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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
6A Al -:
BUIL0t 1USN STELLING RD ��d� $��
WEST BUILDERS, INC.
.
08050PERMIT 08050190 ,
OWNER'S NAME:
PERMIT ISSUE DATE
PROMETHEUS
1608 4TH ST STE 120
07/09/2008
PHONE
SANITARY NO. CONTROL NO.
(510) 525-9378
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
E= a 0 a
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that f am licensed under provisions of Chapter 9 (commencing
with Section 70DD) ofDivision 3 of the Business and Professions Code, and my license is
INSTALLATION OF EXTERIOR TEMPORARY PROPANE TANKS
in full force and effect
License class, Lt r J_
&
Date �1 ARCxrrEcrs� I o
TEMPORARY UNDERGROUND PIPES.
I ,,ndelyAnd my plans "I 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 reamn. (Section 7031.5, Business and Professions Code: Any city or County
which requites a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed surrmcm
he is licensed to the Contracturs License Law 9
Sq. Ft. Floor Area$4000
Valuation
that pursuant provisions of the (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) w
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
3 2 6 0 9 0 5 6, "17V�
Occu anC T
P y Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNum
re m
not moan five hundred dollars (5500).
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required fired Ins eeti ons
will do the warp and the structure is not intended or offered for sale (Sec. 70", Business
de: Contractor's License Law donot ay toe an owner or
and Professions coThe Contractorrs ppl
q P
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that. such improvements are not intended or offered for sale If.
however, the building or improvement is sold within one yew of complmioa, the owner -
builder will have the burden of proving that he cid not build or imprrne for purpose of
sale.}
❑ L as owner of the property, am exclusively contracting with licensed contract°rs to
construct the project (See. 7044, Business and Professions Code:) The Comracmes U -
cense Law does not apply to an owner of property who builds or improves themon, and,
.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec B & P C for this reason
Owner Dare
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ I bare and will maintain a Certificate of Consent to self -insure for WoenesCompen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
weak for which this permit is issued.
❑ I have and will maintain Worker's Compensadon Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insu oartinx and Policy nu�mbry are:
�y
Grier. Polity Na : 7 l to ✓' S D/7!
nICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section steed Trot be completed if the permit is for one hundred dollars (5100)
or Icsa)
1 ttnifv 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 Workers' Compensation
Lawn of California Dale
Applicant
NOTICE TO APPLICANT: If, after making this 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 permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
'
Lenders Name —
Lenders Address
I testify that I have mad this application and state that the above information is
correct. 1 agree to comply with all city and country ordinances and slue laws relating to
building construction, and hereby authorize mpresenwhu of this city to emerupon the
above-mentioned property for inspection pmposea
(We) agree to save, indemnify and keep harmless the City of Cupertino against
-
liabilities, judgment&, toss and expenses which may in any way accrue against said City
in consequence of the granting of permit.
APPLICANT UNDERSTANDILLWITH ALL NON -POINT
Issued by: Date i7,6 d'
SOURCE REGULATIONS. -7—LJ
/
7
Re -roofs
Type of Roof
Signature of Applicant/ConLActor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as damned by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely
Code. Section 23532(a)T
❑ Yes �,
�qv,AA
All roofs shall be inspected prior to any roofing material being installed.
f_uturreo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or e building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ YesNe
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & SafetyCodc, Sections 25505, 25533 and 25534. I understand tha If the building
does not currently have a taunt LL (s y respormbl " y otify the occupant of the
requirements which must be met. °r Ot�`P'
Signature of Applicant Date
��
— All roof coverings to be Class ",`' or better
Owner Or Authorized agent Date
alF
CUPEfQTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
0050/90
APN# 2��(�+ !
Ue o 9 o5 o C> �O
Date:
Building Address:
10VO 5
t,A J' z vwv"
Owner's Name:
Phone #:
(v5()• g3/.Z1�57
Contractor:
Phone #: 1/00, 7WO. 603
1L a G
Fax #: JOY • -7*. 5;)33
Contractor License #:
Cupertino Business License #:
Qz-5 3�i 5
71-9&1
Contact:
Phone #: 510. S rz, 1'e' -Z-'
N61 L VOWOC7
Fax #: Sp 10 • 550 . 7*bI
Building Permit fo:
Elect ❑ Plumb [ Mech ❑
Residential Commercial
Job Description: �j 4, S �rXa*"v�
F r Re dential Installations:
Attic ❑ I" floor 0/
2" 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 Reguired ❑
Cost of Project: Type of Construction
(Usage Class):
�5 L(Wo . o o
lz�
Strapped H On Platform El 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.
CITY OF CUPERTINO go,
FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Permit Type
Group
FURNACE
FURN/AC
1MCRAA
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
1BPGAS
For each gas piping system of 5 or
P
more per outlet.
1 MCAPPVNT
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.
1 MRSUSHTR
Residential Install/Relocate ea
M
suspended heater,recessed.wall htr, or
floor mounted unit heater.
1 MRAPPVNT
Residential for the install/relocate/ or
M
replacement of ea appliance vent
install & not incl in an appI permit.
CITY of
CUPEkTINO
CITY OF CUPERTINO
FURNACE/AC
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Pernvt 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
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
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit
P
I
1 TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B
CI of
CUPEIk1'IN0
CITY OF CUPERTINO
FURNACE/AC
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
AIR
CONDITIONING
FURN/AC
1 BCAIRHAN
Commercial A/C Units <= I Ok CFM
B
1 MCRAA
Commercial Mech Repair/alt/add
M
1BSEISMIC0
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
1 BPGAS
For each gas piping system of 5 or
more per outlet. Comm/Resid
P
1 BREMAIRHAN
Residential A/C units <= I Ok CFM
B
1MRRAA
Residential Mech Repair/alt/add
M
1BSEISMICR
Seismic Residential
B
1 EPERMITFEE
Electric Permit
E
1 MPERMITFEE
Mechanical Permit
M
1 PPERMTTFEE
Plumbing Permit
P
1 TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B