12010024 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010024
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
\f3 LICENSED CONTRACTOR'S DECLARATION r- r
BUILDING PERMIT INFO: BLDG ELECT' PLUMB
License Class Lic.# jg /
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 79,UNIT D,REMODEL KITCHEN(50 SF),ADD A/C
(commencing with Section 7000)of Division 3 of the Business&Professions UNIT AND WASHER/DRYER HOOK-UP
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 regulati'y per the Cupertino Municipal Code,Section
9.18.
A. Issued by: �— Date:,-'
Date
❑ 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:
1,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:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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,Sections 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 Owe r orize
forthwith comply with such provisions or this permit shall be deemed revoked.
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 # . . . : 12010024
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 CUPE
RTINO C)�
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd. bldg.#79 D IDATE: 01/03/2012 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $20, 7
000
RIPERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Buildin4 is PENTA1AATION 1 R2REM
USE: Multi-Family Dwelling >3 Stories Q Yes � 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
Other Mech.Insp. 0.0 �hrs $44.00 El
Li
NOTE: This estimate does not include fees due to other Departments(Le Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the relinsna in ormation available and are onl an estimate. Contact the Dept or addno.
'l info,
FEE ITEMS (I ee Resolution 11-053 ETf. 7-1,/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 50 s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: Q Reg. () OT 0.0 hrs $0.00 $588.00 1REMRESKIT
PME Plan Check: $0.00 1 # Mechanical
Permit Fee: $0.00 $65.00 IBREMAIR A/C Units(<=10K cfm)
Supp/.Insp.Fee 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 0
Work Without Permit? Yes (F) No $0.00 E)
Advanced Planning Tee: $0.00 Select a Non-Residential
T77=
Building or Structure
Travel Documentation Fee: ITRA VDOC $44.00 A
Strong, Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $132.00 $783.00 TOTAL FEE: 1 $915.00
Revised: 12/04/2011
12/29/2011 10 : 58 (FAX) �`� P. 0 3/005
1 V
I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY BUILDING DEVELOPMENT DEPARTMENT• VI
NG DI IN SO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 • buildin (@cuperlino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESSV1"�'�' APN# �•�_0_
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STREET ADDRESS CITY, STATE,ZIP FAX
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CONTACT NAME PHONE E-MAIL
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STREET ADDRESS CITY,STATE, ZIP FAX
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❑OWNER ❑ OWNER-BUILDER - -❑ OWNERAGENT CONTRACTOR..; CONTRACTOR AGENT p 'ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
ONTRACTOR NAME/ LICENSE NUMBER LICENSE
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COMPANY NAME / E-MAIL PAX(--,57,1)
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STREET ADDRESS CITY,STATE,ZIP PHONE Css 3 t
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ARCHITECT/ENGINEER NAME - LICENSE NUMBER - HUS.LTC N
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COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
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ct�i,l-,e.+r=�, \� r-.•�-s ' `•.j C.�v C..�c v-�' �.� 2C�j�L'�C�U.<,
EXISTING USE PROPOSED USE! CONSTR TYPE #STORMS~
Er S ONLY.'
-i''D CRIOW S VALIITI .
EXISTG NEW FLOOR DEMO TOTALI�'l { t '
I I
AREA AREA AREA NET AREAt�,,
BATHROOM KITCHEN OTHER t � '
REMODELAREA REMODELAREA REMODELAREA ro
r
PORCH AREA DECK AREA TOTAL DECK/PORCI I AREA GARAGE AREA:❑ DETACH
❑ATTACH
it DWELLING UNITS: Is A SECOND UNIT ❑YES SECOND STORY ❑YES ,
BEINGADDED? NO I ADDITION? tgNO :. 1'w.i,[ ,_;t
PRE-APPLICATION
❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: f fruGq�lpD i3V� 'I , l t t t fi TOTAL V 'ATION -
PLANNING APPL N PLANNING APPROVAL LETT
EA
v,.0 ttflan ,alt}.atl!?.s Lr ' Ip jai... i�'t s., i- •%[„�.
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's 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 abK2�,/
proper for inspection purposes.
Signature of Applicant/Agent: Date:—SUPPLEMENTAL INFORMATION REQUIRED tt' 't I ti "+'°' l+,t I ' ,-,
„PI,AI,CF3ECICTyPE ROUTIN�{SLIP'
_New SFD or Multifamily dwellings: Apply for demolition pemlit for
I !fFFG�Oi)NT'Et; a ING PLAN.REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permg
it for new building.
AlYNINO PLA,t![tEVIE\Vc}k 4E ' ''d E st't a� tf It t; 0
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure t`PusticrvoRKs`
Form if any Hazardous Materials are lieing used as part of this project.
i ttIlI 1 aN 411 i ❑ FIRE )FPT
ap^ I a Ria l ( I9t sas t
_Copy of Planning Approval Letter or Meeting with Planning prior to
5� 1yi11JORt „}y }, rt tCi SgNaTARY SEWCR DISTRICT
submittal of Building Permit application.
l-•.t 3R_„ i y {: .?, Ia i?'.a,.,ei :''EN:VIR0.NMENTAL11EAGTFI
B1dgApp_2011.doc revised 03/16/11