): 0 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.buildit reen.ora CITY OF CUPEI,TINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1REVCOMNEW Revision Commercial New B 1* 1REVCOMTI Revision Tenant Improvement B 1* TI 1REVSFDWL Revision SFDWL B 1R3SFDW 1 REVRESADD Revision Addition B 1R3SFDADD 1 REVRESREM Revision Remodel B 1R3SFDREM I 1DEFINSP Deferred Submittal not R-3 Inspection B 1* 3 1DEFPLNCK Deferred Submittal not R-3 Plan Check B 1* OR 1* TI 1DEFR3PLNCK Deferred submittal R-3 Plan Chk B 1R3SFDW 1R3SFDADD 1R3SFDREM 2 of 3 �(U?(Ro CITY OF CUPEkTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # Date: Original Permit #: Building Address: Mailing Address (if different from building address): Owner's Name: Phone #: Contractor: Phone: Fax: Contractor License #: Cupertino Business License #: Contact: Phone: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Residential Commercial Job Description: Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B ❑ 11 111/V -A ❑ 11111-J lV-A-f -d Project Size: Standard Large Major L Valuation (cost of project): 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.orp.