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12010088 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010088 CONSTRUCTION COMPANY OWNER'S NAME: VS It LP 88 MONTEREY-SALINAS HWV STE A DATE ISSUED:01/19/2012 OWNER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659 \ YJ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# F Fr l. F 1��5 n MECH RESIDENTIAL COMMERCIAL 'f Contrac �j Date [hereby afrr nr tha I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 73 UNIT K-MULTI-FAMILY KITCHEN (commencing with Section 7000)of Division 3 of tile A/C CINIT e Business&Professions UNL(SOSQFT)AND WASHER/DRYER HOOKUP AND ADD C_'ode and that my license is in full force and effect. A/C 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-paint source regulations per the Cupertino Municipal Code,Section 9.18. Issued bye,,--, lr------Date: Signature ./` 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 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and die structure is not intended or offered for sale(,Sec.7044, Business& Professions Code) Signature of Appliumt: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7044,Business K Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirur 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,Sections 25.505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions ofthe Labor Code,I must Owne rt t6rthwith 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. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 8 ITEMS OF 16 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32609072 . 00 DATE ISSUED. . . . . . . ; 01/19/2012 RECEIPT #. . . . . . . . . BS000015789 REFERENCE ID # . . . : 12010088 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER VS II LP ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST #150 CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 RECEIVED FROM . . . . : MONTEREY CONST CO 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 50 .00 588 . 00 0 .00 588 .00 0 .00 1TR.AVDOC FLAT RATE 1 .00 44 . 00 0 .00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT ; 915. 00 0 . 00 915 .00 0 . 00 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20900 homestead rd bldg#73k DATE: 01/11/2012 REVIEWED BY: bobs. APN: BP#: '"VALUATION: 1$20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK multi-family kitchen remodel and W/D hook-up and A/C unit. SCOPE Mech.Plan Check "00 $0.00 Mech.Permit Fee: 1 MPERMIT Other Mech.Insp. 0.0 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. . Thesefees are based on the prelinina information available and are only an estimate Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution I1-053 Elf. TI/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: E) Reg. 0 OT 0.0 1 hrs $0.00 $588.00 IREMRESKIT PME Plan Check: $0.00 2 I # Mechanical Permit Fee: $0.00 $130.00 1BAPPLOT Other Appliance/Equip Suppl. Insp. Fee.S Reg. Q OT 0.0 hrs $0.00 = # Mechanical PME Unit Fee: $0.00 $65.00 IBREMAIR A/C Units(<=10K cfm) PME Permit Fee: $44.00 Administrative Fee: IADMIN $41.00 Work Without Permit? Yes C) No $0.00 0 Advanced Planning. Fee: $0.00 Select a Non-Residential G or Structure Travel Documentation Fee: ITRA VDOC $44.00 Building � Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $132.00 $783.00 TOTAL FEE: $915.00 Revised: 1/01/2012 01/11/2012 15 : 47 (FAX) j 2-(Lj 00&&P. 002/003 ' CONSTRUCTION PERMIT APPLICATION 112 COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 Lj (408)777-3228• FAX(408)777-3333•bUilding cDcupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS — - v'11' APPI# / ZO G \--�c�m \-eo a 2c�. gtc c . 1t-13 _ - V - OWNER NA t I3 L—V PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME �n7 PHONE E-MAIL C,L7.FA Gv STREET ADDRESS CITY,STATE, ZIP,,G ❑OWNER ❑ OWNER-BUILDER ❑ 0v(NERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT rONTRACTOR NAME,�y LICENSE NUMBER LICENS�TYPE BUS.LIC# _ COMPANY NAME E-MAIL FAX YY�C,s�arE?; ' Cg—c1S A-%— c-A—c�,n C--e - t.— --'1 C<? STREET ADDRESS CITY,STATE,ZIP PHONE C55 31 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# I COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK � - —• �—_ �— kc\\ t' ter- G 2 <s�.r�r C ,►.- \U �� . �7r�S}c:�\ ��� �� c.,�-,c3t:�•-��.'..• vr��� oc_��SL ��:S-a-�Y '•�• •� � Sty:� .•(•t vcc EXISTINGUSE PROPOSEDSE CONSTRTYPE 11 STORIES `fllSl� k'#1'1134('tEt=€hsl,e3�i�`S"h'i,tl,Ct=. F. {, t t t t..iy I' �Ct:='. _ j$I f+ sz zi�iG i il t. . :%c({ S 'VAIIUATION E�XIFS� AREA NET TG NEW AAREA. tt Si �;.�R;+1,i1't4#t�}'7'+ I�'1 S�+ } Itt���`,�'f=I,3j t `II_�'1 1l� ..s(•�t BATHROOM KITCHEN - OTHERM1 i 4 Itl`�(it z {Ixlrin7 RPMODELAREA REMODELAREAi C REMODELAREA {ES4 fr, ? It_,h�(.i,'L� * ? i=I tt;;' t $.• ' t li CI`I =7 I +' riii+ Y•';,1 f't'�SS r t xl, i tl r i PORCH AREA DECK AREA TOTAL DIiCIUPORCII AREA GARAGE AREA:.El DETACH ❑ ATTACH ❑_ ❑ [I#I i�4S �r ("• !{i +'4 t+'1 �? j;jyt ells'!#�a+t a .,�q#t'� # z+ i -:tl K DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES t* 1 u BEING ADDED? NO ADD17lON7 r NO ti+l�1511311 Ex4i")tf I+ {`iP tl {S 'Iii I d{F t t{t ''i+ F f't +i{4 11 PRE-APPLICATION ❑ YES IF YES.PROVIDE CO) PIANNFRS NAME: I§tt}!li:lt?117 'l i"t.i�I "t i,ry3{F§1a1#_C•tlplht<1tztt.(. 3R5..=:. Ix'll1 AIIUA� O+ N PLANNING APPL M [3 NO PIANNO40 APPROVALLETTER fi :I10 + r9 .47 Icr 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 prvi 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 relat��f g construction. I authorize representatives of Cupertino to enter the above1 ,enti8 property for inspection purposes. Signature of Applicant/Agent: ; Date: y , SUPPLEMENTAL INFORMATION REQUIRED :a�i4`.. sAv c�IGci�1txy„ '° ibuTwc;erP _New SFD or Multifamily dwellings: Apply for demolition pemlit for ErliF&DUfITEi€} ,x t tF 3[iU1�PfIVGVLANREVIEW existingbuilding(s), Demolition permit is required prior to issuance of building permit for new building. }} _Conunercial Bldgs: Provide a completed Hazardous Materials Disclosure /{Ifti1'tl't'© PU C1If�IWQRKS form if any Hazardous Materials are being used as part of this project. )'l 1_ '{ i t= Co of Platlrlin Approval Letter or Meeting with Planning prior to PY g pp g g P i �lri &�34' {=1i ra so- C I1 k , !" N1TA1 7( E�VG2;.q#STRICt submittal of Building Permit application. ! ttit t t1 t .# rs ,li 1�7 BldgApp 2011.doc revised 0311 6111