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08050216CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD TYPE 8 CONTRACTOR: WEST BUILDERS, PERMIT NO: 08050216 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 � F- 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 M/E/P (commencing with Section 7000) of Division 3 of the Business & Professions ORIG#07120212-NO Code and that my license is in full force and effect. SANITARY REQUIREMENTS 9/14/9 -RE-OPEN PER BE; REVISION ELECTRICLA 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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.TYPE8 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) I, 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 I 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 I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should 1 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 permit is issued. Owner or authorized agent: Date: 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 I 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 I certify that I have read 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 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 BUILDING DIVISION PEPdMT BUILDING ADDRESS: 20800 H OWNER'S NAME: ,.`KN__I ARCHITECIFNGINEER: O g LICENSED CONTRACTOR'S DECLARATION i I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is H lo roll force and effect. L. �'��s t z Ucense Chu Lk. r DateComnctnr ARCHTIECTS DECLARATION . o. U I undersand my plans shall be used.sv public records a Ucensed Professional y OWNER -BUILDER DECLARATION t f I hereby affirm that 1 am exempt from the Contractor's License low for the :00 r following mason. (Section 7031.5, Business and Professions Code: Any city or county fug which requires a permit to construct, alter, improve, demolish, or repair any structure aprior 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 Contracmes License Law (Chapter 9 2 $ (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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (WW). ❑ L as owner of the property, or my employees with wages as their sole compensation, will do the work and the sanctum Is not intended or offered for sale (Sts. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such wort himself or tlboagh his own employees, provided that such improvements ase not intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of I, as owner of the property. am exclusively contracting with licensed contractors to ?6QE= the project (Sec. 7044. Business and Professions Code:) The Cwuaetoes Li- 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 License Law. C3lam exgmp oder ee , B &P C or ids o pwnej/ Dale N PENSATTON DECLARATION I hereby anhm u#dcr penalty of perjury one of the following declarations ❑ I hate and will maintain a Certifnate of Consent to self -Insure for Workces Compen- 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 Worlrces Compensation insurance, its required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation btsorarkce carrier and Policy number arc Carrier. Policy No.: CERTIFICATE OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ntis section need not be completed if the permit is for one hundred dollars (S 100) or less) I certify that in the performance of the work for which this permit Is issued. I shall not employ any person in any manno as to become object to a orkcts' Compensadop Laws of Califomi arc Applieanl NOTICE TO APP . J, of ng Certifis of emption, you should become subject to a Workers Compensaidoriprovisions of the Labor Code, you maw .J O forthwith comply with such visid. ons or this permit shall be deemed revoke �"4 CONSTRUCTION LENDING AGENCY Cn -n t 4 I hereby affirm that there is a convection lending agency for the performance of .7 the work for which this permit Is issued (Sec. 3097, Civ. C.) aQ Lender's Name z, Lender's Address V Q 1 certify that I have mad this application and sate that the above information is correct, l agree to comply with all City and county ordinances and sate laws relating to 0 r ` building coasuvction, and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes L]. (We) agree to save, indemnify and keep harmless the City of Cupertino against „y liabilities, judgments, costs and expenses which may in any way scenic against said City C.) 7 in consequence of the granting of this permit. A APPLICANT UNDER ND WILL COMPLYWITH LL NON -POINT SOUR Sign tractor Date DOUS MATERIALS ISCLOSU Will the appli t or future building octvpant atom or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? _�/ ❑ Yes $ No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes 040 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health k Safety Codera . o 25505.25533 and 25534.1 understand that if the building currently not rently have a to nuts my responsibility m notify the occupant of the mauimau.Titi wllieh must issuance of a Certificate of Occuoancy. Owner or;;Igirt ed age s 1 Date (510) 525-93 Job Description DEFERRED SUBMITTAL OF M/E/P ORIG#07120212-NO SANITARY REQUIREMENTS Ft. Floor Area APN Number Occupancy Type 32609056.TYPE8 Required Inspections Issued by: Re -roofs Type of Roof Date % 7i`y'rC 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'n" or better PERMIT NO. nAnrmi r) PERMIT ISSf I! DATE A CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description DEFERRED SUBMITTAL OF M/E/P ORIG#07120212-NO SANITARY REQUIREMENTS Ft. Floor Area APN Number Occupancy Type 32609056.TYPE8 Required Inspections Issued by: Re -roofs Type of Roof Date % 7i`y'rC 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'n" or better CI OF CUPERTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # Date: q:t%.dt Original Permit #: 08o5 U2(Le Building Address: 2 -De oO 1-1L)m CS-riE-,,ku cL_0 T`I P -c- 8 Mailing Address (if different from building address): Owner's Name: Phone #: b-50-931-34,57 Pr�c, .zt t✓�.-s Mk V-0 DL,�, co-rc Contractor: Phone: 51 O - 7 73 - 07 7a Fax: yoe) " 7q t9 — 5033 Contractor License #: 62-539-c-;, Cupertino Business License #: Zq 9 (o l Contact: Phone: Sia-- -7 7 3 -0770 Fax: 14a a - 7y U - 5033 Building Permit Info: Bldg 4 Elect ❑ Plumb ❑ Mech ❑ Residential Commercial ❑ Job Description: j-2---- 2s h tc-5 t Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B ❑ Valuation (cost of project): 67 No C�A�C, 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.builditgreen.org Revised 01/07/09 CITY OF CUPEkTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM L( -?qt) S-� APN # np O qo5 � ` �� Date: s- ZZ - 0 g Original Permit #: Q-7 IZCZI Z Building Address: Z0000 "Wt 15St-E54DIZ 'I�> Mailing Address (if different from building address): Owner's Name: Phone #: Contractor: Phone: 40$ _ 7449.50S W `551"�LI�£�� .Z/V� • Fax: qDS • 7449. 5033 Contractor License #: Cupertino Business License #: Contact:�L ��/ Phone: 510• 817—• Z653 7 Fax: 57l0 • ,550 • X81 Building Permit Info: Bldg ❑ Elect 0� Plumb �� Mech Residential CommerciT77 Job Description- , Su��rifiAZ OF M15 -P'S Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B Il/1ll/V-A0 11 Project Size: Standard LJ Large Major LJ 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.buildit2reen.org al' --- -i1 CITY OF CUPEkTINO 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 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R-3 Inspection B 1* 4('7 y D 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