08050213CITY OF CUPERTINO
BUILDING DIVISION PERNUT
$RGQ,NTR°ACTQR II ,ORMAT7Q�
BUILDING ADDRESS:
PERMITN0.
20800 HOMESTEAD RD TYPR 5
WRqT B
R'S NAME:
PERMIT ISSUE DATE
9 0 8
PHONE;
A 0. CONTROL NO.
(510) 525-9378
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGEI.ECr PLUMB MECH
0 0 0 0
LICENSED CON711(AC TOWS DECLARATION
lob Description
P
I hereby affirmNal l are liceved under pmvisioiu of Chapter 9 (commencing
Nth Section 7").f Division 3 o de Busimaa and Professions Code. and my license is
inruBroraandeReev
DEFERRED SUBMITTAL OF M_ /E/P'S,ORIG#0712.0212—NO
Lice.Lac. �
Damr
SANITARY REQUIREMENTS.
ARCHrI M DECLARATION
.
1 understand my plans Nall W used as public records
Licensed Pro essprod
OWNER -BUILDER DECLARATION
I bcmby alum that 1 am exempt fmm the, Contra mos License Law for the
following mason. (SeNan 78713, Business and Profcssiam Cade: Any city or County
which requires a perm(, m conswe, after. imprew, demolish. or repair any structure
prior to its issuance. also Empirical do applicant for such Permit o rile a signed statement
Contractor's License Law 9
Sq. Ft. Floor Area
Valuation
that the s licensed pursuant to the pmvisiou of the (chapter
(commencing with Section 70DO) of Division 7 or the Business and Professions Code) or
$1000
Nat M u exempt tbererrom and de basis for the alleged eatmption Any violation of
APN Number
Occupancy Type
Section 7071.5 by any applicant for a permit mbjccu the applicant to • Civil Penalty of
not mare Oen 0w hundred de11bus IS500).
32609056 TYP5
I, u owuer of Om profcny. err my employm wIN wage u the"v role mmpewOon,
Required Inspections
will do Ne wort and Restructure s net(nm aded m aRered forsale (See. 70th, Business
and ProlOWsiom Cade: The Comractars License Law don not apply m a caner of
propenywho Wildsnrimpaws Ocmn,arW whod.,atchworkhimselrmltlmvgh his
awnemployers, provided that suchimprovements artnot I.,,. moffered fha ale 1%
'
bowever. Ne Wilding or improvement is sold within cue yes, of Completion, the owuery
builder will haw the Wrdcn of proving Nat he did not Wild or improve fear purpose of
ate.).
go 1. as awsor of dm property, w amiusively contracting with BceneW mmamrs to,
CIEF,Wn the pmlee. (sec. 70sd, Business and Prufessiem Code:) The Contractors U.
arae Law don ant apply N an owner of properly who Wilds or taproom teach, ad
who emlBaeB for such pmleeB with a contra ou(S) licensed purmanl m to fAnnaclnrS
Lica. law.
❑lore tae Bhp fm Nu nsan
Date Ole
PENSATION OECLLRAl10
1 hereby an. der pcmltY of perjury are of the following decsratienc
❑ 1 ham and will maintain a Ceniricam or Comenuo alf-inure forvJorkc's Campers
satiom, asprovided for by Seetian 7700 of the Isbm Code, for the performanceof do
whale for which this permit is issued.
❑ 1 have and win maintain Worker's Compensation Insurance, as rryuhed by section
7700 ofthe Lather Code. for do performance of the what for which Otis permit is issued
'
My Workers Compensation htmrsoce carrier and Policy number an;
Cartier. Policy No.:
CERTIFICATE OF EXEMMON FROM WORXERS'
COMPENSATION INSURANCE
(thisaNm aW act W completed if Ne permit is Imam hunheddoBm (5100)
or mans.)
1 codify Nu in Ne Mr... r f9e which NB permit 6 issued. l shall Out
,
employ any person in ay , the Worked' Compensation
div
laws or Cal;fomi.. Dt
APplicuu
Nor7CE TO APPLICANT:: IL aftKolliting this Convince¢ of Exemption, you should
become subject m the Warmers Comp000mmo provisions of the labor Code. you mmL
_
' fanhwiO comply with such provisions or this permit shall W dumW rooked.
i
ON LENDING AGENCY
CONSTRUCTION
thereby aRm Nu Nem isam(Sce, lending agency for Jo performance of
is.
the doh for which the permit s Wood (Sec. ]09'1, Cir. C)
Ls Name
"
� Loendermmes Address
1 aunty that I Mw reed this application and sum Wt Ne move information Is
correct. l agree N comply with all city and county ordinances and mute laws relating In
Wilding conauuction. and hereby authmin representatives of this city N emu upon lW
above-mndored property for imMmim proposes
4 (We) agree m ave, indemnify and keep har umn the City of Cupenim agaimt
0 Iimilitiu.judgmcns. cess and upersm which may in my way accrue against, said City
in APPLLIICANf UNDERSTANDng.i5� WILL COMPLY WI ALL N N -POINT
Issued by: Date
SOURCE
Re -roofs
Type of Roof
(tCW
Signaam of HALJt US MATERIALS DISCLOSU Dam
Willdoapplicamm Lure Wildingac Mtammmhandlebuudomm&Lc"
as &flncd by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety
. Section 15571(.)7 IV,
❑Yrs
or
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 tom appiinn, or future Wilding accvpa, ure equipment or devices which
COME haraNnm air conandams as derirud by the Bay A= Air Quality Management
all new materials for inspection.
Distrfl
❑Yrs )kNu
I have mal thehomrdo r maenasmquiscmcnu undcrChapar6,95a1fde Califon
nia thod"Safety Cade. Scc'w25505,15577 am12557/. l undersand Nnifdc Wilding
Jon mL cumnJY have a ¢ n i, u my rexpon»Nliry m ratify On a Ont of the
require e t roissaaccaraCmd5CW. Ocm err.
Signature of Applicant Date
11 2 0
All roof coverings to be Class'%W' or better
Owner on oris_age Dam'
CITY OF CUPERTINO BUILDING PERMIT 10 JV
BUILDING ADDRESS: 20800 HOMESTEAD RD Ta: P'E 5
CONTRACTOR: WEST BUILDERS,
PERMIT NO: 08050213
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 i-
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; REVISION ELECTRICLA SERVICE
I 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.
1 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.TYP5
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
WEPMN 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
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 & 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. I 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 1 store or handle hazardous
I 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 I
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, l 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
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
KA
CITY f
CUPEKrINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
APN #
Date:
Original Permit #:
006 023
Building Address:
2-D800 "o m CS-re�-40j-o CL -0 TlPE 5
Mailing Address (if different from building address):
Owner's Name:
Phone #: t.50-9-31-34,57
pt`c, �.-�t (-t t✓ c,._s
M 1 tic. E D c.-. C - o T c
Contractor:
Phone: ,' 1 p 7 73 - 07 7a
Fax: tioe - 7q 5-o33
Contfactor License #: E32 -539S
Cupertino Business License #: 2 q 9
Contact:
Phone: S c a -- 7 7 3 -077()
Fax: 4a $ ` 7ti (e - 5033
Building Permit Info:
Bldg,N 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 ❑ II/IIIN-A ❑ II/III B, IV -HT, V -B ❑
Valuation (cost of project):
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
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
0- d� �3
15-7 (( 5-4
APN #
(-P C-) oS <
Date:
1 5-.7-2.06
-6
Original Permit #: of
Orl rLCZl Z
Building Address:
20$0c) }} OWL 6S`T"E4bI7-'. — Tv 5
Mailing Address (if different from building address):
Owner's Name:
Phone #:
G 5v • 931 .36057
Contractor:
Phone: 40$ , -74142. CJ0S
WI%1- -?;kt bex-S ZiVC •
Fax: q05. -74AP• 50'33
Contractor License #: IB7,5 39 5
Cupertino Business License k 7q96P
Contact: L
Phone: 510. 817-• Z8s-3
Fax: 510 . ,5-50 • X81
Building Permit Info:
Bldg ❑ Elect Plumb 0� Mech [�
Residential Commercial
Job Description- ,
�efre� su9n11�� OF MC --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 ❑ 11 %111 /V-A El 11 /I I 1,
Project Size: Standard LJ Large LJ 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, ontact Build it Green at w-w-w_bui r_een.orQ
s t
CITY OF
CUPEQ:1NO
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
1 REVRESREM
Revision Remodel
B
1R3SFDREM
1 DEFINSP
Deferred Submittal not R-3
Inspection
B
1*
1 DEFPLNCK
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