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08060193COVERSHEET 08060193-D 20800 HOMESTEAD RD #45 PERMIT # PROJECT J ADDRESS I APPLICAN 6dJ-6/ TE OWNER F AGENCY IN RETURN Status Init IN RETURN Init IN RETURN Status Mt ,-7 7- UIL BU��G OUTSIDE -177zz,]-Oi PLANNING — -77, /1-/l PUBLIC WORKS FIRE SANITARY HOOD HEALTH ASSESSOR APN# RES. (LUNG) (GARAGE) COMM. SQ. Fr. (NEW) T.I. SQ.FT. RES. REMODEL CONTACT J CO-\'-�- PHONE# 7 FAX S:- Le L4 VALUATION (Cost of Project) Z. f- (d e-", C-, REQD. PAID NOTES: CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSING MITIG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED DATE TOTAL FEES yF� C R C00 ,og u • rn 'za �Hc W CITY OF CUPERTINO DIVISION PERNIIT�lTei�T£�t BUILDING s BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 45 WEST BUILDERS, INC. PERMIT NO. _08060193 OWNER'S NAME: PERM31'I5SUE DATE PROMETHEUS 1608 4TH ST STE 120 07/18/2008' PHONE: SANITARY NO. CONTROL NO. ARCHIECTIENGINEER: INSTL TEMP WTR SPLY& RETRN BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a a o 0 LICENSED CONTRACTOR'S DECLARATION Chapter 9 ^^^ - T Job Description I hereby affirm that I am licensed under provisions of (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full Farce and effect �� S Licence Clazs Lic. # Date Contracto CHI'tEC'SDECLA ATTON I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (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 inquires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Licence Law (Chapter 9 Sq. Ft. Floor Area Valuation (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 APN Number Occupancy Type P Y YP Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections 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 does not apply to an owner of 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 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 (Sec. 7044, Business and Professions Code:) The Contractor's Li - cease Law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a conitactor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self-insum 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 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 Insuranq artier and Policy number are: Cartier. Policy No.: CL�� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars ($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 mannerx 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 pgrnit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a conswcdnn lending agency for the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.) Lenders Name L.endees 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 liabiliucsJudgmems,costs and expenses which may in anyway accrue against said City in consequence or the granting of this permit. / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S Re -roofs Sign c p canaC mctorfuture HAZARDOUS MATERIALS DISCLOSURE Type of Roof or Will the applicant or future building occupant store or handle hazardous material ous • as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Q'No 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? ❑ Yes )iNo 1 have read the hazardous materials requirements under Chapicr ii.95 of the Califor. nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand thalif the building does not currently have tenant, that it is my responsibility to notify the occupant of the regdi hich u t t prior to issuanc ora c ri cote er ancy. Signature of Applicant Date ci� (S All roof coverings to be Class" `` or better . Own Date CITY OF CUPERTINO CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING PERMIT APPLICATION FORM APN # 32609056.�L bO Date: 6/23/2008 Building Address: Building 45, 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 [2"" 1:�> 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.buildit reen.or i 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 1 MPERMITFEE Mechanical Permit Fee M / 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK 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 (`-� 5 of 5