12010026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010026
CONSTRUCTION COMPANY
OWNER'S NAME: VS II LP 88 MONTEREY-SALIVAS 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.#
� MECH RESIDENTIAL COMMERCIAL
Contractorl h �,(�ate /�J"'
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 79,UNIT F,REMODEL KITCHEN(50 SF),ADD A/C
UNIT AND WASHER/DRYER HOOK-UP
(commencing with Section 7000)of Division 3 of the Business&Professions
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 per the 011pertino Municipal Code,Section
9.18.
"� Issued by: G�f�— Date: J__ /Z
Signature Date 7
❑ 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. 1 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 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 r ut rized
forthwith comply with such provisions or this permit shall be deemed revoked. Date: —
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 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. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609072 . 00
DATE ISSUED. . . . . . . : 01/05/2012
RECEIPT #. . . . . . . . . : BS000015681
REFERENCE ID # . . . : 12010026
SITE ADDRESS . . . . . : 20900 HOMESTEAD RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER VS II LP
ADDRESS 20900 HOMESTEAD RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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 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 1.00 588 . 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 3, 660. 00 #5055
---------------
TOTAL RECEIPT 3, 660. 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
.�1 V
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd. bldg.#79 F DATE: 01/03/2012 REVIEWED BY: bobs.
APN: BP#: '"VALUATION: $20,000
Y PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY Building is PENTAMATION 1 R2REM
USE: Multi-Family Dwelling >3 Stories Yes 0 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. FO.0 hrs $44.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the relinina information available and are onlyan estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff 7,,,1;,11) FEE QTY/FEE MISC ITEMS
7771
Plan Check Fee: $0.00 F__5_0__j s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 $588.00 IREMRESKIT
PME Plan Check: $0.00 1 # Mechanical
Permit Fee: $0.00 $65.00 IBR IR A/C Units(<=10K cfm)
Suppl.Insp. Fee-0 Reg. OT r 0.0 hrs $0.00 F_2__1 # Mechanical
PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00 0
Work Without Permit? 0 Yes (F) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure
Travel Documentation Fee: I TRAVDOC $44.00
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $132.00 $783.00 TOTAL FEE: $915.00
Revised: 12/04/2011
12/29/2011 11 : 00 (FAX) P. 005/005
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION //v
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 v
CUPERTINC3 (408)777-3228 • FAX(408)777-3333 •buildinga-Cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECTADDRESS - 011 APN#
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OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE,ZIP. �{ FAX
CONTACT NAME PHONE L•-MAIL
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STREET
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STREET ADDRESS CITY,STATE,ZIP FAX
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❑OWNER ❑OWNER-BUILDER ❑ OWNERAGENT r"l CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrrcT ❑ENGINEER ❑ DEVELOPER ❑TENANT
rONTRACTOR NAME LICENSE NUMBER LICENSF�YPE BUS.LIC#
COMPANY NAME E-MAIL FAX
3'Y>p>1�r2i
STREET ADDRESS CITY,STATE,ZIP PHONE
VSs . 8G.�.a.t'�c.5, c-
-A-
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK r
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• ate,,-�e.�, \� �� `\1 C.�v c�c_u� �- � LC.�,�C�O.G� j�
EXISTING USE PROFOSED USE! CONSTR.TYPE #STORES01'AIGE,USE
_k_ Pr' '1?:OE RiCT•t VALi TI S
EXISTG NEW FLOOR DEMO TOTAL
AREA. AREA AREA NET AREA I 't�:'1 +^' y�t•,�IS'Y O' 't,,,;tsi
BATHROOM KITCHEN OTHER
REMODELAAEA REMODELAREA REMODELAREA
PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE ARCA:❑DETACH 1
IS v
❑ ATTACH ;tti:lta,hllt a 6_sll :41111 a.�ttf.a�.i..l a:,I;,�i,t ,�._.l..a
M DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? NO ALIDITIONt NO -
. '
PRE-APPLICATION ❑ YES IF YES.PROVIDE COPY OP PI.AKNER'SNAKIE:
iTOTAL VALuA ON:
PLANNING APPL K ❑ NO PLANNING APPROVAL TETTER {�+ 1 'tj i S S a I E} ! I ii i
_ ...,..1„,3 t,..,t l4.�irt{..r !.3 � ,,';.5,�w,,, ti •,
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 prgvi 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 stIate laws relating t di g construction. I authorize representatives of Cupertino to enter the above-i<hentified i rty for inspection purposes.
Signature of Applicant/AgenC Date: {
SUPPLEMENTAL INFORMATION REQUIRED
t:3HEOK TYPE ROUTIIVG'SLFP
_New SFD r Multifamily dwellings: Apply for demolition pemrit for " -� Y NGrI.”
ER THE COUf�TER B IE AN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. �I 1�13XPI�I;MTl-- i It,t 1 �'EANNINGPLANREVIE\VI
,4t :i iDq _I r ir, I4 I1, ,eS�tl, , II ,, •
_Commercial Bldgs: Provide a completed Hazardous Materials DisclosureWF
I Qi i�TarDAl{n"I ;; ' }} CI PUBLIC WORKS•
form if any Haardous Materials are being used as part of this project, I;" i ',' " t
IP `RE`DrPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
suttal ofBu�lding Permit application. �t IM\�jY 'l rk is I t 1 4 SAIQITARY SEWER DISTRIOT
bmi
i i Milt tl,
�NYIRQNMBNlAL'}IEAGTH•
BldgApp_2011.doc revised 03//6/11