08060194COVERSHEET
08060194-D
20800 HOMESTEAD RD #43
ISSUED BY DATE TOTAL FEES
CITY OF CUPERTINO �'�s OAPI-
BUILDING DIVISION PERMIT�l.tl��i
PERMIT NO.
BUILp,11�,G OVE!NOMESTEAD BLDG 43 WEST BUILDERS ; - INC . 0 8 0 6 019 4
OWNER'S JNA(JM�EJ: PERMIT ISSUE DATE
PROMETHEUS -1608 4TH ST STE 120 07/18/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: INSTL TEMP WTR SPLY& RETRN BLDG BE�CINNGPERMIT INFO PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION
u 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
' p y in full force and effect
j ? LicClass _ Lic.
ense 8
Date Contractor
CHITECI'S DECLA A O
I understand my plans shall be used as public records
)0.
4 wo y Licensed Professional
OWNER -BUILDER DECLARATION
'y4 a I hereby affirm that 1 am exempt from the Contractor's License Law for the
p o 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
u Z prior to its issuance, also requires the applicant far such permit to file a signed statement
S that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9
t, (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y 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 ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for We. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U.
cense law does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
C]I am exempt under Sea B & P C for this reason
Owner - Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workcrs Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the labor Code, for the performance of the work for which this permit is issued,
My Worker's Compensation
nIInsurance cacarrier and Policy number arc:
Cartier. 't k.Yk � Policy No.: l
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed Kthe permit is forene hundred dollars ($I00)
or Icss)
I certify that in the performance 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 or the labor Coda you must
J O 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 performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
ALender's Name --
z Lender's Address
J C) 1 certify that I have read this application and state that the above information is
corecL I agree to comply with all city and county ordinances and state laws relating to
U building construction, and hereby authorize representatives of this city to enter upon the
ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
y (A liabilities, judgments, cosisandexpcns which may in anyway accrue against said City
J 'Z in consequence of the granting of thi rmdt.
APPLICANT DERSTANDS D L COMPLY WITH ALL N .P TNT
SOUR GUL O
Signature of plic t/ ct ate
H AR00 S ATERIALS DISCLOSURE
Will the applicant or futu building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7 Q,,
❑ Yes pZo
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? Ago
go
Ihave mad thehazardous atcrialsrequirements under Chapter 6.95oftheCalifor.
nia Health& SarctyCodc, SecUoMP505,25533and75534.1understandthatifthebuilding
does not cu a tenant. at' my responsibility m notify the'
cupanl of the
require which m me r trance of a Ceru iica oIOccu cy.
Owner or authori d en Date
Sq
Issued by:
Re -roofs
Type of Roof
Area ,
Job Description
Required Inspections
Type
Date ?'( Ck )
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'!`' or better
CITY OF CUPERTINO
� E IV, T-OEE/ U_LTI_FA�LY��-])W L�IN�
CUPERTINO PERMIT APP),I ATION FORM
APN #
32609056.ALL
Date:
6/23/2008
Building Address: Building 43, 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 IN 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- ,❑ 11,111,1VV-B U�
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.builditgreep.org
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
entity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
IGENRES or
IGENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee)
B
lEPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
/
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
(3P w'okmC Z,
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