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11110024 CI'T'Y OF CUPERTIN'O BUILDING PERMIT BUILDING ADDRESS: 20900110MESTEAD RD C".1; 'RAC I'Olt:MON"ITRI?Y PERMIT NO: 11110024 CONS'II MCCIION COMPANY OWNER'SNAME: PRONIETHil1S DATE ISSUED: II/04/2011 ER'SPHONE: 6509313.100 SA CA 93908 ItII0Nr:N0:0s3t)601-2659 LICENSED COu•1'RACT'O/IVSS DECLARATION Itlll r r L.I11NG PF:IL\Iff INFO: I1LDG ELECT PLIJ\113 License Class_ Lic.4 u / r rJ 1_< //��``JJ��rr,,��r'I / MI:CII RISIDER'1'LV. COMMERCIAL Contractor hereby affirm tuella" ensed under the provisions ol'Clmpter9 JOIi DI?SCI21P'I'ION: BLDG19-lNl'f2r-It IiA10DIiL KIi'CIi1lN(SOSQI''I)& (commencing with Section 7000)of Division 3 of the Business& Professions WASI I1:1UDRYER 11001:UP&ADD N1:W A/C UNIT' Code and that my license is in full farce and el'l'ccl. I hereby affirm under penally at pe, ury(tile of the following hen declarations: I have and will maintain a certi Gcate of consent lo scl l=insure liir Worker's Compensation,as provided for by Section 3700 of the labor Code, for the performance ofthe work for Wiich this permit is issued. I have and will maintain Worker's Compensnlion loaurmce,as provided for by S+ l i l loft, A,ea: Valuation:520000 Section 3700 ofthe Labor Cade, for the perlimnancv of the work forwhieh this _ permit is issued. VI'N N ono her:32609065.00 Oceupan'.% TAla•: APPLIC:AN'T CI'HTI FIC\'I'ION• I certify that I have read this application and sLLtic than the above information is correct.1 agree to comply with all cky and county ordinances and state laws relating to building construction,and livebyanthorive tv Piesentatives ofthis city to enter PER1�lIT EXPIRES.IF WORK IS NOT STARTED upon die above mentioned property for inspecfwn purposes. (We)agree to save indemnify and keep harmless the City afCupertinoagainst liabilities,judgments, WITHIN 180 DAYS OI' PERIMIT ISSUANCE OR costs,and expenses which may aecnmagainst soidCity inconsequence ofthe INO DAYS FRONI LASTCALLEDINSPECTION. granting of this permit Additionally,dile applicant understands and will comply with all non-point source regulations sr the Copertino Municipal Code,Section 9.18. Issued Ind DOte�/ y Signature D;nc OWNER-IIIIIIMFIt IIECLAR\TION RP:ROOFS: Mt roof,shall he in,peeled prior to unv tooling mnlerial heng installed. If a roof is 1 herebynfftrm that 1 am esenipl train the Conlrarlur's License,Law for one ut' 1 st:,i_I he:Ihunt Ilrsl ohtoining all inspection,I matte to remove;111 nor materials for the following two reasons: iml.cr(toil 1,as owner ofthe property,or lit\,employees wish wages as their sole compensation, will do the work,and the stmchn'c is not intended or ollfered for sale(Sec.7044, Sign l ac of:Applicant: Dale: Business&Professions Coile) _ 1,as owner ofthe property,ant esclusivcly cnmroctin3 ty th licensed contractors to construct the project(Sec.7044,Itusiness& Prollcssions Code), A LI.HOOF COVER INCS TO BE,CLASS"A"Olt 111i1-I'F3t I hereby affirm under penally of perjury mor al'tile I'ulluwing Ihree declarations: I IA ZA It DOI LS J IAll?It Lk LsIIISCLOSI IItE I have and will maintain a Cc,iilic;uc ol'Consenl to sell'-insure for Workers Iha\t rend t he lnreardous unle,asrequirenn•nts under Chapter 6.95 ofthe Compensation,as provided I'm by Section 3700 to dhc I.;[hor Code, for the Colih.,not I Ictdth&Sat'ety Code,Sections 25505,25533,and 25534. 1 will maintain performance ofthe work for which This permit is issued. tonpli net-wilh the C livrtino Municipal Code,Chapter 9.12 and the Ile:dth& 1 have and will maintain Worker's Compensation Insurance,ns provided for by Sart 1, (-'ode,Section 25532(a)sho ld I store or handle hazardous mao-i al. Section 3700 ofthe Labor Code,litr the pertonmmcc of dhc wolk for which this Add tlnnally should I lite equipment or devices which emit hazardaols air rnut mu trumt,as dclined by the Inn'Area Air Quality Mlanngemenl Di<irivl I will ' permit is issued. muian(in cunlpliance u'ilh the Cupcnino Jlunieipal Code,Chapacr A 12 and the 1 certify that in the performance ofthe work lonchich this permit is issued,I shall lit atil, .4 S:di•ty Code,Sections 25505,25S3.3,:Ind 25534• notemploy any person in any monncr so as to hctomc subject to dile Worker's Compensation laws of Calitihmin. 11;niter onakimt this ccnil arae olcxcntption,l O„t ri> become subject to the Worker's C'nmpensmion pto, sions ol'Ihe Lahnr Code,I must forthwith comply with such provisions or this pnnhii shall be deemed revoked. \ CON:S'I Itllf:TION I.N_NI)ING AGVNCV APPLICANT CI(It'I'I 1 IC'V'1'ION Thar!+v lfwil thin there is a construction lending agency for the perfnnnnnec ofmrk's I certify that I have read this npplic;otinn and sunt Thal Iloc above inlivntation is fit t, rich this permit is is,sucd(Soo 3097.Civ C.) correct.I agree to complywith all city and county ordinnnces anNatal- to d slate Imus relating Lena,.',building construction,and hcrchy amhoriic represcnultives of this city to enter upon the above mentioned propeny for inspection purposes.(We)agree to save Ly...1, nddn•s mify and keep harmless the Citv of Cupcnino against liahili6cs•judgments, and expenses which may iecnw against ';lit City is conscqucncc of the din ofthia ermit.Additional) theattlic,mumdc rsimids and still coat I :112Cllfl'IY'f'S DIiCI.,AR:A"PION' k•-• g P 5' II comply with all non-point source regtdntitsos per the Cupertino Municipal Code,Section I undcr,mnd any plans shell he used ns public records. 9.18. Lieru.rd I'rufrssionul Signature Dak• 11/03/2011 15: 33 (FAX) 004/005 _ r 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ' • 10300 TORRE PT/ENUE •CUPFRTINO, CA 95014-3255 CUP6RTIN0 (408)777-3228..• FAX (408)777-3333• buildinn(a�cuoertino ora ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEPERRED ORIGINAL PERMIT N PROJECT ADDRESS tante APNN 20G00 \-1cx^r�es�earA � 61d�c u OWNER NAML' PHONE p. IL Ecom ws 2er.V_ E:'��:�1-e G_tc STREET ADDRESS CRY,STATE,ZIP EAX CONTACT NAMC PHONE E. IL STREET ADDRESS CITY,STATE, ZIP AlF y`r1c.Nvk 0 _::Jc.Q�..nwS Nt.%y, +Rl (a roc C.-r� 3 C�c' 3x V• ❑OwHER ❑OWNER-BUILDEI ❑ OWNERAGHNT CONTRACTOR ❑CONTRAC R AGENT ❑ ARCHITECT ❑ENGINEER ❑ DE TUOPER ❑TENANT cONTMCT00.NAME LICF.NSCNUMBER LICENSI�;PE BUS.LIC x -2 COMPANY NAME E-MAIL YY-me>T-v�"2 C.r:c1S'-F-r� c:F�ern! -1-\�eJ.�e.P me t:.nr siK-v�rh�,�. w-. 55 -—I C-.?\'. STREET ADDRESS CITY,STATE,ZIP PHONE```4 r 15sf r•nor�rel' -S r..:.'s \A.� SCa.fL:.fvS. C1a G3�G�6' `1S5 '1G'',.> ARCHITECT/ENGINEER NAME LICENSENUMBER BUS.LIC0 COMPANY NAME EMAIL TAX STREET ADDRESS CITY,STATE,ZIP PHONE OESCRIPT1ONOr WOR% erer _-1- lY C_ a '. mss, \c \.\S . \/akuc.,-cx-\ - ' 2�p Iv�yO.ra E%LSTIOUSE PROPOSED USE CONSnt TYPE I MSTORHSSI 1{ J j.� �PII { �� � - 11,,: q,1 II qq1 91 1 1 111' {.,f III I.I Es T ISTO New FLOOR DEMO TOTAL I IItr4l I{�11S�I It(1i1 TNI) Ili )il' /� AREA AREA AREA ' NM ARHA 1 BATHROOM RJrcmw ona•x' {�{'I'Id'S'�9�Nj IPt!II)hT)IPIu�I1111 R[MOD[LARPJ, REMODMARE.A KPMODELAREA \O .. llul,4f{I,i,I`pr' PORCN ARCA DECK AREA TOTALDECKa'ORa1 ARRA GARAOEARG:❑DETACH {I /I 111 1"Ii r111tn11 ,�I�Ir�iP °�r TT ❑ATTACH ,1 11I>✓� 1li �{ rl)1'✓ihl ' 141 I' 1{ki4/IIti1x- 1d. xoWLLDNo uNITs: Ixnxeeuw umT YL9❑ CCONDxTom vas ❑s us ,G ,t( I11, !141 fi'k AI��,11 {Ij I if mc noncar qa mmnonr 'No , 1{i���C .xIliU PRP.APPUCATVN ❑ YES IFVRSPROVWBC0PYOP FUNNF.R'SNAWL 1'1111 NI r 71. Ill p•. �ry Tl 1 1} 1 H h�SU� 7t II�Ay� M 1� 'N I 1 T'y FUNNM]MFu !io FUNNwO MFRwAL12TfER J 02 y�`f I' Icy) }�17 TOII LVALVAh'ION ❑ 111 {{"11 rI 2'IP Ib�,��4i. �I119a94�14'1M 141.- brlhaa-0.,•.-;_:. By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the properl.e owner's behalf. 1 have read this application and Iha inConnntion I have prpvi ed is correct. I have rend the Description of Work and verify it is accurate. I o Tee to comply with all applicable local ordinances and stele laws relat!ng I '(di g construction. 1 aullwrim rcpresentutivea of Cupn'Iino to enter the above dent tiiedproperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMA'P!ION REQUIRED •I,...A• NP ANLCnEC PnI IP,07 I, . .. U1114.0'S-D:P. . New SFD or Multifanmly dwellings: Apply for demolition permit for existingbuilding(s). Demolition permit is required prior to issuance of building l�j1111e� �IuNil��k I,r 1�Q UILPINC PLAN IIEVIEW P 9 P g 1 'u ,I 1 P g.. J 1`�Irl y,(J!4,d II 11{ lr� V I - permit for new building,. J iElc td I 't I r91 jm!�{� of I JJJJ Conunmcial Bldgs: Provide a completed Hazardous Materials Disclosure 'm PA1yI�m B 4�\tt11 i ull�t II'I 1 P'll rli4Lte wonits ' form if any Hazardous Materials are being used-as part of this project GB� Itl�{ti�111:N a �!{ rllty' i I ti ifµ1I ✓ O�f +I1 ll � ��; IaPDEPgt II. Copy ofPlanrilng ApprovRl Letter oT Meeting with Planning prior to submittal of Building Permits application. I,r I.£n�lr �tY SEW RBISTRICT 8 PP 11h •'R` IF �. . rENumI`N�EH�Inilln�nlm��.- BldgApp_201 Ldoc revised 03/16/1/ • CITY OF CUPERTINO 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32609065 . 00 DATE ISSUED. . . . . . . : 11/04/2011 RECEIPT #. . . . . . . . . : BS0000IS241 REFERENCE ID # . . . : 11110024 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . _ OWNER . . . . . . . . . . . . : PROMF..T!?EUS ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE 150 CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 RECEIVED FROM . . . . : RICH' D REGA CONTRACTOR . . . . . . . : BEN REGA LIC # 32275 COMPANY . . . . . . . . . . : MONTEREY CONSTRUCTION COMPANY ADDRESS . . . . . . . 88 MONTEREY-SALINAS HWY STE A CITY/STATE/ZIP . . . : SALINAS, CA 93908 TELEPHONE . . . . . . . . : (831) 601-2659 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1. 00 11. . 00 0 . 00 41. 00 0 . 00 1BAPPLOTHE NO OF APPLIAN 2 . 00 130 . 00 0. 00 130 . 00 0.00 1BCBSC VALUATION 20, 000 . 00 1 . 00 0 . 00 1 . 00 0.00 1BREMAIRHA NO.UNITS 1 . 00 65 . 00 0 . 00 65 . 00 0. 00 1BSEISMICR VALUATION 20, 000 . 00 2 . 00 0 . 00 2 .00 0. 00 1MPERMITFE FLAT RATE 1. 00 44 . 00 0 . 00 44 .00 0.00 1REMRESKIT SQ FEET 50 . 00 588 . 00 0. 00 588.00 0.00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0.00 44 .00 0.00 ---------- ---------- ---------- TOTAL -------- TOTAL PERMIT 91.5 . 00 0. 00 915.00 0. 00 • • CITY OF CUPERTINO ITEM 3 OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32609065 . 00 DATE ISSUED. . . . . . . : 11/07/2011 RECEIPT #. . . . . . . . . : BS000015248 REFERENCE ID # . . . : 11110024 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PROMETHEUS ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE 150 CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 RECEIVED FROM . . . . : MICHAEL FURTADO CONTRACTOR . . . . . . . : BEN REGA LIC # 32275 COMPANY . . . . . . . . . . : MONTEREY CONSTRUCTION COMPANY ADDRESS . . . . . . . . . . : 88 MONTEREY-SALINAS HWY STE A CITY/STATE/ZIP . . . : SALINAS, CA 93908 TELEPHONE . . . . . . . . : (831) 601-2659 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- lADMIN HOURS 2 .00 82 . 00 41. 00 41. 00 0 . 00 1BAPPLOTHE NO OF APPLIAN 2 . 00 130. 00 130. 00 0 . 00 0. 00 1BCBSC VALUATION 20, 000 .00 1. 00 1. 00 0 .00 0. 00 1BREMAIRHA NO.UNITS 1 .00 65. 00 65. 00 0 .00 0. 00 1BSEISMICR VALUATION 20, 000 .00 2. 00 2 . 00 0 .00 0. 00 1MPERMITFE FLAT RATE 1.00 44 . 00 44 . 00 0 .00 0. 00 1REMRESKIT SQ FEET 50 . 00 588. 00 588. 00 0 .00 0. 00 1TRAVDOC FLAT RATE 1. 00 44 . 00 44 . 00 0 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 956. 00 915 . 00 41 .00 0. 00 •