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12010089 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010089 CONSTRUCTION COMPANY OWNER'S NANIE: VS It LP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:01/19/2012 OWNER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659 LICENSED CONTRACTOR'S DECLARATION £mm F 55�� �' `�/' BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# C 5._,. 3 MECH RESIDENTIAL COMMERCIAL Contractor 'date I hereby affirm that I am I° nsed under the provisions Of Chapter 9 JOB DESCRIPTION:BLDG 73 UNIT L-MULTI-FAMILY KITCHEN (cOrnrnencinA/C g with Section 7000)of Division 3 of the Business&Professions /C UNIT EL(SOSQFT)AND WASHER/DRYER HOOKUP AND ADD Code and that my license is in full force and effect. AU I hereby affirm under penalty of perjury one of the following two declarations: 1 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 1 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 reguiatiot per the Cupertino Municipal Code,Section Issued by _ - �---- Date: Signature r! !� 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 hvo 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 tlae project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby al'tirru 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 tine Cupertino Municipal Code,Chapter 9.12 and tine t€ot 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 t5K9rizgd t rthwith 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 herebv 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 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20900 homestead rd bldg#731 DATE: 01/11/2012 REVIEWED BY: bob s. APN: I BP#: "VALUATION: 1$20,000 }PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: p PERMIT TYPE: WORK multi-family kitchen remodel and W/D hook-up and A/C unit. SCOPE Mech.Plan Check 07ohrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $44.00 F-1 L NOTE:This estimate does not include fees due to other Departments(Lem Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on therelin ina information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 11-053 Ef.7,!1,-11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 50 s.£ Remodel,Kitchen(<=300 sf) Suppl.PC Fee: E) Reg. Q OT 0.0 hrs $0.00 $588.00 IREMRESKIT PME Plan Check: $0.00 = # Mechanical Permit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip Suppl.Insp.Feer 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: ]ADMIN $41.00 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: 1 TRAVDOC $44.00 Building or Structure St1•ona Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $132.001 $783.00 TOTAL FEE: $915.00 Revised: 1/01/2012 01/11/2012 15: 48 (FAX) j 2�� v�: . 003/003 -.r tit CONSTRUCTION PERMIT APPLICATION COMMIJNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION i 90300 TORRE AVENUE •CUPERTINO, CA 95014-32.55 CUPERTINO (408)777-3228 • FAX(408)777-3333 •building0cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION I Ti ❑ REVISION/DE_FERRED ORIGINAL PERMIT# PROJECT ADDRESS ` V �! -ZC> C3 t^ c>—y-1 ``'' �/J��({�� �Ac1 C.��Yyv APN H — OWNER NAME �1 ✓ L— PHONE E-MAIL Los, Gly STREETADDRESS _ CITY, STATE,ZIP FAX CONTACT NAMEPHONE EMAIL 2 G_ `i5✓� l�`��- lC i'J\ -7c C�m� STREET ADDRESS CITY,STATE, ZIP (_ C ❑OWNER ❑OWNER-BUILDER OWNERAGENT-. CONTRACTOR [ICONTRACTORAGENT ❑ ARCHITECT. ❑ENGINEER ❑ DEVELOPER ❑TENANT !ONTRACTOR NAME/ LICENSE NUMBER- E-MAIL FAX LICENSg�TYPE BUS.LIC N _ COMPANY NAME `J Ct:c1S-A-r- c''kc^.U.n. -I-\-,e:�.�e.� mr C_.o�c-.'S�-ruc.:+\- �n- ems'^^ STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME i LICENSENUMBER BUS.LIC N COMPANY NAME E-MAIL FAX i STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK C .s�::� C_(i SLS-St�C71� L lr\�� \4CQV �cu1 EXISTING USE "i r 'li l({t4N5}I lil"9{3�ii•`litta af.�f t I :afi,.N ]�I < PROPOSED USECONSTR TYPE p STORIES tw bk_It t't�p .tf'.ii i 9D S•RtF1TIbN +tis l EXISTG NEW FLOOR DIMO TOTAL rs AREA AREA AREA [ .. NET AREA BATHROONI KITCHENgls}1Es t I, - OTHER - i li{t}iD�t}Il�ri.I`{ REMODELAREA REMODELAREA;I REMODELAREA 1Oi fp" l.ic sp�rcK,.1srE " a 1 y, PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA; ❑DETACH i q saklll p at ft s I -:�'1'I � {��Id II ❑ATrncH ;�� 1 �l Y;+4(a I ��I;�� � h�;rss` s �'tlf{�13 4��t# til� t,i N DWELLING UNITS-. IS A SECOPD UNIT! ❑YES SECOND STORY ❑YES ifstt I'� r41 W111, ,� Sys psi t 5`S Ss x t rt [ DEING ADOEDT NO AODIT[ON7 < NO flfi;i yatll,�sff'Still"j�'1 ;£S#sfc 1 I i`TI Ffs;i tsf!tit�.` t i is s }s t s 1. lt,iL{'.t,i .i1 rstlE>uSn..S;, f..'s. c t.t-„ 3,..._zil ._.-..•:._. PRE•APPLICAT)ON iaRt T4l'I I s'•14 .1'1`±'s ❑ YES IF YES,PROVIDE CO'YOP PLANNER'S NAME: & s S h $ } c 5 a Is I s t{ias §tj PLANNfIVG ADPL M ❑ NO PLANNNO APPROV LETTER �1ii`s` �(y5(��}t I f� t ti 7{Sa ;'ss!! tit tl,f� f t IWTAI;V L A Oj�l " .L�i1� t�'�f} I t i¢ Lit to.�Itjj�-#i]I 510 Ti t t; 3 2 S+ 'IM"I ,} i . ,xrY 3(t,I,t?S,SIi...<, . 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 infonnalion I have pr vi ed is correct. 1 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 f construction. I authorize representatives of Cupertino to enter the above 1F Werth Ie ix pert for inspection purposes. Signature of Applicant/Agent: Date: tJ tj SUPPLEMENTAL INFORMATION REQUIRED z I t tI All a> tt�t,l'i t 5a, y;l at t Lai Q nJ11A i" All fTYPLi I t + R(gUTtNGSLIP New SFD or Multifamily dwelling's: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildingii Itis`i, tT 5i is Q =ry `I� ',< >I DING PLAN REVIEW permit for new buildin Iii, i i at}get ! t Cs 7" tilt s'(5 I �( If k s ft , _ ' + It Ft's' h I, t Is� xi tis{ i0 i'vANNI PI A'NIREv w r;tt Commercial Bldgs: Provide a completed Hazardous Materials Disclosure xIT> DI sls}t"i;`,a,itli(ti t�I t© P� t[I w' Rxs g part form if an Hazardous Materials are bean used.as art of thispec ro� t. _ _ Copy of Planning 1 t tit. �Ii l P 6r Approval Letter or Meeting with Planning prior to t#1 Ii ti p sta i fl t i submittal ofBuilding Permit a lication. _ � r>t }2 !i s I< �flt sAISI,�Iz�t�SEw�R nI$'�'RICT' g Pp 0 r(1NENTALtI11 A4TH BldgApp_M1.docrevised 03/16/1