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08060195COVERSHEET 08060195-D 20800 HOMESTEAD RD #41 PE MIT # DATE PROJECT ,j --,A4 Z% 1,�4 ,�e , 1, ADDRESS 2o-eoo APPLICANT S nOWNER r, AGENCY IN RETURN Status Init IN RETURN Status Init IN RETURN Status Init r� C/ /' b OUTSIDE PLANNING PUBLIC WORDS FIRE SANITARY HOOD HEALTH ASSESSOR APN# Z-S. (LVNG) (GARAGE) COMM. SQ. F T. (NEW) T.I. SQ.F'I: RES. REMODEL CONTACT " - .,, PHO # 2-7 s'FAX `72 5 W-eIK- VALUATION (Cost of Project) �206 , -'L READ. PAID NOTES: CONSTRUCTION T (Y) (N) SCHOOL FEES (Y) (N) HOUSING MITIG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED BY <.-- ` -. �� DATETOTAL�-��>c��./ ES BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMiI' NO. 20800 HOMESTEAD RD BLDG 41 WEST BUILDERS, INC. 08060195 OWNER'S NAME: PERMIT ISSUE DATE PROMETHEUS 1608 4TH ST STE 120 07/18/2008 PHONE: SANITARY NO. CONTROL NO. ARCHnECIENGINEER: j O p LICENSED CONTRACTOR'S DECLARATION Uz IZ 1 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 a y in full force and effect �2 ,Z, License Claz Lie. N =7 p Datc Contractor ARCHrIECPS DECLARATION aZ a 1 understand my plans shall be used as public records a y o H Licensed Professional y � OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the In 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 } prior to its issuance, also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 5p 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 (5500). ❑ 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 Conuactoe3 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. tense 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 See. 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 Workers 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 Warker'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 lasuran c carrier and Policy number am, Canier��t�� PolicyNa.:i ZS bZ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foranc 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 mannerso as to become subject to the Workcrs' 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY er 5. 1 hereby affirm that there is a construction lending agency for the performance of rT the work for which this permit is issued (Sec. 3097, Civ. C.) i7 A Lenders Name z Lcndees Address J Q 1 certify that 1 have read this application and state that the above informadun is y Fcorrect. 1 agree to comply with all city and county ordinances and state laws relating to V building construction, and hereby authorize representatives of this city to enter upon the Uabove -mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against � to liabilides,judgmenls,co and expenses which may in anyway accrue against said City ;) 7 in consequence or the Ong f this permit. r� AP NOE AND WILL COMP Y WITH e LL NON -POINT URCE LA L Signa u tlC ntractor D Date ARDOUS MATERIALS DISCLOSURE Will the appl ant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely Code, Section 25532(a)? ❑Yes ❑No 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? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505,25533and 25534.1undc'rstandthat ifthe building does ntly have na that it is my responsibility to notify the occupant or the re uirements hi m Her to issuance of a erlifrca of Occu ancy. Owne or a eri ee Date ' BUILDING PERMITINPO INSTL TEMP WTR SPLY& RETRN BL�DG ELECT' PLUMB rriDra(, rrs;sT fj tgEw eem .. Job Description Required Inspections Issued by: Re -roofs Type of Roof Type Date �7_ �j 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 'j`' or better MECH CITY of CUPEI,TINO CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING PERMIT APPLICATION FORM APN # 32609056.ALL 15a�: 6/23/2008 Building Address: Building 41, 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: I -A, 11-B ❑ 11, 111, V-A ❑ 11, 111, lV V-B k 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 i 'INO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE hfity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1 GENCOM 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR 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 L1BSEISMICR Seismic Residential B 1 BSEISMICO Seismic Commercial B ` / 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B DP tz, <! ( 2�✓ 5 of 5