08060202COVERSHEET
08060202-D
20800 HOMESTEAD RD #26
ISSUED DATE TOTAL FEES
CITY OF CUPERTINO
PERMIT
�I RE 'PCTR � � • y
BUILDING DIVISION
BUIL 1 G D ESS:
HOMESTEAD RD BLDG 26
WEST BUILDERS, INC.
PERMIT NO.
08060202
OWNER'S NAME:
PERMIT ISSUE DATE
PROMETHEUS
1608 4TH ST STE 120
0.7/18/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITEGTCENGLNEER:
INSTL TEMP WTR SPLY& RETRN .
BLDG BUILDING PERp`UMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
"^^ "^ ^ Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Cgde, and my license is
in full force and effect '�
License Class Lic. ff
•
Dam Contractor%�
—ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 file a signed statement
License law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions or the Contractor's
(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
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 sale compensation,
RequiredIns actions
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
P
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 Contractor's Li.
tense Law does not apply to an owner or 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 mason
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 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
Policy
7d.
My Worker's Compensation Insurance carrier and tuber:h `
�-\VS Policy No.: ,u
Cartiee
CERTIFICATE OF 7�r CEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit Is forone hundred dollars ($100)
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 manner so as to become subject to the Workers' Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this pctmit shall be deemed mvoked.
i
CONSTRUCTION LENDING AGENCY
1 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.)
Lender's Name T
Lenders Address
I certify that I have read this application and state that the above information is
corral I agree to comply with all city and county onlinances 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
I liabilities,judgmcnts,costs and expenses which may in any way accrue against said City
in consequence of the g n this permit.
APPLICA DER S A AND WILL COMPLY ON -POINT
ry
Issued by: Date
SOUR EGU S
)7ALLr
�
•
3
Re -roofs
l r
Type of Roof
Signature firkp—plicantkantractor k t Date
HAZARDOUS 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 Safely
Code, Section 25532(a)? i�
All roofs shall be inspected prior to any roofing material being installed.
❑Yes UINo
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 jig[{o
I have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not curentI It a ten 4 that It is my responsibility to notify the occupant or the
requ' swhic s etpdortoissuance race 'fie nr ancr•
Signature of Applicant Date
6
All roof coverings to be Class rA'' or better
_
Owner or au ze agent
Date '
CITE` OF
CUPEkTINO
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
PERMIT APPLICATION FORM
APN # r 32609056.
� � ,1�,�
Date: 6/23/2008
Building Address: Building 26, 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 d—e
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
CITY OF CUPERTINO
,iNO GENERAL BUILDING APPLICATION
FEE SCHEDULE
,intity/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
1EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
i
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
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