12010162 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010162
CONSTRUCTION COMPANY
OWNER'S NAME: VS II LP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:02/08/2012
OWNS PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659
LICENSED CONTRACTOR'S DECLARATION €r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# 957A7 `"
Contractor ��-U�� �6ti+�-� Date_24
8 1� MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 KITCHEJOB DESCRIPTION: BLDG 76#G-APT.COMPLEX REMODEL,
(commencing with Section 7000)of Division 3 of the Business&Professions N(SOSQFT),ADD NEW A/C UNIT&WASHER DRYER
HOOKUP
Code and that my license is in full force and effect. HOOKUP
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 Cupertino Municipal Code,Section
9.18.
Issued by: �--� == Date: �V, �-
Signature Date4
❑ OWNER-BU DER 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 BE"T"TER
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 6.9.5 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
1 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 25.532(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
1 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 Owner o.0authorized agent:
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 16 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609072 . 00
DATE ISSUED. . . . . . . : 02/08/2012
RECEIPT # . . . . . . . • . : BS000015957
REFERENCE ID # . . . : 12010162
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 . . . . : RICHARD REGA
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
1TRAVDOC 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 76##G DATE: 01/26/2012 REVIEWED BY: bobs.
APN: ,07..2 BP#: /&" 6Z 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 Apt. complex remodel = kitchen add new A/C unit W/D hookku .
SCOPE
FN!1ech:P1an CheckFo-o-1hrs $0.00
Mech.Permit Fee: IMPERMIT
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.). These,Lees are based on the ereliminary information available,and are only an estimate. Contact the De t or addn'l in o.
FEE ITEMS F e, a fad >¢,fi 1_.-'5 �f.` ' t;' 1 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 50 s.f. Remodel,Kitchen(<=300 st)
Suppl.PC Fee: (j) Reg. Q OT E0j hrs $0.00 $588.00 IREMRESK[T
PME Plan Check: $0.00 1 1 # Mechanical
Permit Fee: $0.00 $05.00 IBREMAIR I AIC Units(<=10K cfm)
Suppl. Insp. Fee-0 Reg. 0 OT El hrs $0.00 = # Mechanical
PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00 Q
Work Without Perrnit? 0 Yes 0 No $0.00 E)
i'h<b� �_n, I #;--° $0.00 Select a Non-Residential
.00
Travel Documentation Fee: ITRAv'DOC $44
Building or Stricture
IBSEISAKCR $2.00 Select an Administrative Item
P1 < `ate-s C orrmiissjon Fee: IBCBSC $1.00
�_._ .
SUBTOTALS: $132.00 $783.00 TOTAL FEE: E $915.00
Revised: 1/19/2012
01/26/2012 14 : 19 (FAK) � . 002/003
CONSTRUCTION PERMIT APPLICATION
• COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINQ (408)777-3228• FAX(408)777-3333 • building(ahcupertino.om
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS l�Y1°� APN# C V
OWNER NAME - PHONE E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
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CONTACT NAME �7 PHONE E-MAIL
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CA
STREET
STREET ADDRESS CITY,STATE, ZIP FAX
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❑OWNER ❑ OWNER-BUILDER ❑ O%VNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
PONTRACTOR NAME LICENSE NUMBER LICENS YPE BUS.LIC N
COMPANY NAME E-MAIL FAX Lti E=lN)
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STREET ADDRESS CITY,STATE,ZIP PHONE
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ARCHITECT/ENGINEER NAMELICENSE NUMBER I BUS.LIC#
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COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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DESCRIPTION OF WORK
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�� t fii EJ=; 1fS x}�!it€if°:�4 i3r?I£3^�TE EEEt,Fk-.3;;i x1111'.• S<aL1';^
EXISTING USE PROPOSED USE CONSTR.TYPE #STORMS
i.dCC.,,F�f,sS{E .TYF'FI x ' CQES RIPTION S FT. V l ATI S
EXISTG NEW FLOCK DEMO TOTAL
AREA AREA AREA NET AREA {gip ? £,,I
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA
REMODEL AREA
Et7q? Es S.sj jt t v1Xi# (i ,tai j "r S 2 -
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑DETACH Y
�;`i 3fi,B
❑ATTACH 1°,£=
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N DWELLING UNITS: IS A SECONFD UNIT ❑YES SECONDSTORY ❑YES [1Fr;r€i It$i£113i a U?}S-IS fttr£ilii fy a!t c tet' t 3!
BEING ADDED? NO ADDITION? NO € l Illlx ft i�t,� :�it4.>4 1{fi�"{:f Ef f$ 511✓z f jj£,}-s>.:�t :.<It fs s3r i
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PRE-APPLICATION ❑ YES IF YES.PROVIDE COPYOF PLANNER'S NAME: , $ csll I€' t 4< i ,g r r lr Y 1 t '
tiitz tt 3 1�t f;"! €r a I (TOTAL VLtJ¢Yt9N:
PLANNING APPL N ❑ NO PLANNING APPROVAL £ , I /v
:�31t13,fit�s;t. t.:.__?"Itts.,?°F r et'<;.i•�i:(tf5. .r::.°. €?.>or:<c= _'i.'s..
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 pr vi 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 'd' g construction. I authorize representatives of Cupertino to enter the above-i entitied�pt perty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
: ,ROUTINUSLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
tr OYE i TI>E Cq I1 ERs; a I❑ ,B.UILDING PLAN REVIEW
existingbuilding(s). DemoIition permit is required prior to issuance of building
+
p 4 P g t
permit for new building. 1 !rsa k=£zl I j t I4 itr= g,
s, e s I
pI}EtS },a st f? „I❑"PLA NINCr PLAN REVIEW
Es t{�syyti"1(jji €is rFti r5, i TxTs s f t£rSi t t i a tj s is�. d i f z
ttt
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ' E ~ �r�ND }sF<�=; ,I,'S ' ��' f� Pt{B tc WORKS
a' ;Fs I} E t t,t i,t lq t
form if an Hazardous Materials are being used as art of this project. I,t �'•I;, l;�.l�i=ttf 3 r 't
Y g P P J {; 1s r r tAtii,7
€1Qt l�� � �sv l�k ft f,t a':d sit t ela itl;IIS s f$IRE DEPT ?
Copy of Planning Approval Letter or Meeting with Planning prior to ;, ��, I k si►Ft k- 4 s r f 5, , ,,� ,£t{ i
,F r tMAJR 1 €t(s { s r'!tt 4 f `�,}t c°t i i'SANITARY SEWER DISTRICT
submittal of Building Pennit application. !!,I£ai {„=,t, ,,i£E E , E , , ,) Y ,, $,,
E }} t ;,
t4;t3 stat I�s s t nS 'flit,
it a F
,!iI„tt3 174” s€;£=iE,.,v.i v.�•:rl;NlrlItQN1►1E1VTAL'HEeILTII'.
B1dgApp_2011.doc revised(13116111