10100177CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 76 CONTRACTOR: �� / PERMIT NO: 10100177
P&T-EIRMIt4ED b10/) l',eV L/11,57�G'i-7/)
I OWNER'S NAME: PROMETHEUS J Rl 1%1iril �l®ne//.__ �s/iln�o &U IJ DATE ISSUED: 01/13/2011 1
OWNER'S PHONE: 6509313476
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. 0
Contractorp,A 64-rr/- r,5,i (0y) ' 60 Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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 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 liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regula,Tns per th upertmo Municipal jode7)1
tion 9.18.
Signature �/� t//�— Dat, /
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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 & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. 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 Worker's
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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 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 liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Cj I6I GC _61( H I PHONE NO:
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
BLDG 76 C; REMODEL EXISTING KITCHEN(50SQ)CABINETS
& LIGHTS, INSTALL NEW WASHER/DRYER AT EXISTING
CLOSET(I OSQ),INSTALL NEW AIR CONDITION UNITS;NO
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 32609065.76 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by.• -- --- Date:
RE -ROOFS:
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 Appl
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or aut ?ized,
4/ Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professio
Signature
Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
*VALUATION: 1$20,000
rPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Building is
3 Stories 0 Yes ED No
PENTAMATION 1R3SFDREM
PERMIT TYPE: A
WORK
SCOPE
Mech. Plan Check 0.0 hrs $0.00
Plruub. Phw Check
Elec. Plan Check
Mech. Permit Fee: IMPERMIT
Plmnb, pooh Eec
Ek"c. permi7 Fee:
Other Mech. Insp. 0.0 hrs $42.00
Olho. Phimb lav).
Other Elec. Insp,01_
ddech. 111'y. Fcc.
PlItIO), %nsp, FPt':
Elec. Insp, Fcc.
NOTE: These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 E '. 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
50 s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT I
A
Suppl. PC Fee: E) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
10 s.£
$380.00
Remodel, Other
IREMRESOTH
Permit Fee:
$0.00
Suppl. Insp. Fee'0 Reg.
0 OT
Rflhrs
$0.00
= # Mechanical
$63.00 IBREMAIR A/C Units (<=10K cfm)
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
Cotisltwction Tax
Acoustical Fee:
0 Yes (D No
$0.00
G
Work Without Permit? 0 Yes E) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
i
Travel Documentation Fee: ITRAVD0C
$42.00
Strong Motion Fee:
IBSEISMICR
$2.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$87.00
$1, 013.00
TOTAL FEE:
1 $1,100.00
Revised: 10/17/2010