11120006 h .1 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 78 CONTRACTOR:MONTEREY PERMIT NO: 11120006
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS 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.7 r,
����� BUILDING PERMIT INFO: BLDG -- ELECT PLUMB
License Class Lic.N r r' r
{r/ MECH RESIDENTIAL COMMERCIAL
Contractor JOB DESCRIPTION:UNIT H.REMODEL 50 SQ FT OF KITCHEN,INSTALL NEW
WASHER/DRYER AT EXISTING CLOSET,NEW AIR
I hereby affirm that 1 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 following 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 which this 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 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.1 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^,
granting of this permit Additionally,the applicant understands and will comply Issued by: Dater-
with all no ht source r I tons per the Cupertino Municipal Code,Section
9.18.
I...r _ RE-ROOFS;
Signature Date L All of,shall be inspected prior to any roofing materiel 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 I em 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 erployees with wages as their sole comirnsation,
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
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 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 whichthis 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,Sec ' as 25505,25533 a 534.
Section 3700 of the Labor Code,for the performance of the work for which this jZ
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 Cal ifomia. If,alter making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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 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 mentimed property fm inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
s,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 # . . . : 11120006
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 .00 568 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 .00 44 . 00 0 . 0.0
---------- ---------- ---------- ----------
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: 12 (FAR) P. 006/006
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTIN0 (408)777-3228• FAX(408)777-3333•buildinafG�cupertino.org I I I /�DO�
❑NEW CONSTRUC-ION ❑ ADDITION TERAT'ION/TI ❑ REVISION/DEFERRED ORIGINALL PERMIT H lJJ
PROJECT ADDRESS 'L APNq �} ^ ' n O/1 JAI^/
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OWNERNAME PHONE • E-MAIL
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COMPANY NAME E-MAIL FAX
SrRERTADDRaS CITY,STAT ,ZIP PHONE
DESCRIPTION OF WORK --
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2%I6T0 NEW FLOOR DEMO TO'IAl
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BATHROOM KITCHEN OTHER • ,rl , n I �Il
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PORCH A[lEA
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BEING"DED? NO Apn,ngYr NO
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3y my signature below,I certify to each of Iha following: I nm the property owner o authorized agent to act on I110 properly owner's behnlf. 1 have read this
application and the information I have p vi ed is correct. 1 have read ilia Descriplio of Work and verify it is accurate. I agree to comply wilh all applicable local
ordinances and sate laws relating I d' g construction. 1 authorize representativeof Cupertino to cuter the above'.''d lifed p operty for inspection purposes.
Signature of Applicant/Agent: Dale: �\ I
SUPPLEMENTAL INFORMATION REQUIRED 'rl n(In°Ni �ylrr�{TNPGN'�- ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existingbuilding(s), Demolition permit is required prior to issuance of built Ing U�,I i ) F,I�b)lNT'pl�i�,lal; IIC, *rt[RcmIEAN,n¢YI¢w
permit for new building.
� ¢$1�(rasr., 1 { "' N �fi7 'nI„11N1N1 jo bLAnatEgi¢sv
Commercial Bldgs: Provide a completed Hazardous Materials Disclosu a • II G'lUltT R{�. p I til Ili{;A ' y7* p4UplC wpRKs
foml if any Hazardous Materials are being used as part of this project.
Copy ofPlanal ng Approval Letter or Meeting with PlBGnhlg prior to 1( I g n
submittal of Building Permit application. AI igl `)'I Ql(>'IhlQ��In�t�''�6 I ,��1tT IE U15TR;
� � 111;( � I'I - "p
'gNVmONMENTAL BEAnTH
B1dgApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
• ADDRESS: 20900 homestead rd 78#H DATE:/'I REVIEWED BY: bobs.
APN: BP#: *VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Multi-FamilyDwelling Buildina is PENTAMATION 1R2REM
USE: g >3 Stories O Yes (E) No PERMIT TYPE: At
WORK remodel kitchen non structural add new W/D hook-up, and A/C unit.
SCOPE
Mech.Plan Check 0.0 hrs $0.00 P(umb.Plan Greek Eler_Plan CharA
Mech.Permit Fee: IMPERMIT Plund+..Perndr Fisc: Elsa. Fermi:Fee:
• Other Mech.Insp. 0.0 hrs $44.00 ('hher Planih 7rry. Other F.7ec. Lisp. Ej
d9adt.Invi. Pee: /7uui6.Ina'p.h"er: filer.Invp. Petr
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 preffindina information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 L/. 7/1/1 U FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 50 s.f. Remodel,Bath(<=300 s0
Suppl. PC Fee: (F) Reg. 0 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(<=I OK cfm)
Suppl. Insp. Fee:Q Reg. 0 OT 0.0 1 hrs $0.00 2 # Mechanical
PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
Constrm"liun Tm
Administrative Fee: (ADMIN $41.00 0
Work Without Permit? 0 Yes 0 No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Documentation Fee: ITRAVDOC $44.00 Building or Structure 0
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $132.001 $783.001, TOTAL FEE: 1 $815.00
Revised: 10/01/2011