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11110086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11110086 CONSTRUCTION COMPANY OWNER'S NAME: VS 11 LP 88 MONTEREY-SALINAS HWY STEA DATE ISSUED: 11/17/2011 'R'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(931)601-2659 LIC NSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.8 MECH r RESIDENTIAL r COMMERCIAL Contractor Date - 1 hereby eRrm that t a censed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 79,UNIT G,REMODEL R-2 KITCHEN(50 SF),ADD (commencing with Section 7000)of Division 3 of the Business&Professions NEW WASHER&DRYER(10 SF),AND NEW A/C UNIT 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 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. 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 Sq.Ft Floor Area: Valuation:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:32609072.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep hamiless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations pe he Cupertino Municipal Code,Section 9.18. / / Issued by: Data!-Z-27 Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,1 agree to remove all new materials for 1,m owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,m owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,m provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,m provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sectio 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner o• h •I ed forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(See.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save t ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ii�hnd expenses which may accrue against said City in consequence of the gr mg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO • 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32609072 .00 DATE ISSUED. . . . . . . : 11/17/2011 RECEIPT #. . . . . . . . . : BS000015349 REFERENCE ID # . . . : 11110086 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . VS II LP ADDRESS . . . . . . . . . . : 20900 HOMESTEAD RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RICHARD 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 02589Z --------------- TOTAL RECEIPT 3, 660 . 00 • CITY OF CUPERTINO ` 1 FEE ESTIMATOR-BUILDING DIVISION • tAPN S: 20900 homestead rd DATE: 11/15/2011 REVIEWED BY: bobs. BP#: "VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PERMIT 1R3SFDREM USE: PERMIT TYPE: USE": r-2 kitchen add new W/D and new A/C unit. SCOPE v s.F.;k"::xi�'.firq^..�,F �l,.ar.���,�+�i�`.r•�'�. ` � # TMi !. . y {�. 74 r'r ,tdY �t4�r rr• Iv_ •'� tfi' - is t ,. ,v3+ - a._- ,- � -"; ' 3: Mech. Plan Check 0.0 hrs $0.00 P'lowl- I lao Ourh Flo", 1,001 Ow,6 Mech.Permit Fee: JMPERM/T 1'honj, Prrr,t:r Frr. 13r P,mw fs • Other Mech. Insp. 0.0 hrs $44.00 nd„, )trunD Li,p ,, J I<v !,:,;. Ahr,:L, Inv, !"ro )'luu;h, beep_ !',a�' €irr Ju yr.Far NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelinI information available and are only an estimate. Contact the Det for addn'l info. FEE ITEMS (Fie Resolution 11-053 EB' 7,11/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 s0 Suppl. PC Fee: Q Reg. Q OT 0.0 Thrs $0.00 $588.00 1 /REMRESKIT PME Plan Check: $0.00 1 1 # Mechanical Permit Fee: $0.00 $65.00 IBREMA/R A/C Units(<=I OK cfm) Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 2 # Mechanical PME Unit Fee: $0.00 $130.00 JBAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 Construction Tav Administrative Fee: JADMIN $41.00 Q Work Without Permit? O Yes Q No $0.00 E) Advanced Planning Pee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item • Bldg Stds Commission Fee IBCBSC $1,00 SUBTOT•AtiS:' $132.00 $783.00 TOTAL FEEr:' $915.00 Revised: 10/01/2011 11/15/2011 14 : 54 (FAX) P. 004/005 CONSTRUCTION PERMIT APPLICATION' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION • 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTIN0 (408)777-3228• FAX(408)777-3333 •building(Rcunedino ortt ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI 0'_REVISION/DEFERRED ORIGINALPERMITN PROJECTADDRESS 0,;t- APNN 0 p, ^� /� 2 GOO \ lame\eccR 2�0, F'a1dc' q H C� = 1 D OWNER NAMQ PTvm� eiLJ�7 �`QC 1,� �,cU+ala Pf10NE � E-MAIL •moo Gi\-3yuo STREET ADDRESS CITY,STATE,ZIP PAX -.L qoo r �o, �� �1. a i5co n r c Few, ' CONfACr NAME v J\ PHONE &MAIL. �2. G_ 31 La�7- ci�J\ '}�"1le.�LG(�r•nr G=,:1:'a�r�Jl�h�U�.f.,,... STREHT ADDRESS CITY,STATD, ZIP YYI=.rcF Cr _`�G4i-rtes Ht.+ :H ' roc- C..f�. C13 l� 4'3\ ❑OWNER ❑OWNER-BUILDER ❑ OWNCRAOENT CONTRACTOR ❑CONTRAMRAGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑TENANT r'ONTRACTOR NAME ��C .g 1�r�0._ LICENS��MDEIt\� LICENEF. BUS.LICA .��J�Z�� COMPANY NAME EMAIL FAX TY'ro1�Y C.e:r� }r.Iew. +1-�eJ.�r_. , rry f.orF'v-�c:4:.�. r.>, •SS-'1 SSSln STREIrT ADORI;SS CITY,STATE,ZIP PHONE«''•++'� �i55� TV16rVreJ' r�A.•S \ SCa..Qw.(�C.S, LA G3�;0�G' Lass '1C.3 ARCHITELTrENOINEER NAMp LICENSE NUMBER BUS.LIE Y COMPANY NAME E-MAIL PAX STREET ADDRESS CITY,STATE,ZIP PHONE. DESCRIPTION 0P WORK \-c.\ EXISMOUSQ PROPOSED USE CONSTIL TYPE #STORIES `nl 9 hY.{1 l �1 lfJ Iwo 1 L T I .'S EXISTO NEW mom DEMO TOTAL - III�II I I ! I I I,I L(�1 {�II{Ih Ipl ISP Il flit IV T AREA AREA AREA NET AREA I)1.41��I 11 �ta"tl 'm��1Y11 lil�l)9,1? "klr:a� r:,i � ' ,;�INII..f t , BATHROOM KITCHEN OTHER RPMODELAREA REMODCLARG REMGDELARBA PORCH AREA DECK AREA TOTAL OECKIPORCTI ARCA GARAGE MCA:❑ pf!1'ACH �N( P f1 H "I it 7d 1 E ❑ATTACH •Ki l� 1 LIN I{P' d( „u fUWELYNO VNITID I ISAYecaw UNr rm ..r.mercmr ❑M RI velNC Anvevrr4no womaNr It �N u� 18N r wlU��t16s1i1r V�J f-�: r Irh{ PRadMLICATDN ❑ yp5 PYPS,pROVIn¢COM'Dp PLANNFA'SNAM6 euNNEGAPPLS ❑ Np PUNxwD AIreWALldirSl I ! P' { 1 T�TAL\A4IJATIbN application my Signature below,l wrlif I to each of the following: I have the property Owner or authonzed agent to act on the properly owner's behalf 1 have rend this appliallon and the infannalion]h¢va pr vi rd is correct. I have rud Ilse Description of Work and verify i1 is eaumle: 1 agree Io comply wish all applicable local ordinances and slate Iowa relating 1 I g eanstruction. 1 authorize representatives of Cuperlfno to enter[he above-� endfied� operty Cor Inepcction purposes. Signature ofApplianl/Agent: Date:_ 1\ I I ` SUPPLEMENTAL INFORMATION REQUIRED 1 11' \+ , + I+• + , 1'v I _ tRDUTINaSur New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildingIVILDmD PLAN REVIEW permit for new building. "a1'L N ]NOILAN�' VIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure l'ps )s<p4 1�,11� +Ijru IQ won%s I . tbrm if ally Hazardous Materials are being used as part of this project. � � , p 1� ` b II�t 'll 1a� n T ) 6 k N�u1�4 uI�{° n 1 f21'f 1jDLPT' Copy of Planning Approval Letter Or Meeting with Planning prior to '+ �I) III liJ41� !I (I1� II ,' + 1 ` submittal of Building Permit application. ij{5� 6'1J1�N�'AIJLT,fny sEWsq pErmer !'m�lll.l�t �II 4'�II (I �I�1G�'1'�N�L�NIYp NMENT 'L IIBALTII Bldg.4pp 20/l,docrevised03/16/11