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12010019 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010019 CONSTRUCTION COMPANY OWNER'S NAME: VS II LP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:01/05/2012 OWNER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r _ MECH RESIDENTIAL COMMERCIAL Contractor to I hereby affirm that I am li sed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 79,UNIT C-REMODEL KITCHEN(50 SF),ADD A/C (commencing with Section 7000)of Division 3 of the Business&Professions UNIT AND WASHER/DRYER HOOK-UPS Code and that my license is in full force and effect. I 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. 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 Sq.Ft Floor Area: Valuation:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:32609072.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulat' s per the Cupertino Municipal Code,Section 9.18. Date: Issued by: ,��' Signature 4aDate 1-540 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25 P 05,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I > become subject to the Worker's Compensation provisions of the Labor Code,I must Date forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of wrk's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: TraciC Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32609072 .00 INVOICE DATE. . . . . . : 01/03/2012 REFERENCE ID # . . . : 12010019 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . VS II LP ADDRESS . . . . . . . . . . : 20900 HOMESTEAD RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- ADMIN/CLERICAL FEE APPLICATION 41. 00 0. 00 41 . 00 OTHER APPLIANCES PRINTING PERMIT 130. 00 0 . 00 130 . 00 CAL BLDG STAND COMMISSION F PRINTING PERMIT 1. 00 0 .00 1 . 00 RES A/C UNITS <= 10, 000CFM PRINTING PERMIT 65. 00 0 .00 65. 00 SEISMIC RESIDENTIAL PRINTING PERMIT 2 . 00 0 . 00 2 . 00 MECH PERMIT ISSUANCE PRINTING PERMIT 44 . 00 0 . 00 44 . 00 REMODEL: RES KITCHEN PRINTING PERMIT 588. 00 0 . 00 588 . 00 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 44 . 00 0 . 00 44 . 00 ---------- ---------- ---------- 915. 00 0 . 00 915 . 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 516 FINAL BUILDING CITY OF CUPERTINO U� CC FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20900 homestead rd. bldg.#79 c DATE: 01/03/2012 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Building is PENTAMATION 1 R2REM USE: Multi-Family Dwelling >3 Stories Q Yes (F) No PERMIT TYPE: WORK remodel kitchen add A/C unit W/D hook-up. SCOPE Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT her Mech.Insp. 0.0 hrs $44.00 = Li NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesein-fees are based on the relinina in ormation available and are onlyan estimate. Contact the Dept or addn'l o. FEE ITEMS (C'ec IZeso/tttiosz 11-11531'ff. FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.0050 s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $588.00 1 IREMRESKIT PME Plan Check: $0.00F$65.001 # Mechanical Permit Fee: $0.00 1BREMAIR A/C Units(<=10K cfm) Suppl.Insp.Fee-0 Reg. Q OT 10.0 1 hrs $0.00 = # Mechanical PME Unit Fee: $0.00 $130.001]BAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 0 Work Without Permit? Q Yes (F) No $0.00 E) Advanced Plannin_Fee: $0.00 Select a Non-Residential Building or Structure Travel Documentation Fee: ITRA VDOC $44.00 i Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Bldy,Stds Commission Fee: ]BCBSC $1.00 SUBTOTALS: $132.00 $783.00 TOTAL FEE: $915.00 Revised: 12/04/2011 12/29/2011 10 : 57 (FAX) P. 002/005 CONSTRUCTION PERMIT APPLICATION 1 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 Z I CUPERTINO (408)777-3228• FAX(408)777-3333• buildinp(a)-cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT k PROJECT ADDRESS APN H OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX ICt00 , 31 15CU CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE.''ZIP FAX S^(1ot��Cs 2 -vcQi.r�c�5 1�w' 4A ❑OWNER ❑ OwNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CON TRAClORAGENT ❑ ARCHITECT ❑ENGAIEER ❑ DEVELOPER ❑TENANT rONTRACTOR NAME LICENSE NUMBER j LICENSEAYPE BUS.LIC# COMPANY NAME E-MAIL FAX 3 1�cr1��2; L L c1:�•\ C" CA-C),^ STREET�ADDRESS n CITY,STATE;ZIP PHONE C%— t `"6`� � +SSS\�P.-r•-�a.k-•S�x_.l lac+.`� \�n�--�, '\i ��c:�2.,�_r��, C.,C•� G 3�--tv`=� �1SS- '1ci�?�\ ARCHITECT/ENGINEERNAMME LICENSENUMBER tee— BUS.LIC H COMPANY NAME E-MAIL FAX i i STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK \0 1� Lr15kG.\\ I lug C.:�r Gvnc>til-t�l ,: �� 1'1C��r \\ �'}'�� \•�L�LJ L,,,....��.�J—� — V.> 2�i�...J\�.1��.C.a., EXISTING USE PROPOSED USE' CONSTR.TYPE N STORIES ...TYPC'r, ES('RIPTION ";VALUATION� EXISTG NEW FLOOR DEMO TOTAL j+'"_t tlf�r"' t l+ti ; T +j i y' + ' it AREA AREA AREA NET AREA 113 BATHROOM KrrCHEN OTHLR RL-MODELAREA REMODEL AREA REMODEL AREA 4.. PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH 71t 1+ ❑ ATTACK u•rt t,tit i ++++i s s i R- N DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND 570RY _❑YES , _ Y "'- d ti BEING ADDED7 NO ADDITIONT t1+1 d 1- �Ilgtl - W, 1 t,I PRE-APP I L CATION 1 Y , ❑ ES IF YES.PROVIDE COPY PLANNER'S NAME: it �Gl'I�EPIDY + , NOTA VAL A N: P[ANNIN6 APPL N ❑ NO PLANNING APPROVAL LETTER ?+ ..!-}j,t '?+ t+�lt�. +, + ; 'j " +t+til t!I I,. By my signature below,I certify to each of the following: I am the property owner or authorized agent to ac on the property owners behalf. I have read this application and the information I have provi ed is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t di g construction. I authorize representatives of Cupertino to enter the above-ide ificd//p��rope ty for inspection purposes. Signature of Applicant/Agent: Date:_ 1 v{ SUPPLEMENTAL INFORMATION REQUIRED ;'= i l='.f='r4� —+ t','+ 1 if I}'itAN tNlilacKRO,UTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for '+' '�' ! QYLrt�H COIIITEI� BUILDING PLAiV REVIEW existing building(s). Demolition permit is required prior to issuance of buildlhg + f !dSt� stt+l f7i, 1 ' s,z li s/ ,+ permit for new building. j r> '60,i9 ; 11,I Rt ,I (, ,fd + Ha �4i r s e Il sS�- pLdNN1Ng"PLAtY REY[EW_- - +�1'•�14}f}f1Y�X{f�1{tldy 4 I = _Commercial Bldgs: Provide a co npleted Hazardous Materials.Disclosure iYy7ftlS'P\NDARb+ , s r ,`+ ❑'rruBLte woRKS` form if any Hazardous Materials are being used as part of this project. 71R>;YIF,Pr _Copy of Planning Approval Letter Dr Meeting with Planning prior t0 " lmi 1`,' submittal of Building Permit application. ;Q��tIi�?^ Q1 {,lI''��4 (z]+ SANITili2lYssEWR DTs7>zicT I #�nK`=4?it,{��+tint'}.t+f� ism?¢:e tt�c tj fir!:Ft t,�,ie<}; ' � h:•, -�,-.ENV�RONNIEN'PAL.IiEAlTkI iv B1dgApp_ Ol Ldoc revised 03116111 I