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11110025 CI'T'Y OF CUPERTINO IMILDINC PER1NUT BUILDING ADDRESS: 209001 I0N4ES'1'EAD RD (,'l I NACfOlt:NION'11'lz FY PERMITNO: 11110025 CO,S'I'R UCI'ION CON IPANY OWNER'S NAME: PROMB'1'I ZEUS 88 talus'I'6;I?EV-SA I,IN',AS I IAA'),SI'FA DATE ISSUED: 11/0 ER'SPHONE: 6509313,100 KAIdT.x S,Cn 93908 Pu0Nl:N0:(83D601-2659 Q LICENSED CONTRACTI)i UWl HON F F (-i --a9_�- BI111.ULNC. PEItAII'I' INFO: BLDG Fl,ECT PLUMB License Class I,iaH All?CII 121:S 111l:\Lr COMM ERCIA 1. Contracmr D:Ilc p/ CS I hereby affirm that l a licensed fader the pruyisions of Chapter 9 0011 D ESCH1P'I•IO,\': BLDG 7N-UNI'1'Yf-sENIODf:L Rf1'CI IhN(50Sn1;1')& (commencing with Section 7000)ill'Di%ision 3 Ili III,Ilmsinrss R Professions lx�ASI 11:1U t'YElk I10OKUP&ADD NEAV A/C UNI I' Code and that my license is in lull force and,ffict. 1 hereby affirm under penally of prriury Inc of IIIc hlloo'inp nen declar tions: I have and will maintain a certificate of ennsenl m sell-insure G,,\Voiker's Compensation,as provided for by Section 3700(Atilt I.:Ihol Code,for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Clmpensntion In9ur;lna•,ns provided for by „I Vidualion:520000 Section 3700 ofthe Labor Code, Inr the perl'nnnan.r of the work lar which this permit is issued. — .V' bur:32(091165.0(1 Ocrupnncv lypv: APPLICA.N f CrRTI I ICA'I ION I certifythat I have read this npplicm on will cane ilim dm above ininnnation is correct.I agree to comply with w11 6ty and couwy oldlu:wces and,tam laws relating to building construction,and hel authorize representatives of this city reenter IIF 10,11"I' E\P I R ES I F NVO R I< IS NOT SI'A RTI D upon the above mentioned property I'Ir inspection purplscs (We)agree to save indemnify and keep harmless the CilyofCupeniuom,mistlinhilitics,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which nutyacculcagain.tsaidCityill Consequence ofthe 1,AU I)AYS FROM LAST CALI.EI) INSPECTION. granting of this permit. Additinmlllr,the applic:m:uuJCrshnuls and still comply with all non-point sourcereguktims per C ulmlinl Nlwliclpal Code,Section 9.16. i � ,/���/��// // �/ Isued bv• /1� Date:/ Signature _i2�SI7/"C/—Date.L-[--4—JI / OWNER-RU11,DKI[ IIFCLARA i IDN RE-ROOFS: AllI, ',shall he inslivocd prior to mw fooling m:ucrial belle) insinted.11'a roof ishereby affirm that I am exempt f om Ihe.Cnntrnrtnr'.s License Law fur one If in.:dI- I ol.hota first hminim,an inspection,I nglce In remove ill new m:nem6 or the following two reasons: I,as owner of the property,or my employees with Ivugcs is(heir sole comlbnswlio11, will do the work,and the strict tire is not intended Or I-leted IDr site(See.7044, Sir cu.-,of Applic:un: Utile: Business&Professions Code) 1,as owner of the property,ani ecclusiecly cliimcI;u_with licensed contractors w construct die project(Sec.704,I,Hnsincs3& I'mlissiols Code). I.I, 1[11111'COVERINGS]O Ill:CLASS"A"OIi ISI':fl'192 1 hereby affirm under penally II'perj try one nl'Ilit,ell l to Ill Ire declarations: IIAIA RIMUS \L\'llilt IAA S DISCLOSIi RE, I have and will maintain a Coniffciae of Cousenl lnsClf-huurc lite AVotker's Ihev, nvdfhch:rzaNlus'uullcriaLs rrquirclnents uodrr C1111pler.(95 of the Compensation,as provided I'of tw S:ction 3700 of it c I dhor Code.hn the l:nL I1,•;dth S&defy.Cndc,Sections 255115,25533,;tad 25534. 1 will maintain performance of the work for which tills permit is i,sncl. eomplianee o'ilh Ihr Cupertino Ahmicipal Code,Chapin 9,12 and the health& >ahlp I'Idr.srcliou 2555'-Uthould I slore ur h:mdle hnzardnus material. I have and will maintain Worker's Compensation Insurance,us provided fur by s 1 Section 3700 of the Labor Code.tin the perlivuanve tt the work l7 r which this Addal,,aolly.should l my ecluipnvnl ur devlrr.c which emit hazardous air run.m.Hill ill,as delinrd he the Ikq :Aran Air Qualite,Ali na:„emrnl District I pill permit is issued. til;: v locwnpli:uuv o'ith file Cuprrlillo Municipal Code.Chapter 9.12 and file 1 certify that in the performance ol'the work k,r whidi this permit is issued,1 shift] I ire ,8 Suli•q Code,Scefiu 25505,`5533,:Ind 25534. not employ any person in any maooer so as to hec n t:suhiect Ie the Worker's Compensation laws of Calililruia. Il;niter making tii,ccnilic:ac nlezengniun,l u”11 .Il izr _ become subject to the Worker's Clnlpens:ainn prnvi.inns nl dm Labor Code,I inlet Darr: forthwith comply with such provisions or this pe:iiiii OtIll he deemed revoked. LII:SD INC,\G I.NCY APill.IC,AN'I CI:101 NI('V'lION 1ll,- ;:" ;1111I'll tha1filet:isaCon,struction Iced ing;Igency fou the performance ofcork's 1 certify that 1 have read this opplicfnion n11d 1111L a ;a the shove in fm 11121 ion is Ib1 .I-II This permit is issued(Sec.3097,Civ C.) correct.1 agree to complywith all city and ceuniv:ndinmmcs and slate laws relating I eI. Cr'.v,I.c to building construction,and hcrehy awhorize repiC acnmlivcs OI'Ihis city to enter upon the above mentioned prupcny kor inspection purpnscs.(\Vc):Igtee to save LCndcr','Address jiMnify and keep harmless the City ol'Cuperti110 ot,�ainst liobilities,iudglnenls, and expenses which miry aH cefue agalnsold C,t} ill couzrqurnec of the g, ming ofthis permit.Additionullr,the:glplic::nlLnd::Yl INNS and o ill comply .-A RCI I I'l E(A Is D FCI„A It AT ION with all non-point source reguIanols per IIIC CIpC1;uw Nlunicipnl Cndc,Section I III J f,':III I it,pinnsshull he used as public records. 9.18. Signature U:uc ti/03/2011 15: 33 (FAX) l I (JI��P. 005/005 CONSTRUCTION PERMIT APPLICATION E9 CLENOMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORREIAVENUE•CUPERTINO, CA 95014-3255 CUPERTIN0 (408)777-32201I• FAX(408)777-3333• buildlnClAcupertlnoom ED NEW CONSTRUCTION ❑ ADDITION ❑ ALTE�RA'fIONTI ❑ REVISION/DEFERRED ORIGUNAL PERM IT9 PROJECT ADDRESS AI'NN ZC�g00 \ �Cm�eS� ecd1 2c4 . F31 _�C1 n >WNER NAML' PHONE E. IL STREETADDRPSSCITY,STA TE,ZIP FAX %V i1 '.yam Mc3c'(a. 0,� o CDNTA LT NAME � PHONE R.M IL cn'Z>\ STMETADDRESS CPTY,STRC, ZIP FAX 3 R V�S-1eis6tn 0 OWNER 0 OWNC&BUBOIX ❑ OWNERAGENT pt CONTRACTOR OCONTRACTORAGENT ❑ ARCHITECT O ENGMEER O DEVELOPER ❑TENANT r.ONTRACTORNAMH LICENSE ELLICENSIgPE BUS.LIC Ny t� COMPANY NAME E-MAIL FAX(.£3M1) u�a-mMC.o r-,�.-�rJ�. . r.,-. SS ---I STREET ADDRESS —� �6u TYIC T\b t'l ` CITY,STATE,ZIP _ PHONE C 9-6' e-4- .�r.IL%rw'S. \ktPi-�, {{ �, Sc_R:.r.G's_r�fa c-Y'>SG�! VSS' -lc=r 3 ARCHITECT/ENOINEER NAME LICENSE NUMBER BUS.LICA COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE.ZIP PHONE DESCRIPTION OP WORK �— \ wc.=mer/G4rer _ c:.h- e.x�a-\-;•r.., ITIS}Nz\\ >,u� cur i-ti17.".v-e EXISTIPM USE PROPOSED USE CONSIRTvPE MBTORNS rull'YIU 11�I�tl IIPII��II! ;Itftgpikr;!. WILL*IT, aP it � I•I INnI Ttl MI11v r- NII IGM1 Ytl. 1 il) ti! 111[ •�'.• 9 V T rxlsrG NEW FLOOR nrJno TOTAL AREA nnPw AMA NETAMA BATHROOM KrrCHEN OTHER i�diil�llt' Ii 1�lI�.� Ilffrl)M M1 ISI II'}���( - RF1dODELAMA R[MODCLARPw Rrmom n'ARPw \O DI, f 1Y r{�'�IT(. //I' PORCH AMA DECK AMA TOTALDECKIPOKOI AREA OARAGEMNA:O DETACH �!;I I 'I� II (t 5 II `¢pITS Irl 1 1 ICI 11 . !� f IIIY iii ILII i r n.i O ATrncu ( JpryII+1 �I U r 1 1 I p,l urr 1'II11 I '.VAR..INa.Ks' INA NmaNJ UNIT yes 9rco.STonv OYES IN�1��1• IP �• � '� � '.11'171 1 lr Y . anNceancar Nb .mmNONro N1 ( � +1+1 a Ihtt Oi PsdAPPLIGTPJN ❑ YEN If Yes,PROVIDE COPYOF PLANNER'S NOMI ,I NGn 1111%Y S` N 1 'll PIANNINKI NO 4II��I I�Y�Lw�I jIJ�I�.TI+lN'i1l111�PIrTvALVALTIO�N: 1 .GJ�a By my signature below,I certify to cacti of the following: I am the progeny owner or authorized ngent to Ect on the proper) owncr'e behalf. 1 have read this application and theinfonnalion I have pr vi ed is correct. I have rend the Description of Wnrk and vui(y it is necurme, I o Tee to comply with ell applicable tocol ordinances and stole laws rclaling t di g construction. I authorize representatives of Cupulino to enter the ahovo-�denl�ied(propert/y for Inspection purposes, Signature of Applicant/Agent: Dale: f�—Gf i�� SUPPLEMENTAL INFORMATION IU-,QUIRED ILII M1�DIl+ Rt A1�GAE�KPJn PG.rl+w� Ni +.LY' P{oUTINC`lldiP New SPD or Multifanuly dwellings: Apply for demolition permit for �T �1+1" i+'i;liM1+'+LS 'n4r11 It Is -r ; 1 'tl HEI OU PENN '? I�} ��,,,,,,,,,,,,PLAN REVIEW permit building(s). Demolition permit is required prior to issuance ofbuilding III II II ,{1P1 II,r,u�ISPI I III..�I'•••� for new building. I Q PIIS Ib�C"� 1J lu 1jJ� )N I' St1' Commercial Bldgs: Provide a completed Hazardous Materials DisclosureY�uA�ry�i1NJGlrLANiRGV1EN. g P i(1�1'krAapU41 11 , form if any Hazardous Materials are being used las part of this project. IU 1 III II t y{IF )#1 a1©'`I nolle wonus Copy of Planning Approval Letter or Meeting with Planning prior tok�r I��r;)'f1)�Aat{ lT^�i�6l � ly�li{ip RenFt7 submittal of Building Permit application. ITARYSEwgwpiSTRICT j{�N ' til II Ip fl l l 1 ;I';rNV RONMENTAL,HEALTII' BldgApp_201 l.doc revised 03116111 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 #. . . . . . . . . : BS000015241 REFERENCE ID # . . . : 11110025 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 . . . . : 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 41. 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 PERMIT 915 . 00 0. 00 915 .00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --- ----------------- CREDIT CARD 3, 660. 00 MC --------------- TOTAL RECEIPT 3, 660 . 00 • CITY OF CUPERTINO ITEM 2 OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 32609065 . 00 DATE ISSUED. . . . . . . : 11/07/2011 RECEIPT #. . . . . . . . . : BS000015246 REFERENCE ID # . . . : 11110025 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- ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN 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