08060192COVERSHEET
08060197-D
20800 HOMESTEAD RD #47
OWNER
WORKS
mom
ASSESSOR
COMM.PUBLIC
tREMODEL
VALUATION
REQD. PAID
NOTES:
CONSTRUCTION TAX (Y) (N)
HOUSING
HEART OF
BUILDING DIVISION PERMIT
BUIL 1 G D ESS: PERMIT NO.
�Z (� �� HOMESTEAD RD BLDG 47 WEST BUILDERS, INC. 0 8 0 6 019 2
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS 1608 4TH ST STE 120 07/18/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
INSTL TEMP WTR SPLY& RETRN
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Chapter 9 (commencing
r
' "^^ "^ ^ Job Description
I hereby affirm that I am licensed under provisions of
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect
License I�ss Lic. k
Dale-M \ ( Contractor
'
ARCHITECTS DECLARATION
I understand my plans shall 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 mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed statement
that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) art
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 penally of
APN Number
Occupancy e
PnC Y TYP
not more than rive hundred dollars ($500).
❑ 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
Required Inspections
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
awn employees, provided that such improvements are not intended or offered for We. 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
sale.).
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (See. 7044, Business and Professions Code:) The Contractoes 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. ,
❑ 1 am exempt under Sea B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's 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 Worker's Compensation 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 Insurance carrier and Policy number are:
Carrier: fp� t2�!VA iK> Policy No.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ibis section need not be completed if the permit is for one hundred dollars ($100)
or less)
1 certify that in the perrormance of the work for which this permit is issued, I shall not
employ any person in any mannerso as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perfurnanca of
the work for which this permit is issued (Sec. 3097, Civ, C.)
Lender's Name
Lender's Address
i certify that 1 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
(Wo) agree to save, indemnify and keep harmless the City of Cupertino against
liabilides,judgmenis, costs and expenses which may in any way accrue against said City
in consequence or the granting of this permit.
APPLICANT UNDER TA SAND WILL COMPLY WITH ALL NON -POINT
y
Issued by: Date
SO RE An
b
Re -roofs
Sig 6WK o c C ntractor Irate
ARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupantstoro or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes �a
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 the applicant or future 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?
❑ YesNo
1 have mad the hazardous materials requirements under Chapter6.95 of the Cali for.
niaHealth & Safety Code, Sections 25505,25533 and 25534. 1 undc dthatifthebuilding
does not currently have a tenant, that it is my responsibility to no fy the u ant of the
require nts w • h be prior to issue a ertifrc ter span
Signature of Applicant Date
' "
All roof coverings to be Class "j4`' or better
Owner or au a ecn Datc
o
CITY OF
CUPS TINO
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
APN #
32609056.A�� E�y-
Date: 6/23/2008
Building Address: Building 47, 20800 Homestead Rd.
Mailing Address (if different from building address):
20800 Homestead Rd., Unit 8C
Owner's Name: Prometheus
Phone # : 650-931-3457
Contractor:
Phone #: 510-525-9378
West Builders
Fax #: 510-867-6983
Contractor License #: 825395
Cupertino Business License #: 29961
Contact:
Phone #: 925-250-0576
Scott Thomas
Fax #: 925-846-2243
Alternate Contact:
Phone #: 510-773-0477
Katy Bilodeau
Fax #: 408-746-5033
Single -Story ❑ Two -Story ❑ Three -Story ❑ Basement ❑ Hillside ❑
Multi -family ❑ Apartment ® Condo ❑ Townhouse ❑
Sq.Ft. Living Area (Including Basement & Attached Garage:
Sq. Ft. Garage (Detached Only):
Valuation: $15,000.00
Job Description:
Installation of temporary water supply and return piping. Installation of new commercial water heater.
Type of Construction (Usage Class):
Occupancy Type:
1-A, 11-B ❑ 11, 111, V-A ❑ 11, 111, lV V-B [�(
- 1
Project Size: Standard ❑ Large❑ Major ❑
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.builditgreen.org
CITY OF CUPERTINO
,'ENO GENERAL BUILDING APPLICATION
FEE SCHEDULE
entity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee)
B
1 EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
I
1PPERMITFEE
Plumbing Permit Fee
P
1ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1PLMPLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
/
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
/
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
aP wIbrm_ IR ,