11120005 .. r� CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 76 CONTRACTOR:MONTEREY PERMIT NO: 11120005
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE DATE ISSUED: 12/01/2011
WW PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659
LICENSED CONTRACTOR'S DECLARAATIO^1N r r_. r
License Class O�SZ-1 / BUILDING PERMIT INFO: BLDG ELECT PLUMB
Lic.N
('T'�1(}}-y /��1 1�-� MECH r RESIDENTIAL r COMMERCIAL �
ContmctarJ V'C IC.♦i/ lJr wlrJ {gate 2 Z� JOB DESCRIPTION:UNIT 1-REMODEL 50 SQ FT OF KITCHEN,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 which this permit is issued. Sq.FI 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
1 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. 6AdaLprially,the applicant understands and will comply Issued by: Date"l !
with all nottpolffr9eyf6c regulafions per the Cupertino Municipal Code,Section
9.1 B. 41
�'L—7/t RE-ROOFS:
Signature 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
1 hereby affirm that I 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 Cade)
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. t 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 I store or handle hazardous
I have and will maintain a Certificate of Consent to 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
performance of the work for which this permit is issued, will maintain compliance w' 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, cc fon 5,25533 and 25534.
Section 3700 of the Labor Code,for/he performance of the work for which this
Owner or authorized eg t: Date: Z
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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 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
mnify and keep hamhless the City of Cupertino against liabilities,judgments,
is,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 . 76
DATE ISSUED. . . . . . . : 12/01/2011
RECEIPT #. . . . . . . . . : BS000015462
REFERENCE ID # . . . : 11120005
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
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: 09 (FAX) P. 002/006
0
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION
'). J 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTIblO (408)777-3228• FAX(408)777-3333•buildinclocuoertino.crn I I I 2,000�
❑NEW CONSTRUCTION ❑ ADDITION A I nRATION/Tl ❑ REVISION/DF-FERRED ORIGINAL PERMIT#
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DESCRIPTION OH WORK
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EXISTING USE PRoeosED USE CONSUL rYPI aSTORLLS
0 � qIJ eiprilRiIII,,'I `us uu; VALUATIONnI
EXISTO NEW PLOpt DEMO TOTAL
AM.A
ARA ARIA NEPAAPA
BATHROOM KITCHEN OTHER14
REMODELARPA REMODELAREA � RIAIODF.LARP.A \O -
PORCHAREA DECKARE.A TOTALDECKIPORCHARPA OARAGEM :❑ DETACH
❑ATTACH r 1 P 4 1
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DZIAGADDEDI ND AppITIDYI ND
PREdPPOGnON Cl YES TY PROYIDECOPYOP PIANNER'SNAADI'. Ckl`ICP 1y
PLANNRAAI 'Jill
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By my siganlure below,1 certify to each of the following: I mn the property owner or authorized agent tc Dcl on[lieti properly owner's behalf. 1 have rcad this
applicationand the information 1 have pr9vi ed is collect. I have rend the Description of Work and verify kis accurate, i agree to comply with DII applicable local
ordinances and state laws Totaling t 'ldi g construction. I authorize mpresentatives of Cupertino to enter the above-jdenjined property for inspection purposes.
Signalmcof Appncant/Agent:
SUPPLEMENTAL INFORMATION REQUIRED
t ' IIfIA!>'CIINCMHIYI I. I v - 1i0UTINO SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for LI 1 'I
existing building(s). Demolition permit is required prior to issuance of building Aovrlt:T'lle ebuNTegl - nl uiLo1NC r1.AN Rewaw
pcnnit for new building. if.) ,N JiU1LCs� !;l LEI Pj,ANNINGnLAN,ItEVIEw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11srArD;\aD 'Glr`rli9DicwnKs
o
form if any Hazardous Materials are being used as part of lldl:project. C7hAhriM/'
f' Ftae nfrr
Copy of Planning Approval Letter or Meeting with Planning prior to ILi hlnaol( Isgivl'rAnr BE nisrnlcr
submittal of Building Permit application.
I,45rENVIRONh1ENTALIIRALTi1
BIAgApy_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR —BUILDING DIVISION
. ADDRESS: 20900 homestead rd 76#I DATE: 2_�_//' REVIEWED BY: bob s.
APN: BP#: "VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1R2REM
USE: 3 Stories O Yes (E) 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 Numb. Pian Check Eler.Plan Chcck
Mech. Permit Fee: IMPERMIT Murch. Per ma Fee: li7cc. Permh F""e:
Other Mech. Insp. 0.0 hrs $44.00 n:her Piuurh/nsp Li 011ie) Lkc. Lisp. ET
Aeeh.Insp. Fee: /Tull!/.hrrp. Fet: /'lee.Insp. Fee:
NOTE: This estimale 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 prelinina information ava!(ab(e and are only an esthnale. Contact the Dept for addn 7 Info.
FEE ITEMS O�ee Resohdion 11-053 Eff 7/blli FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 50 s.f. Remodel,Bath (<=300 sf)
Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 $588.00 IREMRESBAT
PME Plan Check: $0.00 1 # Mechanical
Permit Fee: $0.00 $65.001 IBREMAIR I A/C Units(<=10K cfm)
Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 = # Mechanical
PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
Construction Tax
Administrative Fee: (ADMIN $41.00 Q
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure Q
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
. Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:` $132.00 $783.00 '�' TOTAL FEE: $915.00
Revised: 10/01/2011