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12010163 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12010163 CONSTRUCTION COMPANY OWNER'S NAME: VS 11 LP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:02/08/2012 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.# �� �� 1 MECH RESIDENTIAL COMMERCIAL Contractor - a�—� Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 76#H-APT COMPLEX REMODEL, (commencing with Section 7000)of Division 3 of the Business&Professions KI"I Code and that my license is in full force and effect. ADDD NEW SOS EW A/C UNIT&WASHER/DRYF,R 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 ource regulations per the Cupertino Municipal Code,Section 9.18. Issued by�� -� r - Date: 2 0 V Signature � Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 1 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: 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,[ become subject to the Worker's Compensation provisions of the Labor Code,I must Own or tho ' ed agent: f forthwith comply with such provisions or this permit shall be deemed revoked. �' Date: Z PY P Z5 ___U 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. 1 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 # . . . : 12010163 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------- CREDIT CARD 1, 830 . 00 VISA --------------- TOTAL RECEIPT 1, 830 . 00 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION me ADDRESS: 20900 homestead rd bldg 76#H DATE: 01/26/2012 REVIEWED BY: bobs. APN: 3a& 6?® 73FB #: �01& ,VALUATION: 1$20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Du lex PENTAMATION 1 R3SFDREM L)SE: p PERMIT TYPE: WORK Apt. complex remodel = kitchen add new A/C unit W/D hookku . SCOPE klech.Plan Check 0.0 hrs $0.00 Flech,Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $44.00 JN10TE: This estitnate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the erelinina information available and are onl an estimate. Contact the De t or addn'l info. ITEMS 'z :.:�� �;'� �t _ ��' 7,1,"i, 1 FEE (QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1= s.f. Remodel,Kitchen(<=300 sf) .'uppl.PC Fee: Q Reg. a OT 001. hrs $0.00 $588.00 IREMRESKIT PME Plan Check: $0.00 1 1 # Mechanical Permit Fee: $0.00 $65.00 IBREAmm I A/C Units(<=tOK cfm) Suppl. Insp.Fee:Q Reg. 0 OTQ.0 hrs $0.00 2 1 # Mechanical PME Unit Fee: $0.00 $130.00IBAPPLOT Other Appliance/Equip PINE Permit Fee: $44.00 L__j Administrative Fee: 1ADAffN $41.00 0 Work Without Permit? 0 Yes No $0.00 G i I v I lw. 7 ri�A I ceE $0.00 Select a Non-Residential Building or Structure 0 Travel Documentation Fee: I TRA VDOC $44.00 •i:r__��A« fi�is ors Fele: IBSEISAffC.R $2.00 Select an Administrative Item _S1(1 tyr M IBCBSC $1.00 SUBTOTALS: $132.00 $783.00 TOTAL FEE: $915.00 Revised: 1/19/2012 01/26/2012 14 : 20 (FAX) 2 (D' C)i �p P. 003/003 CONSTRUCTION PERMIT APPLICATION w COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 GitP �tTiNQ (408)777-3228- FAX(408)777-3333 bUildinc a�cu eriino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT it PROJECT ADDRESSUr�'4 APN n '•Zo �O !-�C�-�r-���-�c�.c� 2t�. �3�cAc"'1tiD'��-1 �, �P- _ t OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAIX CONTACT NAME n PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX C�\ ❑OWNER ❑OWNER-BUILDER ❑ OWNERAGENT X CONTRACrORf ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME `LICENSE NUMBER LICENSE.XYPE BUS.LIC N COMPANY NAME EMAIL FAX C-e�'�7 C t C,�C3"-\ -lt-�c c�Y-r�r C tsr f uc1l�.r CA>^-. STREET ADDRESS CITY,STATE,ZIPI `�'3£ 1,16W 'iY�C�s�ar j- s `5 ��vy ?CcSl�..r`c•'o. C-6-2s :a PHONE C ARCHITECT/ENGINEER NAME LICENSE NUMBER - BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK C._. A.-I l rl`v}tG.`\ r1 cmtA7 C.a:tr Gc7t-1C�L�1-.�:c�..'(�G LJ�t�r ' 4—,r-10C 1ek £ EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES t�' #i���Izl�IIs I£KIWI,iY��te�'1 r, rf t;�+l j � �}+;0 `��' ` ., ?_:=:bCG ttfsitls,,,tt TYPIs,9'1Fs .. DHSCRt TI H S FT. A T! N EXISTG NEW FLOOR DEMO TOTALtri t f,Ig'' a csI AREA AREA AREA NET AREA S•:t£ }",�£' "£ {'} } stl BATHROOM KITCHEN OTHER 3's REMODEL AREA REtvtODELAREA RLMODELAREA `� „<` £ a.' • PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: ❑ DETACH Q ATTACH i;ir�lll;t i,i£ F£ P.trltt t t tr;�4. t r t S,a€Yac,r=:=r I 1 F1;7" �b..,.{�,l t•,:t r,r.. If iati DWELLING UNITS: 19 A SECONID UP£iT ❑YES SECOND STORY ❑YES lt. )j x if S r s3i1t £3tlilt i i d j!z F I s t BEING ADDED? NO ADDITION? C91tNO i xt.t.te..a;1t l.a ..:a PRE-APPLICATION SI 1 4 ❑YES IF YES,PROVIDE COPYOF PLANNER'S NAME: ItY PLANNING MPL M ❑ NO PLANNING APPROVAL LETTER ; t r (tF� t fF 3 t s t'�TQTAL V �,UAN F i;S�££ £t £`tt T '` t4 '4 S za£}`i;;s ti 1 si i t1 't t.t3 .1;,££.? :.t<..r.1 e1 r! s•> ,I't,s3,.�, t By my signature below,I certify to each of(lie 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\Nark and verify it.is accurate. I agree to comply:with all applicable local ordinances and state laws relati=tWig construction. I authorize representatives of Cupertino to enter the abo • ntifie i -operty for inspection purposes. Signature of Applicant/Agent: Date:-176 I j a SUPPLEMENTAL IINFORMATION REQUIREDi >Y' ='gig'" 4CTXpI ,,g4rt1, ! ROtfT!t.NG SLIP New SFD or Multifamily dwellings: Apply for demolition permit for a F 4 P ta HE-1COUN�'EIt<�,f F r h� NG PLAMREViE1V existing building(s). Demolition permit is required prior to issuance of building: tf t'o 1 t1 c a�, �� } permit for new building. ff` } .. i it s+a tf IYi l:drf!!h „SXPE�S y111 tr t t£F1 #rltlt {,t# tI�],I'LAVNING PLA N ftEVtEW y3i5 ££f tf!!t;�•t f it�3;�i h f S F E,F t �.k�l i1 fi T k"5 L S e 41 ti£s ;f i§l t..f I��iitt�� �,l ty g• I j i Commercial Bldgs: Provide a completed Hazardous Mal, Disclosure r ;1�ysrAlvDAIjtljf £` ; r= _ O PUBi,IcwpRKs form if any Hazardous Materials are being used as part of this project. 1 15 t`L�jA'i¢,}�Ih riilts i t t s;Fs�£ £t t r` FIRE DtaPT }f It�7 ri£ i;1�Y-!s E �3a 7 - 3 ' Copy of Planning Approval Letter or Meeting with Planning prior to Vis"` submittal of Building Permit application. ° 1M �t°€�a lYa�' }_ _`�'+' '` t I Q'x5A�I�TARY'SEWERDISTRICT ';`tt fll� t r 4'1ti� fJs 1 }i:" £, t 1� t }Sa:t F £!'t,s + , R#}S5 i.II£SSi a1 }I1 ?I "RONIhiEN:TAL'HEALT H' i. 7>,ElY BIdgApp_2011.doc revised 03/10/11