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
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OWNER NAME PHONE E-MAIL
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rONTRACTOR� NAME,,/�-�` LICENSE NUMBER LICENSEgPE Bus.LICA Q11 "X0. �
COMPANY NAME v GMAIL FAX
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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