12030043 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12030043
CONSTRUCTION COMPANY
OWNER'S NAME: VS 11 LP 88 MONTEREY-SALINAS IR\'%'STE A DATE ISSUED:03/0912012
OWNER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(8311601-'659
❑ LICENSED CONTRAMR'S DECLARATION BUILDING PERMIT INFO: BLDG [ ELECT r PLUMB r
License Class Lic.q (—/
AIECH r RESIDENTIAL [ COMMERCIAL r
Contmcto e -71A
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 75 UNIT 1-INSTALL NEW WASHER/DRYERS AND
(commencing with Section 7010)of Division 3 of the Business C Professions A/C.REMODEL EXISTING KITCHEN(50SQFf)
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
(have mid 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
perfatmmnce of the work for which(tis permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Flour Area: \'alumtimm$20000
Section 3700 of the Labor Code,for(lie performance of t e work for which this
permit is issued.
ANN Number:3260907200 Occupancy Type:
APPLICAN'r CFRTIFICATION
(certify tlml I have read this applications and state that(lie above infonnalionn is
correct.I agree to comply with all city and county ordinances mid slate laws relating
to building construction,and hereby authorize representatives ofthis city to enter PERNUT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
Indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this pennii. Additionally,the applicant understands mid will comply
with all non-point sourceregulation;per the Cupertino Municipal Code,Section
9.18. G
r!f/�L� Issued by: ���/1� 6lZz Date:
Signature Date
Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that 1 sell exempt front the Contractor's License Law for one of installed without first obtaining:"inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation.
will do the work,mid the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:4
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sea.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm tinder penalty of perjury are of the following three
declarations: HAZARDOUS MIATERIAI S DISCLOSURE
I have mid will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code.Sections 25505.25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
(have mid will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(a)slmuld 1 store or handle hazardous material.
Section 3700 of the Libor Code,for tire perfonnance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. coelm ummus as defined by the Bay Area Air Quality'Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of die work for which this permit is issued,I shall Health&Safety Code,Sections 25505.25533,and 25534.
not employ any Person in any manner so as to become subject to the Worker's �>
Compensation paws ofCalifomia, If,allerniakingthiscertificmeofexemplion,l Ovincrorsuor, dpgyr(� z q
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forhwith comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of mark's
I.certify that I have read this application and state that the above information is for which this pennit is issued(Sec.3097,Civ C.)
correct.1 agree to comply with all city real county ordinances and state paws relating Lender's Name
to building wnstruction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harnless the City of Cupertino against liabilities,judgnnents,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'SDECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plats shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
9 ITEMS OF 21 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609072 . 00
DATE ISSUED. . . . . . . : 03/09/2012
RECEIPT # . . . . . . . . . BS000016236
REFERENCE ID # . . . : 12030043
SITE ADDRESS . . . . . : 20900 HOMESTEAD RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VS II LP
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST 4150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
RECEIVED FROM . . . . : MONTEREY CONSTRUCTI
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 SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-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
1STINSP UNITS 2 .00 260 .00 0 .00 260 .00 0 . 00
1TRAVDOC FLAT RATE 1 .00 44 .00 0.00 44 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1175.00 0.. 00 1175 .00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -------------------
CHECK 2, 939. 50 #5211
---------------
TOTAL RECEIPT 2, 939.50
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
17M ADDRESS: 20900 homestead rd. bldg 75#J,I DATE: 03/08/2012 REVIEWED BY: bob s.
APN: I BP#: "VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY PENTAMATIOIY 1R3SFDREM
USE: SFD Or Duplex PER(11IT TYPE:
WORK install new w/d and A/C. Remodel existi n kitchen.
SCOPE
A1ech. Plan Check 0.0 his $0.00 plumb. Plan Check Flee.Plan Chcck
t tech.Permit Fee: 1 UPERdUT Pluoth.Perndt Fee: Elec. Pernaia Fee.
Other A1ech. Insp. 0.0 hrs $44.00 Od�u•Phunh hsp. Other h7m.hap.
ED
1ti..h. Imp Feo Plwub.ln"p.Fw: Fier.lnyt.Fee:
NOTE: This estiomte does not include jeer due to other Departments(i.e. Planning,Public/forks. Fire,Sanitary Sewer District.School
District,etc.). These fees are based on the rrelininary in ornunion available and are on/v an estinmle. Contact the De t or addn7 in o.
FEE ITEMS (Fee Resohaion 11-053 EH 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 50 s.f. Remodel, Kitchen(<=300 so
Supp/. PC Fee: (DReg. OOT 0.0 [its $0.00 $588.00 IRE,URESKIT
Pbt E Plan Check: $0.00 1 # Mechanical
Permit Fee: Hourly Only? O Yes Q No $0.00 $65.00 IBREMAIR A/C Units(<=IOK cfm)
Suppl. Insp. Fee.0 Reg. O OT 0,0 hrs $0.00 F---27 # Mechanical
PME Unit Fee: $0.00 $130.00IBAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
Cowirrtetion Tax
Administrative Fee: IAD,t1IN $41.00 O
Work Without Pennit? O Yes (F) No $0.00 0
Advanced Planning Fee: $0.00 = hours Inspections O
Travel Documentation Fee: 1TR.4I DOC $44.00 $260.00 ISTiA'SP Inspection,Hourly O
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: . 1BCBSC $1.00
SUBTOTALS: $132.001$1,043.00TOTAL FEE: $1,175.00
Revised: 1/1M012
03/03/2012 10: 03 (FAX) 4 3P• 002/002
CONIS"1-H CTI ON PERMIT APPLICATIO14 i
COMMIIJNITY EVELOPMENT DEPARTMENT•BUILDING DIVISIONHERE
10300 TORRE VENUE • CUPERTINO,CA 95014-3255
0CUPERTIIN (408)7%7-322 • FAX(408)777-3333 • bulldlnDCg)cuoertino org
❑NEW CONSTRUCTION ❑ ADDITIO ALTERATION/T] El 'REVISION/DEFERREDI ORIGINAL PERMIT N
PROJECT ADURE$$ 07:a" IAPNY
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By my signature helow,1 certify to each ofIhc follm�ing: d oin'the properly owner or outhonzed apcnt to act on Ihapropcify owner i'behalf. 1 have read this.
application and the infonnation I have pr vl ed is co ecL,l 6ave'rend the Ducdptioli of work and verify it bi accurate. I ngree to comply with all applicable local
ordinances and State laws relating t pi g constm tion, 1 authorize rcpresenlmivm of Cup&tlno Ia enter the above- Ii Ie
de d roperty:for inspaction`puryoses.
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Signature of Applicant/Agcnc
SUPPLE,VIEN7 AC INFO
RIDIAI ION;RGQUIRED
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'• I'IIF"q'1/II1NrCI(kGKlfl}II'llt 'A J�'�I'1 �`'^'iy'd ROUTit.f$I lisx
_New SFD or Multifay dwellings: Appl ;for demolition pclinitfor i�'a fdlY hr lhf"T NIIs�IR�f�I��k 'Q.-t+,f IIp .� 1 r
existing building(s).:Demohuon pcnm[is reyu rcd'prior to Issu7nce of Guilditig• >I F�II(I11�vRL't ll�' Il 0 v A +4r sl'DIVG Pt1 nrREvtEw
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permit for new building' 1A
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_Conunereial B(dgs:'Provide a completedTzardous Materials Disclosure
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foif any Hazardous Materials are being used part'of this project ,; �YIl )IIkIIIj(I ' y�,. \`Yjl; r�l °PI��I•II i' I r Ji t,i
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Copy of Planning Approval Letter orMeeting with Plamung prior to
submittal of Building Permit application. 1 ' �M^' '�' I �I 1 la l 'a' S�INIPaPRY5E1VeHi1i 'DsT'RICr'+
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