08060203COVERSHEET
08060203-D
20800 HOMESTEAD RD #24
PERMIT # 0 So 4,0 203
ISSUED BYE -----
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BUILDING DIVISION PERMIT
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STEAD RD BLDG 24 rrrc0 8 0
WEST BUILDERS, INC. 08060203
OWNER'S NAME: PMIrf ZSUE DATE
PROMETHEUS 1608 4TH ST STE 120 1 07/18/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHIT ECTIENGINEER:
I hereby affirm that 1 am licensed under provisions or Chapter 9 (commencing
with Section 7000) ofDivision 3 of thm Business and Professions Cg&.gn I my license is
in full force and eff L //L✓� C]� •)1 S
License C s Lic. N
Date Contractor
RCHITECTS DECL ,R TION
I understand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt Crum the Contractor's License Law for the
fallowing 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 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
(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
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 or 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 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 li-
cense Caw does not apply to an ownerof property who builds or improves thereon, and
who contracts for such pmjects with a contractor(s) licensed pursuant to the Contractor's
License Law.
C]I am exempt under Sec. 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 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.
❑ 1 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 Workers Campensauon insuranw carrier and Policy number arm,
Carrie rSii�� F V N Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forome hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so 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 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.)
Lcndees Name
Landers Address
I certify that I have mad this application and state that the above information is
morecL 1 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
liabilities, judgments, costs and expenses which may in anyway accrue against said City
in consequence or the granting of this permit.
APPLICANT UNDER TANDS AND WILL COMPLY WITH ALL ON -POINT
SOUR E ULA
Signal pli V clot Date
HAZARDOUS MATERIALS DISCLOSURE
Will the cep leant 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 �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 JqNo
I have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if uic building
dots not currently haw tenon that it is my responsibility to notify the upant of the
requi which m riot to issuance of a Crpiil c r cup
Owner d cc t Zh— Date '
BUILDING PERMIT INFO
INSTL • TEMP WTR SPLY& RETRN BLDG ELECT PLUMB
T .. Job Description
Ft.
Issued by:
Re -roofs
Type of Roof
Required Inspections
Valuation
Occupancy
Date
All roofs 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 'A"' or better
i
CITY OF CUPERTINO
NEW SINGLE/MULTI FAMILY DWELLING
CUPERTINO PERMIT APPLICATION FORM
APN # 32609056.ALL
Date: 6/23/2008
Building Address: Building 24, 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- ❑ 11, 111, lV V-B Lg
o t
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
;,ENO GENERAL BUILDING APPLICATION
FEE SCHEDULE
entity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1 GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1WINMEWSTR
New Window -structural shear
walUmasonry (includes plan ck fee)
B
IEPERMITFEE
Electrical Permit Fee
E
1 MPERMITFEE
Mechanical Permit Fee
M
/
1 PPERMITFEE
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
1BSEISMICO
Seismic Commercial
B
/
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
rA
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