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11120012
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 78 CONTRACTOR:MONTEREY PERMIT NO: 11120012 CONSTRUCTION COMPANY OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE DATE ISSUED: 12/01/2011 ER'S PHONE: 6509313400 SALINAS, CA 93908 PHONE NO:(831)601-2659 LICENSED CONTRACTOR'S DECLARATION r r r B SL`s � BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class_ Lic.# $ r r r t71�/J -/ /�,.,, %; L —2 MUCH RESIDENTIAL COMMERCIAL Conuacmr M�""r�t—`�/ �.EJIV sY.6lc � JOB DESCRIPTION:UNIT E-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)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 whichthis permit is issued. Sq.FI 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 forwhich 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.l agree to complywith 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 by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Si nature Date j Z—Z I 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 1 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 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(Sec.7044, Business&Professions Code) I,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. I 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 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 1 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,See ' as 5,25533,and 25534. Section 3700 of the Labor Code,for die performance of the work for which this Owner or authorized agent: Date: z 1 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 I 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 19siithe above mentioned property for inspection purposes.(We)agree to save mnity and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION gr, 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 # . . . : 11120012 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 12/01/Z01_t 15: 17 (PAX) P. 002/002 CONSTRUCTION PERMIT APPLICATION ® COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION moO 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-:3333 •bUllding(rDCUoertino orn ❑NEW CONSTRUCTION ❑ ADDITION__❑ ALTERATIC/N/TI ❑ REVISION/DEPERRED ORIGINAL PERMIT it PROJECT ADDRESS - "3 4 11'NN _2C::)G0G \OWNER NAMG PHONE QSo� 31- estit�o STREETADDRESS CITY,STATB,ZIP PAX q00 rum- \IL�-. H 1SGJ �xs� Y`I'N c�re.�t gl�y4� CONTACT NAME PHONE EMAIL Sm IA- - C:;3\ fi4-sc.\t c.err C.r_,�:'�A•ruc.•1:ts..w... STItL•Er ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OwNER-BUILDER ❑ OWNERAGLRJT CONTMCIOR ❑COMPACTOR AGEN T ❑ ARCIDTaCr O FAGINEEB ❑ DEVELOPER ❑TENANT CONTRACTOR NAME�-`c �PJ1 `�• GG` LICENSE LICCNSP,3YPE BUS.LICA J X2215 COMPANY NAME IYMALL FAX(_PC3") -1.1-,cJ.t L (:.o-�s♦r�c�4;,r..' w... SS -1S .0 STREET ADDRESS CITY,STAT 21P , 16w TYIGE�YCt' ,DarwS \-\l.0 Ca CSCIL. S. t�('� C' PHO-Es- �'>r1G�C �•1SS� '1S ?> ARCHITEC/ENGINEER NAME LICENSE NUMBER BUS LIC N I COMPANY NAME P MAIL FAX SfREETADDRESS CITY.STAT:,ZIP PHONE DESCRIPTION OP W ILK 2(-),CSC ()C ` [XISTWGIJSB _ - - PROPOSEDUSE CONSTR TITS ISl'ORIES I` 'p OR RICF IISE_Ofilyi_� 0 p_ ,.� NPP. ( D ..V EXESTO NEW FLOOR DEMO TOTAL A AREA AREA AREA NET AREA BATHROOMKRCHW OTHER ,.; 111 ', — 1— R. REMODELARBA REMODVLARPA RWODEI.ARCY \� �p1„',il 111.,,�. � 1• . , . PORCH ARBA DECK AREA TOTAL DI:CKA'ORCII AREA GAMOEAREA: ❑ DET CH '' I )q' I 1 ' ❑ATT CH rU\VF,LUNO IMIT9' INASECU.WUNIT ❑Yes IECOMI STORY ❑TLf I,, 1' u aE1NGM0[U) NO MOITIUNI NO PRLNPLIGTpN ❑ YFS IPYC9.P111IOe COPYOP PUNNCICS NAME I IIIJCNfYRU BY, P 1VI 11 PUNNtNOArPLY ❑ NO PUNNwOAPrxOIALLETTSR 1 'jTEThL VALUATION. „I By my signature below,I certify to each of the following: I am the property owner o aulhorized agent to act on the property owner•a behalf. I hove read This application and the information I have p vi led is correct. I have read the D=iplio of Work and verify it Is accurate. 1 agree to comply with all applicable local oldinnnces and stale laws relating t 'di g Construction. I authorize rcprescnlativ orcupertinnte D to ell the above-'dcntifi I�praperty for inspection puryoses. Signature of Applicant/Agentt Date:_ SUPPLEMENTAL INFORMATION REQUIRED p )I)L�AN 1jlRrKTXRk I!1•. , Rt}u'nwG'sLrr _New SFD or Multifamily dwellings: Apply fordemolition permit for ,l I�Ir�- 11� li>I 1 existing building(s). Demolition permit is required prior to issuan C of built ill ';I(�� ou�,a kl�m cdljN llnq I' 1 illy .Jiuu DING rcpN nevH:mv permit for new building. t,ll�IIITX�I IIPIStNlllt it 111 IA 1 I . 111 1�11){�ryN)NP IJ A,NiIU;VIEW Co runercial Bldgs: Provide a completed hazardous Materials Disclosu form if any hazardous Materials arc being used as part of this project. '{{�I �NI aP;P yI�hhI„( �e ldnlhllll.,,ELI V I© It wppKS submittal ofBuilding Permit application. U Copy ofPlanning Approval Letter or Meeting with PlnnniUbprior to @gW$tipl8bn[C!r Illligl�tlllll{�UI{n�Pl Itl �� Ihlhl {�,u I II yl I(\ �I I 1 1pNJiRonMIINTA041PALTIr Bl lgApp_201 Ldoc reviser/1131/6/11