12010022 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010022
CONSTRUCTION COMPANY
OWNER'S NAME: VS 11 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 fI—
License ClassLic.#
BUILDING PERMIT INFO: BLDG ELECT' PLUMB
_/
MECH. RESIDENTIAL F COMMERCIAL F
Contractor � -Date
I hereby affirm that I a lensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 79,UNIT E,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 regulations er the Cupertino Municipal Code,Section
9.18.
SignatureDate �!];:
/ Issued Date,---'ZAa f
❑ 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
1,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&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
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,Sec'ons 25505,25533,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 Own or' e i
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 work'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. 1 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 # 12010022
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 44 . 00
------0_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 I
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd. bldg.#79 E7
DATE: 01/03/2012 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$20,000
RIPERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY Multi-Famil Dwellin Bulldina is PENTAMATION 1 R2REM
USE: Y g >3 Stories Yes (F) No PERMIT TYPE:
WORK remodel kitchen add A/C unit W/D hook-up.
SCOPE
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $44.00
Li
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the preffindina information available and are only an estimate Contact the Dept-for addn 7 info,
FEE ITEMS (Ece Resolution 11-053 Eff 7,1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.0050 s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: Q Reg. () OT 0.0 hrs $0.00 $588.00 IREMRESKIT
PME Plan Check: $0.00F$65.00
# Mechanical
Permit Fee: $0.00 1BREMAIR A/C Units(<=IOK cfm)
Suppl. Insp.Fee:Q Reg. Q OT 0,0 hrs $0.00 2 # Mechanical
PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
Administrative Fee: 1ADMIN $41.00 Q
Work Without Permit? 0 Yes 0 No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure
i
Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item
BldiStds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $132.001 $783.00 TOTAL FEE: 1 $915.00
Revised: 12/04/2011
12/29/2011 10 : 59 (FAX) P. 004/005
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
-
CUPERTINO a(408)777-3228• FAX(408)777-3333 - building cupeliino.mg
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL PERMIT N
PROJECT ADDRESS 6n- APN#
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OWNER NAME PHONE E-MAIL
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CONTACT NAME �j PHONE E-MAIL
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❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 9 CONTRACrOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
fONTRACTOR NAMELICENSE NUMBER LICENSE�YPE BUS.LIC# C
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COMPANY NAME �-J E-MAIL FAX Lea',')
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC It
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK -
!�-.U•�-c�1\ r,c�.,� c._i�c,���-,�.r- �r e� c:,�C e.x\o-1-�r�� C�.v�:�':,'c 10 -_� - . •�
itnS•�e.\\ r,u� �r ����c�ti'��-i��'.��� v���'f- ��,oc�.eQ �X�S� i�� � Susi .�--�
EXISTING USE PROPOSED USE' CONSTR-TYPE #STORIFS a.•;ipl?a S{Iw th I,?f s 'Jf=i,i:', l i[ F,{ SE ONLY's
,TYP.E'< `s 'DEs' .T O `S :_ VALUATION MI
EXISTGNEW FLOOR DEMO AREA NLTOTAL i till It= $rl t I .
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AREA AREA T AREP. i
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREA w REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH
❑ATTACH ���..!I�c'''tl"l�aa�,'f�i4lrzl:�:
X DIVELLING UNITS: IN A NECOND UNIT ❑YTS NP.COND NTORY ❑YES ti<I i.' I!t'litl II l }4I 1 ll I I ( 11
%
a EINGADDED7 NO ADDITION? NOl 1}It
_ tf'i-,,.53 Ss 1t,1 r# ,t 7[�t,a t. 1 I • _
PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNFR'SNAME: fAND(fY t n t ,TOTA4VALUATION:
�F pt ! ( t 31 14 3 S tf
PLANNING APPL 0 NO PLANNING APPROVAL LETTER 1 1 11 t
❑
By my signature below,I certify to each of the following: I atm the property owner or authorized agent to act on the property owner's behalfe 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 i di g construction. I authorize representatives of Cupertino to enter the above-w ntified prope for inspection purposes.
Signature of Applicant/Agent: Date: ;
SUPPLEMENTAL INFORMATION REQUIRED
In I'.1tAIYiOIIEGI<.'I�.'PE -'.-' - ROUTING SLfI'
_New SFD or Multifamily dwellings: Apply for demolition permit for "r
HO'v&%ii;
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. C1,isratr G sitF#+� =,°d, 5111 i't It,�` ��p��NNINGPLAiyREYIEW
Ltii�
_
Commercial Bldgs: Provide a completed Hazardous Materials 1]isclosure t+s f'1�}TANI)�iW " i ` w i j FCJ 4PUBL'IClWORKS;
form if any Hazardous Materials are being used as part of this project, 1 i
sF11M DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to Ft I k�N til
submittal of Building Permit application.
Ri,'!�?S?R l�t ; t, !�� JANITARY SI yVhRsDISTRICT
b
B1dgApp_2011,doc revised 03/16/11