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11120002 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 76 corvTRAcroR:MONTEREY PERMIT No: 11120002 CONSTRUCTION COMPANY OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE DATE ISSUED: 12/01/2011 NERS PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659 LICENSED CONTRACTOR'S DECLARATION r r. r O� '] BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class � Liic.4 [ O$SZ� ( (—; r7 r N t 1--r��7 wr�/D�Date ^f MECH RESIDENTIAL COMMERCIAL ContmctorMd 1Z_Z JOB DESCRIPTION:UNIT J-REMODEL 50 SQ FT OF KITCHEN,INSTALL NEW WASHER/DRYER AT EXISTING CLOSET,NEW AIR hereby affirm that 1 am licensed under the provisions of Chapter 9 CONDITIONING UNIT,CABINET LIGHTS (commencing with Section 7000)or Division 3 of the Business&Professions Code and that my license Is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consentto self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for whichthis permit is issued. Sq.Ft Floor Area: Valuation:$20000 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 APN Number:32609065.76 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the /� granting of this permit. Additionally,the applicant understands and will comply Issued byres Date: / � with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. �-Z— l / RE-ROOFS: natur Date All roofs shall be inspected prior to any roofing material berg installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three - maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous 1 have and will maintain a Certificate of Consentto self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for whichthis permit is issued, will maintain compliance a Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, �25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Dete: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct.1 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 In the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION mnify and keep harmless the City of Cupertino against liabilities,judgments, sits,and expenses which may accrue against said City in consequence of the I understand my plans shall be used w public records, granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO • 8 ITEMS OF 48 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32609065 .76 DATE ISSUED. . . . . . . : 12/01/2011 RECEIPT #. . . . . . . . 1 : BS000015462 REFERENCE ID # . . . : 11120002 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD BLDG 76 SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PROMETHEUS ADDRESS . . . . . . . . . . : 1900 SOUTH NORFOLK ST STE 150 CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 RECEIVED FROM . . . . : MONTEREY CONSTR 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 5, 490 . 00 visa --------------- TOTAL RECEIPT 5, 490 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 307 INSULATION • 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 317 MECHANICL ABOVE CEILING 11/ .30/ 2011 14 : 10 (PAX) P. 003/006 CONSTRUCTION PERMIT APPLICATION . COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION B10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 /�'� CUPERTIN0 (408)777-3228 • FAX(408)777-3333•bulldingOcuoerlino.om I I ✓� 1)00 2— ❑NEW CONSTRUCTION ❑ ADDITIONALTERATION/Tl ❑ REVISION/DEFERRED ORIGINAL PERMIT N PROJECTADDRESS 11 rr�� � Q. .L ack "lin 1M U— AM q OWNER NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP PAX IQOO S, 1�1or-Fo1YL4y1-. -x..>1 -g,=,s CU��IITAAME ,�J PHONE E-MAIL \'`7CTN STIIEET ADDRESS CITY,STATE,ZITFAX - \^l,ol�k Cr _i'>c Qi.r�cC� HL.,• #1 ir.a' ' U=-1 �j Gr' - s v-1`�`-�- -lr-��X4, ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT XCOKRAClmt ❑CONTRACTORAGENT ❑ ARCHITECT ❑EN(U),l ❑ DEVELOPER ❑TENANT rONTRACTOR� NAME,,/�-�` LICENSE NUMBER LICENSEgPE Bus.LICA Q11 "X0. � COMPANY NAME v GMAIL FAX TYlcrv\`lL L-L<lS-�-r" c++��Un G •. �'r�c.�s� + mr G:i-r��.}.r uc.+Ir.r.. c...... 1 �.0 STREET ADDRESS CITY,STATE,ZIP PHONE C'D-'4Y`r'1oa�tSr..1t:. %. 'lr=s?> ARCHITECTIENOWEER NAME LICENSE NUMBER _— BUS.LICA COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DL'SCRIPTION G -�< q WORK O c EXISTwa USE PROPOSED USE cONSTIL TYPH ASTORIE$ ' 1 I 1-I 1 f1 llybp ICE�l$P. 0l +1.41; MSTO NEWFLOOt DEMO TOTAL =iiI l��1111WH 4,' (1 Il a.:yA',fl Ali ARM AREA ARM REMODELAREA KITCHEN VV i��1�yQ21�)II lIti�'I1�� I BATHROOM REMODELAREREAODELARG PORCH AREA DECKAREA TOTALO[CKA'ORUTAREA GAAAOCAREA:❑ DETACII 3 1 Ij I ',1 1 ] ATPA011 '' Ilk{� Bli Li1!I{l�ul SI Vii�y� IP II31i11PtJ �U ' IDww,unaUIBS: ISAsecowUMT ❑YES IEC.MsTURY ❑YES III IMEI1Ts IWi'1�1�''�I1Li�:� q�11t I�1 Tr 141- I 11 BEIM ADDED? rtyLL No AaalTlIXir . NO PRII-APPLICATION ❑ Yf$ DYMMOVIDEcoPYOp PIANN60.'S NAMit j ^' 1p 1' '1 1 'Y 7 "TOTAL YAL TION: MIANNDIDAPrLI ❑ No puwm APrxma IdTIG )H,I IYP ��il� +: 1 i:ll'dlll i,.. i f.1• '� Ey my signature below,I certify to each of the following: I am the property owner Or authorized agent to net on the properly owner's behalf. I have read this Application and the information 1 have pryvi led is correct. I havc read the Description of Work and verify It is accurate. I agree to comply with all applicable local ordinances and amts Iowa relating I {di g construction. I authorize representatives Bf Cupertino to enter[he above-jdentificd 9 operty for inspection purposes. Signature of Applicant/Agent: Date;_ SUPPLEMENTAL INFORMATION REQUIRED !'y�,kulyl?�� 'riortnmGstm New SFD or Multifamily dwellings: Apply for demolition pennit for 11,7,T v. - ezislin building(s). Demolition ennit is required prior to issuaner,of buildin ', 1 1 .."r'1� PG egDINc PLAN REVIEIY 8P 9 V g � •` h NF 4' permit for new building. °IT-r]Ib't)XII 11¢4tyIill� rl i�.Sk, i''li IQ PNApNlrvcnunn;llgvlgw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �iL'9jh gxxA00A 11 III �It.'I :��O A,1Z.le lboAgs Toon if any Hazardous Materials Bre being used as part of thin project. I' 1 b71 Copy of Planning Approval Letter or Meeting with Planning prior IG N lIf� 110�' I� �II�I ' ' 11'+ E IIT ti�s�de��nFrT '- submittal of Building Permit application. �� igtMAl�pnp°ip�� p,rs !I Til lir,,.+I�, I�II'�� jA'tJj,TARV seWryri'Ipisrnlcr ®� 411ti��l yjj�7la i,hjj�ln.:ylqIENV'1116NMRNTA1dI12AETU' BIAgApp_Nl/L(Ioc reviscd t)3/l6111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION • ADDRESS: 20900 homestead rd 76#J DATEV),-/ It, 7REVIEWED BY: bob s. APN: BP#: *VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-Family Dwelling Build'Ina Is PENTAMATION 1R2REM USE: y 9 >3 Stories O Yes (F) No PERMIT TYPE: WORK remodel kitchen non structural add new W/D hook-up, and A/C unit. SCOPE Mech. Plan Check 0.0 hrs $0.00 1164nh. plan 0feck ISlcv.1'!an Clod Mech.Permit Fee: IMPERMIT Plund" Permit Fee: El ac. Pernrir Per: • Other Mech. Insp. 0.0 hrs $44.00 t'hGer Plumb Gr..p. Li Ot4er/-I[ Inp. Mad+.Imp. Fee: Plu»;1r. Insp,]-"e: Elan.Insp. Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc. . These fees are based on the prelindina In ormation avdlable and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (!Lee Resolution 11-053 E8' 7/1/1 U FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath (<=300 st) Suppl. PC Fee: Q Reg. OOT 0.0 hrs $0.00 $588.00 IREMRESBAT PME Plan Check: $0.00 F-1-7 # Mechanical Permit Fee: $0.00 $65.00IBREMAIR A/C Units(<=10K cfm) Suppl. Insp. Fee.-0 Reg. Q OT 0,0 hrs $0.00 2 # Mechanical PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 Construction nix Administrative Fee: 1ADMIN $41.00 Work Without Permit? O Yes (F) No $0.00 0 Advanced Planning Pee: $0.00 Select aNan-Residential Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure 0 Sttrone Motion Fee: IBSEISMICR $2.00 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $132.001 $783.001' TOTAL FEE: 1 $915.00 Revised: 10/01/2011