11110088 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11110088
CONSTRUCTION COMPANY
OWNER'S NAME: VS II LP • 88 MONTEREY-SALINAS HWY STE A DATE ISSUED: 11/17/2011
.R'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class;a
q
�� 2 MECH r RESIDENTIAL r COMMERCIAL r
Convacto ate
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 7UNIT C,REMODEL R-2 KITCHEN(50 SF),ADD
(commencing with Section 7000)of Division 3 of the Business&Professions NEW WASHER&DRYER(IO 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:
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.
1 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:
1 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 harmless 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 per the Cupertino Municipal Code,Section
9.18. /�jJ _ J
Signatur a� Date IA4&=-- Issued by: DateV�Ti2�7
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,I agree to remove all new materials for
1,as 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(See.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as 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
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 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,as 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 dented by the Bay Area Air Quality Management District I will
1 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,Sections 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 Own or I�orize p
forthwith comply with such provisions or this permit shall be deemed revoked. Dater
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 certify that I 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(Sec.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
nVoify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
cnd expenses which may accrue against said City in consequence of the
gr ng 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. 1 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 # . . . : 11110088
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
•
DO
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
• ADDRESS: 20900 homestead rd DATE: 11/15/2011 REVIEWED BY: bob s.
APN: BP#: "VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE: At
WORK remodel r-2 kitchen add new W/D and new A/C unit.
SCOPE
Mech.Plan Check 0.0 hrs $0.00 I'lun,h 1'1.,..Cheek F •r. Plev,Chv'A
Mech. Permit Fee: IMPERMIT INnn,L. Po"w 1'rr. 0, 14 rual fcr
Other Mech. Insp. 0.0 hrs $44.00 Oda, Ptru.dhb..pEl
,it+,.' fl', 4„P.
hlrah. Lesp Fv,z. Plun.h_Lav P_ F", Oo h..I Prr
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution /1-053 E$ 7.'/,'11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 so
Suppl. PC Fee: Q Reg. Q OT FO.0 hrs $0.00 $588.00 1REMRESKIT
PME Plan Check: $0.00 717 # Mechanical
Permit Fee: $0.00 $65.00 IBREMAIR A/C Units(<=I OK cfm)
Suppl. Insp. Fee:Q Reg. t7 OT 0.0 hrs $0.00 2 # Mechanical
PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
Consiruenon fav
Administrative Fee: 1ADMIN $41.00 C)
Work Without Permit? O Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
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
"SUBTOTALS: ' $132.00 $783.00 :`TOTAL`FEE: $915.00
Revised: 10/01/2011
11/15/2011 14: 53 (FAR) / /P. 002/005
CONSTRUCTION PERMIT APPLICATION; \CP
• ,.• COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ��
10300 TORRE AVENUE•CUPERTINO,CA 95014.3255
CUPERTI NO (408)777.3228• FAX(408)777-3333•bUIIdInO fI CIIDertlmo ora
❑NEW CONSTRUCTION El ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINALPERMITN
PROJECT ADDRESS 1M 4 APN p /)v•
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By my signature below,I certify[Beach Of the following: I am the property Owner or authorized agent to act on the property owner's behalf. 1 hove read Ihle
applicationfinanes and llse intormatlon I have pr vi ed is correct. I have read Rha Description of Work and verify it is accurate, 1¢gree to comply with all applicable local
ordinances and stale I=relaling 1 1 g construction. 1 authorize representatives Of Cupertino to enter the above�d I ogre property for inspection purposes,
ble roc
Signature ofApphcanUAgenl; Y 5
Date \\/ 1 66 �
SUPPLEMENTAL AIFORMATION REQUIRED
trill Jl t•�i�AIEC E:� ,:>x>,I ,1111 'RouTlNc scrr
New SFD or Multifamily dwellings: Apply for demolition permit for i + n 1
existing building(s). Demolition permit is required prior tD issuance ofbuildin , f i tri 11 i DUIODINC`pLAN�neVIEw -
8 �I 1pp l{ I l tl i l r u
permit for new building. : ,
Anil 1
I,11 N J) I 1�� t PW�\,'t11NG PIAN REVIgtV
Commercial Bldgs: Provide a wmpleled Hazardous Materials Disclosure
y1Ql A U W)Y@P;tL P})I�JI 1P�rj1p1�PI1l,IC WORKS
form if any Hazardous Materials are being used as part of this project,
Copy of Planning Approval Latter or Meeting with Planning prior tD
submittal of Building Permit application.
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BldgApp_2011.doc revised 03116///