11120004 k`~ ' • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 78 CONTRACTOR:MONTEREY PERMIT NO: 11120004
CONSTRUCTION COMPANY
OWNERBNAME: PROMETHEUS 88 MONTEREY-SALRIAS HWY STE DATE ISSUED: 12/01/2011
NER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659
LICENSED CONTRACTOR'S DECLARATION_ r- r. r
- OSZ-1� COMMERCIAL BUILDING PERMIT INFO: BLDG ELECT PLUMB
License ClasstT�O'QLLiic. 7O# —1
Contractor 1`r 1 1.-F-1./ �-Y+N r.me F� I JOB DESCRIPTION:UNIT G 0 REMODEL SQ FT OF KITCHEN,
VO INSTALL NEW
WASHER/DRYER 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.
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 whichlhis 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 the 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 accrue against said City in consequence of the 2,2— l�
Staining of this permit. Additionally,the applicant understands and will comply Issued by Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
j 2 Z'� I RE-ROOFS:
Si nature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,l agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that t em exempt from the Contractor's License Lew 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(Sec,7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
constmct 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 I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' n 25505,2 P, nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,l 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,I must 1 hereby arcnn that there is a construction lending agency for the perfamhance 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 comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
I
minify and keep harmless the City of Cupertino against liabilities,judgments,
s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
ting of this permit.Additionally,the applicant understands and will comply
all non•point source regulations per the Cupertino Municipal Code,Section Licensed Professional
.
ature 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 # . . . : 11120004
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. 005/006
CONSTRUCTION PERMIT APPLICATION
® COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 I
CUPERTIPIO (408)777-3228• FAX (408)777-3333• building(a)cupertino ord I
❑NEW CONSTRUCTION ❑ ADDITION TERAT•ION I TI ❑ REVISION I DEFERRED ORIGINAL PERMIT It
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❑ESCRIPTIDN OP WORK
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_ ll TT, lfUATIONIExISTO UEMOTOTAL Y —A/ARPd AREA NETARRA •f6f I r ' 'I'll I X11 I71JM' ' ' .'' iX.EAi11RO0M HO.1 UTImA REMODELAREADELARBA l AJ REmODELARPA \OPORCHARA DECTOTALUECIUPOROJAREA oARAOCAREA:ODLTCIIAir tri r` ICONI UNIT OYES JeCOMSTOUY ❑Yu I� IIil itAUOCa1 NO NIa1TIM? NOPRCMPL. IGN ❑ PQW1aaool PUNNFN'SNAM4PIANNnnArvu 0 aIOAPPawAL.rr.R '• �EN 1qT° I IIr�Y 1 1 ',1:11 I ff it tLl 'j1�rAL�
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By my signature below,l certify to each of the following; I am the properly owner o authorized agent to act an the property owner's behalf. I have read this
application and the information 1 have pr ed is correct. I have read the Descriptio of Work and verify it Is accurate. I agree to comply with all applicable local
ordinances and state Iaws relatin I 'd' g constluclitu. 1 authorize mprewntmiv of Cupertino to enter the nbov s*de`mi gelId property for inspection purposes.
Signature ol'Applicant/AgenC Dote: 1\�t �\y
SUPPLEMENTAL INPORMATION REQUIRED �� .,�,iV�l l�-' a✓;nH� �iN{gY,jt �,1�+ ,1'I'frP: ,. 'b
�ilj'hJ,R,UTINOSLIP'
New SFD or Multifamily dwellings: Apply for demolition permit for
�' �aR='Rgfit('OUNTRR�'IL EW DMC,
existing building(s). Demolition permit is required prior to issuance of buil ing ;i ! �� I� +, 1 +l 4 PLAN ngvrzw
permit for new building. L71p 11 ti I ! o
'DXPRFSSI
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IG PLANIAGVIgw
Commercial Bldgs: Provide a completed Hazardous Materials Disclose e 'i1 111 ) r I Ill a i n u 1( t r
a A I rl Pd i IcwoRRs
form if any Hazardous Materials aro being used as part of this project. i� $ )I d def 11 Y�N�IIN�'�I'fll I �I�)I{{i�r,l
Copy ofPlanning Approval Letter or Meeting with Planning prior to I IYe(Ip
submittal of Building Permit application. •1�IrI�^M °a,, q l�l,l� , I'' ,�Ir;� ���(� ,�F,!�TA?YY. Wp DjOrucr-
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Bldg,4pp_2O1/.clot revised O3/1 h/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
• ADDRESS: 20900 homestead rd 78#G DATE: REVIEWED BY: bob s.
APN: BP#: *VALUATION: 1$20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Multi-Family 9 Dwellin Buildina is PENTAMATION 1R2REM
USE: >3 Stories O Yes (F) No PERMIT TYPE:
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 Pluoth Plan CIw k 1stce.Plan Chcrk
Mech.Permit Fee: I MPF.RMIT Plunih. Pomil Feer S7ec. T'ernm Fre:
Other Mech. Insp. 0.0 hrs 1 $44.00 iil4m-PLuah A1sp. Odle,Elec. hrcp.
IncP. Fee: Ptund:. lm.p.l-"ee: Flea.Iag>. 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 prelimina !n ormation available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS fF'ee Resohi ion 11-053 Eff 7/UI U FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F__507 s.f Remodel,Bath(<=300 so
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $588.00 IREMRESBAT
PME Plan Check: $0.00 F-7-1 # Mechanical
Permit Fee: $0.00 $65.001 IBREMAIR I A/C Units(<=10K cfm)
Suppl. Insp. Fee:Q 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
("onsinictiun Tar
Administrative Fee: ]ADMIN $41.00 Q
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select allon-Residential (F)
Travel Documentation Fee: ITRAVDOC $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 $783.00 TOTAL FEE: $915.00
Revised: 10/01/2011