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11120003
j CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 78 CONTRACTOR:MONTEREY PERMIT NO: 11120003 CONSTRUCTION COMPANY 0 NER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE DATE ISSUED: 12/01/2011 NE 's PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659 LICENSED CONTRACTOR'S DECLARATION r r PLUMBr License Class_ Lic.N a OS2� BUILDING PERMIT INFO: BLDG ELECT COMMERCIAL l,� �►t� MECH r RESIDENTIAL� COMMERCIAL r Contractor P`ogme 6D lV-)1 Date—� JOB DESCRIPTION:UNIT F-REMODEL 50 SQ FT OF KITCHEN,INSTALL NEW _I WASHERIDRYER AT EXISTING CLOSET,NEW AIR I hereby affirm that I am licensed under the provisions of Chapter 9 CONDITIONING UNIT,CABINET LIGHTS (commencing with Section 7000)of 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 fallowing 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$20000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for die performance of the work for which this APN Number:32609065.78 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 accme against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued b Date: 2' L with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: ignature Date �•2-�Z ( All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 am exempt from the Contractor's License Lew for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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), 1 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(x)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 which this permit is issued. will maintain compliance w th the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety C ,and 25534. 1 Section 3700 of the Labor Code,for die performance of the work for which this �L Z-1 Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person many manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I •CONS ON LEND ENCY become subject to the Worker's Compensation provisions of the Labor Code,I 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 I have read this application and state that the above information is correct.I agree to complywith all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter pson the above mentioned property for inspection purposes.(We)agree to save m - enify and keep hamhless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as 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 . 78 DATE ISSUED. . . . . . . : 12/01/2011 RECEIPT #. . . . . . . . . : BS000015462 REFERENCE ID # . . . : 11120003 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD BLDG 78 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 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 318 ELECTRICAL ABOVE CEILING 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 11/30/2011 14 : 11 (FAX) P. 004/006 CONSTRUCTION PERMIT APPLICATION ® COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228 ' FAX(408)777-3333'bulldlno(ftlCUDertino.org CUPERTINO III 2OoU ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECTADDRESS \)n;L APN4 7� OWNCR NAME PHONE E-MAIL. �C.}h _ ';DC7 b C)g ADDRESS Cln',STATE,ZIP FAX Ig00 >, Yb�'{-o\\L�-. d ISt� �7c'.1� r'f'�C Pa s� a`;�{o S CONTALT NAME PHONE E-MAIL �'e 0. St u-�.5• -1c1.3� '�-\'lG\i4 Crnr (ir\6+�uch:u+.w... STREET ADDRESS CITY,STAT[,ZIP FA% 3� V`�S- 1GKt� O OWNHR ❑ OWNIM- -BUILDER ,4 OwNERAGENr, X,CONTRACIOR .Q,COWRACmRAGENI'; ❑ ARCHITECT 0ENOINEER ❑ DEVELOPER ❑TENANT r'ONTRACTOR NAME,-` LICMSSE14UMBER � LICENS YPE BUS.LICK COMPANY NAME. E-MAIL FAX L-C!5N) T` YbIrlr4er -r1S�-� Cr�Un -1-\rJ.� +� A-r-ur�k:✓.. tn�. SS "1r'.Q1+a STREET ADDRASS - .. CITY. ,ZIP .c� - PHONE 06- -6SS 1�1C,1\}l'1- rw'S \ ��G-Q�. S U-� l-\�Jr=ill b uAvs- ARCHITECT1ENGINEER NAME .. .. _ . . LICENSB NUMBE0. -... .. ..... .. .. .BUS.LICA COMPANY NAME - H{MAIL' FA STREET ADDRESS .. CRY,STAT:,zIP PHONE DESCRIPTION OF WORK }c.\\ rNceA—. - e r1Sa-a\\ r1e. a;'f cA:l-1:or. vr.:.+::• oc�eQ 2 .S e.Es, \ C-6^Irs ., �LSZvc �cu1..- 'p2<�tC�CzC�.w OHS{7N0 USE PROPOSED USE CONSTRTYPE. #STORES p. y�l ,�Q +LGE V,4 pjl I ipl,Lyn NNW lil.l It hl4 1 VALHATIONISI [%LSTO New FLOOR DEMO TOTAL 1 fi YN J 11! 1 Ill 11 IIID I y ©: AREA AREA AIrPI, AREA yIrll p Ii p( 11 I^W A Wt 'J 1 1 t BATHROOM KITCHEN OTHPJe ,1j�III�If�I�V i(l i REMODELAREA RPMODELARM RFMODCLARM \� I _ PORCH AREA DECK AREA TOTALDFOKA'O0.O{AREA OARAOEARM:❑ bar CH h14 111111 ry II 1 1 1 'J q G" h �Qhry - I ' I d I ryy� ❑AT! CH I�dall(Ill„l'I�II YDw Ulna uNr13: [nAaecowumT Yrs RECONDETGAY 0YES' - U[1NGMaED1 NO AaaITIDNr NO �'llh �'II(1411(IEl hlj'�Ir~I��ijIl�gl li�Nt)h IhLi�l�i� I,:�1�111 dl lO ,• PaLAPFUC iDN ❑ YEE P YEE.PROVIDE COPYBP PUNNEWS NAMIL P":WMAnt.I p No Furmwo APrsw.u.ranm lllPu6 II,1 lr /vA it".P t ,d uvIls,n 1iM 1 _By my signature below,1 certify to each of the following: I am the properly owner c a4lhorized agent to act on the properly owner's hehalC 1 have read this application and the itrfonnation 1 have p vi ed is correct. I have read the Descriptio of Work and verify it is accurate. I agree to comply with all applicable low] ordinances and at nte Inws relnnng,t i g construction. I authorize representative;Of Cupertino to enter the a ovudde^nti Ediproperty for inspection purposes. Signalur,of Applicant/Agent: Date- SUPPLEMENTAL INFORMATION REQUIRED III y,l I ;'.' l.p(;r I o .. ial gIAN��Cn4i 11 ft6uruvalsup, New SFD or Multifamily dwellings: Apply for demolition permit for il �R,,��P11A GpUP1TF1{ existing building(s). Demolition permit is required prior to issuance ofbuil in¢ UILDING PLAN REVIEW- �1 1 �gI1C11i nl l'I II"{dal ' v 't-, permit for new building. 4� tw�gpgsiil�W�) t t , y';PIIII tI' �I� IPIry1NN1Nc�rL�N;ggvlEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosu cPJdlblcwat%s- formifanyHazardousMaterialsambeingusedDspartofthisproject. ' slj lall�f`1!i�l�hlq��i l)1{Ip,,G11111In�:�le 11 IIs It� ''�QI B4gtFSS ,I., I) °yllLil�V,y,drlp 4111Ta�Dgrr Copy of Planning Approval LDHar or Meeting with Plonnhlg prior to ��h' ��11 I•NI E I� + � � submittal of Building Permit application. Iti IIyelIl il,�w I�1L+} �StF,MyI#17t lsT' rtiCT 4 1111 1 "•n'' tCIIBALTW BldgApp_201 L.doc revised 0116111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20900 homestead rd 78#F DATE: /)-/—// REVIEWED BY: bobs. APN: BP#: "VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-FamilyDwelling Buildinc is PENTAMATION 1R2REM USE: g >3 Stories O Yes 0 No PERMITTYPE: WORK I remodel kitchen non structural add new W/D hook-up, and A/C unit. SCOPE { Mech.Plan Check 0.0 hrs $0.00 Numb. Plan Check Elee Pian(.heck Mech.Permit Fee: IMPERMIT I Plund!.Pemlh Fee: I Flet. Perniii 1,ec: Other Mech.Insp. 0.0 hrs L$44.00 Otho PLunh bvp, Other L:Gro. 1etp. I fedv Imp. Fee. Plumb. Insp,Fee: idee.Insp. Fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,efc. . These fees are based on the prellmhur Information available and are only an estimate. Contact the De t eraddn7 infa. FEE ITEMS Wee Resohttion 11.053 L'/C 7/1/1 1) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F__50__j s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $588.00 IREMRESBAT PME Plan Check: $0.00 F 1 # Mechanical Permit Fee: $0.00 $65.00IBREMAIR A/C Units(<=10K cfm) Suppl. Insp.Fee:O Reg. 0 OT 0,0 hrs $0.00 2 # Mechanical PME Unit Fee: $0.00 $130.00 IBAPPGOT I Other Appliance/Equip PME Permit Fee: $44.00 Construction 7'(a Administrative Fee: ]ADMIN $41.00 0 Work Without Permit? O Yes 0 No $0.00 0 Advanced Planninc Fee-. $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure A 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