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08060196COVERSHEET 08060196-D 20800 HOMESTEAD RD #40 PE MI'T -DATE PROJECT ADDRESS APPLICANT OWNER AGENCY IN RETURN Status Init IN RETURN Status Init IN RETURN Status Init BUILDING 1-4,2 A OUTSIDE PLANNING PUBLIC WORKS FIRE SANITARY HOOD HEALTH ASSESSOR /r Am# _324 e0�6 S-4 I_Z__ RES. (LUNG) (GARAGE) COMM. SQ. FF. (NEW) T.I. SQ.Fr. RES. REMODEL CONTACT PHONE#'ZFAX 2Z,S:: 2'e Z2_ fZ VALUATION (Cost of Project REQD. PAID NOTES: CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSING MITIG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED BY DATE TOTAL FEES CY OF CUPEKrL U BUILDING DIVISION PERMIT !OZp ZUy U UyqWO i L )yU a Qo 0 '=a 4+� J4 RD BLDG 40 1 WEST BUILDERS, INC. OWNER'S NAME: PROMETHEUS ARCHITEC (ENGINEER: LICENSED CONTRAC1UR'S UbULARAI 1UN 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, an my license is in full force and effecL 7 l2 s'3Q LicenseClascontractor �7 Date �'i F= O otractos�p ARCHITECTS DECLARATI N I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 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 forsuch permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 70Q0) 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 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 sale. If, however, the building or improvement is said 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 Coamcuies 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 Contractors License Law. ❑ I am exempt under Sec. B & P C for this'reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 Com'�e�nsati—on Insurance carrier and Policy numb am: Cartier.S �— N Policy No.: �L CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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 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 Codc, 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 performance of the work for which this permit Is issued (Sec. 3097, Civ, C.) L.endces Name 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 authorim 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 liabilides,judgments, costs and expenses which may In any way accrue against said City in consequence of the granting of this permit. APPLIC UNVEMS A ND WILL COMPLY WITH ALL NON -POINT SO ERE signalican on or Da AZARDOUS MATERIALS DISCLOSURE Will the applicant or future 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)? ❑Yes o 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? [I Yes N71vU I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not curtentiy have ten at ll is my responsWit m notify a occupant of the requ' cnts hic us bo r te issuance of a C 'frcate of cup a� t Owner a'Ahorized a ens Date ' 1608 4TH ST STE 120 PERMIT NO. 08060196 PERMIT ISSUE DATE 07/18/2008 SANITARY NO, CONTROL NO. INSTL TEMP WTR SPLY& RETRN y 7r'TT Lr."iTVG,TiV� .i 1. im.° , r .. r Job Description Sq, Ft. Floor Required Inspections Issued by: Re -roofs Type of Roof BUILDING PERMIT INFO Type 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. Signature of Applicant Date All roof coverings to be Classor better MECH 6o,5 o � 0 0/ V �_= CITY OF CUPERTINO CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING PERMIT APPLICATION FORM APN # 32609056.ALL Date: 6/23/2008 Building Address: Building 40, 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, IV V-B ®� fk Project Size: Standard U- 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 ,r CITY OF CUPERTINO 11 NO 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 IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M > 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK 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 1BSEISMIC0 Seismic Commercial B / 1TRAVDOC Travel & Documentation B 1 BUSLIC Business License B CAP wAtIC-rtz, ` -� 5 of 5