11110089 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11110089
CONSTRUCTION COMPANY
OWNER'S NAME: VS 11 LP 88 MONTEREY-SALINAS RWY STE A DATE ISSUED: 11/17/2011
R'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(sap 601-2659
AO LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class L1c.q
MECH r RESIDENTIAL r COMMERCIAL.r
Contmctor Date_
1 hereby affirm that 1 ant licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 79,UNIT H,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 farce 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
indemnity andeharmlesstheCityofCupertinoagainstliabilities,judgments, WITHIN 180 DAYS' OF PERMIT ISSUANCE OR
costs,and expensxpensess accrue may ecce against said City in consequence of the
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. Z�l/
Issued by. - Date:
Signature 'e Date
dw OWNER-BUILDER DECLARATION
RE-ROOFS:
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
I,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
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I 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(x)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as def ned by the Bay Area Air Quality Management District 1 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,Sections 25505,25533,and 25534.
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 Ow a
forthwith comply with such provisions or this permit shall be deemed revoked. Date:`
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I 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
in�fy and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
cc d expenses which may acerae against said City in consequence of the
gran 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. 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 # . . . : 11110089
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
•
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
• ADDRESS: 20900 homestead rd DATE: 11/15/2011 REVIEWED BY: bob s.
APN; BPti: "VALUATION: $20,000
4PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM
USE: PERMIT TYPE:
WORK remodel r-2 kitchen add new W/D and new A/C unit.
SCOPE
Mech. Plan Check 0.0 hrs $0.00 Plao,h. Plan Cherk Elec.Plan Check
Mech. Permit Fee: I MPERMIT I Plmnh. Pruni!Fee: E1ee.Permit Fee'
• Other Mech. Insp. 0.0 hrs $44.00 Other Plunk bap. Ofhar b h' 1,012. EJ
Meek Insp, Fee: Phrmh. hasp. Fee 17c,. hop. I'er:
NOTE: This estimate floes not include fees flue to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina Information available and are only an estimate. Contact the Dept for addn'l into.
FEE ITEMS (Fee Resolution 11-053 U. 7/1111) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 ETIs.f. Remodel, Kitchen(<=300 so
Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $588.00 IREMRESKIT
PME Plan Check: $0.00 F-1-1 # Mechanical
Permit Fee: $0.00 $65.00 1BREMA/R I A/C Units(<=I OK cfm)
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 = # Mechanical
PME Unit Fee: $0.00 $130.00 /BAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
(.'onslruation Ten-
Administrative Fee: (ADMIN $41.00
Work Without Permit? Yes t'. No $0.00 E)
Advanced Planning Fee: $0.00 Select Non-Residential (E)
Travel Documentation Fee: 1TRAVDOC $44.00 Building or Structure
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $132.001 $783.001 TOTAL FEE: 1 $915.00
Revised: 10/01/2011
11/15/2011 14 : 55 (PAX) P. 005/005
CONSTRUCTION PERMIT APPLICATION 0
,.• COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION t \\
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 \ \
CUPERTINO (408)777-3228• FAX
I-(408)777-3333 •Lldldlng a[�cunerlino ora \
0�NI7W CONSTRUCTION ❑ ADDITION ❑ ALTERATION/1'I ElREVISION/DBIIGRR1iD ORIGINAL PERMIT 0
I'RO11eLT ADDRESS APNX
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❑OWNER ❑ OWNER BUILDER ❑ OWNERAGENT 'A CONIRALTOR ❑CONTIIACIDRAGENr ❑ ARCHITECT ❑ENGMPAR ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICHJNSI•,�YPP. BUS.LIC ff
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COMPANY NAME E-MAIL
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DL'SCRIPTION OP WORK
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By my signaNrc helmv,I certify to each nr the following: I mm the property ownu or authorized agent to act on the properly owner's behmlf. I Imve read this
uppli I.alion mad the in fonnnlion 1 have prtrvi Icd is concet. I Ow.,c id the Description of Work and verify it is accurate. 1 agree to comply with III applicable local
ordinancesandsmtclaws rclltingt 'di gconsWction. Inwhoriu represcmntivrs of Cupertino In enter 'theabove
1dnhfier�p operly for inspection puryases,
SignattecofAppliwnt/AgcI Dme; 1 1� 11
SUITLEMBNTAL INI>OItMA I ION REQUIRED IIp111T' a!NtE I da
ImIP I�i�nl(nMldul ICT>i Ifil'lll ly++rirl. 'BOUTINkSIAP
_New SRD or Mulbfunily dwellings: Apply for demolition permit for 1b 11 t'+' 'm +l'wRl� 't 1%^'!^` '
existing building(s). Demolition ennit is required prior to issuance of buildingPI1?v rile�e�yGaUN1T1t ytIu!holNc I LANIRrvIPW
permit for new pudding. p 9 P Qli"�IrA )I'Ati I14�jit1 �Vt!F\'' 1'+ fprN 11 l t .
ux'i'n Arta Ir 'I ��tl rel i1 Lan Inc rl An urvlEw.
Commercial Bldgs: Provide a completed Hazardous Materials DISGIOSBIe 1ry11 If 1�N1
form if any Hazardous Materials are being used as part of this projectiI,:t,01A,1m1Jtt,yp�� lI 1� a' tn lT10CwOnlcs
_Copy Of Planning Approval Letter or Meeting with Planning prior IIIEW11th'C11(,�E{II� ; Iahl'pp!ttll'I�f r�l' '� a;/'Del r II...
II 141GgII�' 1I@f� tV dllil 111
submittal ofDuilding Permit apphcafiou. N�'IMt •Irt;j�{{1 UII(((II�1 I,1!' i`�StJ aLLL1 71�{ 11 li nni�n rYlsl wl n DIsTIUCP
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