12060066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800110MESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 12060066
CONSTRUCTION COMPANY
OWNER'S NAME: VILLA SERRA APARTMENTS LLC 88 NIONTEREV-SALINAS IIWVSTE A DATE ISSUED:06120/2012
OWNER'S PHONE: SALINAS,CA 93908 PHONE NO:(831)601-2659
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class 7 L' `7 Lic.9
� '� MECH r RESIDENTIAL r COMMERCIAL r
Contractor [1.46 . remy Ctir C-Ca• Dale
hereby affirm that 1 analicensed under the provisions of Chapter JOB DESCRIPTION:BLDG 16-UNITS A4 R-2 COMPLEX REMODEL IN PI IASES,
(commencing with Section 7000)of Division 3 of the Business&Professions WORK INCLUDES KITCHEN.BATT 1,ADD A/C AND
Code and that my license is in full force and effect. WASHER/DRYER I LOOKUP-5280 SQFT
I hereby affirm under penally 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:$120000
permit is issued.
APPLICANT CERTIFICATION APN Number:32609073.20800 Occupancy Type:
I certify that I have read[his application and stale that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to budding 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.
2Issued by: Date:
Signature T v Dale ( �% L
❑ OWNER-BUILDER DECLARATION
RF.-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roots shall he inspected prior to any tooling material bong installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials fix
1,as owner of the property,or nay 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: Dale:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). AL1,ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penally of perjury one of the following three
declarations: IIALARDOUS 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 Ilealth&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 Ilealth&
Section 3700 of the Labor Code,for the performance of the work for which this Safely Code.Section 25532(x)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 forwhich 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 Ilealth&Safety Code.Sections 25505,25533,and 25534.
Compensation laws of Cali Poria. It,after malting this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner,�p/r a/u�trrized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. m/�' Daub
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending ugcncy 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 hamdessthe 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 ARCIIITEC`F'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
91, 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: Building 16(Units A-H) DATE: 06/12/2012REVIEWED BY: Sean
APN: 326-09-073 BP#: 'VALUATION: $120,000
*PERMIT TYPE: Building Permit =
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2REM
USE: >3 Stories OYes No PERMITTYPE:
WORK Buildin 16 - Remodel and add A/C to units A thru H 5zwsq ft
SCOPE
Mech. Plan Check 0.0 hrs $0.00 Fhmrd. PIrnr Chc<k I/n Phnr t'h,r k
Mech. Permit Fee: IMPERMIT /... . f'cr'urir 14rr lSkr. Peri rir G;-,,.
Other Mech. Insp. 0.0 hrs $44.00 Odu•r'l'lumh/nsp, Odra'lila /r�y�-
16'rd. lmp. l'rr: Phunh. Lnp. Frrr Iflcr. Ga/. Fr<:
NOTE: This estimate does not includejees due to otter Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelinddna information available and are only an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 6,000 s.f. Remodel,Other
Suppl. PC Fee: (j) Reg. Q OT FO.01 hrs $0.00 $7,476.00 /REMRES3
PME Plan Check: $0.00 = # Mechanical
Permit Fee: $0.00 $520.00 IBREmfiR A/C Units(<=10K cfm)
Suppl. Insp. Fee:Q Reg. Q OT F0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $44.00
l,ixtrnrrrliun 7rr,r:
Administrative Fee: IADMIN $41.00 O
Work Without Permit? O Yes 0 No $0.00 0
Advanced Plannine Fee: $0.00 Select a Non-Residential 0
re or Structure 0
Building u
Travel Documentation Fee: ITItnvDOC $44.00 Bu �
Strong Motion I'ec IBSEISMICR $12.00 Select an Administrative Item
131d_, Sids Commission Fee: IBCBSC $5.00
SUBTOTALS: $146.00 $7,996.001 TOTAL FEE: $$,142.00
Revised: 06/05/2012
7-Z1/Z-" A-1-f Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
MOF Fax(408)777-3333
CUPER,TINO
Building De artment
JOB ADDRESS: /I PERMIT #
2okOo
1- resfeag AacJC / 10
OWNER'S NAME: toMcA.xe .sea dale/ PHONE # yo — r-15-
GENERAL CONTRACTOR Orl•� ere c4ton�e , FAX # 66D -,4-31 -35-71
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/C8ntractor Signature Date
M\nder o sdr sea b>�: 1
CONSTRUCTION PERMIT APPLICATION 2-cy-3
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 • bulldln0(EDcupertlno.Org C ���
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NEW CONSTRUCTION ADDITION ALTmAT10N ri-II El� REVISION/DEFERRED ORIGLNIAL PERN11T k �D
PROTECT ADDRESS Zogm a 6' AIN* �J C
OWNER NAME
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OWNER 13 0W—BUIDER ❑ OwNERAOFM ❑ (MN RACrOR ❑CONTRACTORAGM' ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑'I'NAYI'
CONTRACCORNAME 280. LICENSE ?21 LICENSE TYPE BUS."C"Z7S
COMPANY NA.'NEMO�\ w_ I /� E-MAIL L"���7�Mr jC0rG)-rUV (, GOPN FAX,??,
STREET ADDRESSA•OrcT sN�A Q STATE.
(I ZIP A. 9(9o8, PHONE�.3�-607"2659
ARCHIFECr/ENGfYEER N,AI'YC C •LIJa"10.� INCENSE NUMBER - /�/2 BUS.EICO2
COMPANYNANIE /� 7 E-MAR• 1 J FAX - .4
K i�ecdr.re. Imnl L r5sarGl': evl2ue.'C✓ v/S� oeZ.ol� 7
STREET ADDRESS r 1 QTY.STATE. O PHONE
.SD SLA u: ` J�✓vP` i,-�S,�C/.�/: �Jtf� c• �/J ,�j�, �°Z/'.') CS
DESCRIPTION OF WORK O4 old vlOC•� �� tp ( e)m5eS. I/rrl,s' � &C u/P &yel (gall J I,
lv_t- Il �4e n 1kn-PZJ� -E',oe"A% ��.i, N iAsaaP! AC u ed
ll�f�z-
EDORTQ+
SE PROPO mU CON TYP #SfORffS
r2II- USE TYPE OCC. SQ-FT. VALUATION(5)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET.AREA
BATHROOM KITCIUN OTHER /[-
MMODELARFARENOOET.AREA - REMODEL ARFA -
P00.CH AREA DELX AREA TOTAL DECK/PORCH AREA GARAGE DETACH
❑ATTACH
#DWELLING UNM 0 A SECOND UR YES SECOND STORY ❑YES
BEING ADDED? '2NO ADDMON'. JRNO
PRE-APPLICATION ❑YES G YES,PROVIDE COPY OF IS THE BLDG AN [0]YES RECEIVED BY: TOTAL V�UATiON:
PLANNINGAPPLp E2'NO PLANNINGAPPROVALLErM EICHLEAHOM? ow1aNO 1 �,S 6CJlJ
By my signattre below,I certify to each of the following: I am the property owner or authorized aeent to act on the prrpenyowner's behalf.77 read[his
application and the information i have provided is correct Jhava read the Description of Work and verify it is accurate. I agree to comply with a]applicabie local
ordinances and state laws relator g coasaDcdoa I prize representatives of Cupertino to enter the above-idripfcd popery for iIspecnon purposes.
Signature of Applicanr/AgenL- Date: 3 /S/1Z..
SUPPLEMENTAL I NFMVUTIO QUIRED PLAN CHECX TYPE ROI-TING SUP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER-Tt�rDLmmeR B'Bu¢Lvc PLAN REVIEW
buildmg(s). Demolition permit is required prior to issuance of building
permit for new building. E❑ PNPR�Ess Q eLREVIEWw NG PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure W-S<1VARD
form if any Hazardous Materials are being used as part of this project. ❑ GE Q PES LE
_ PT
Copy of Planning Approval Letter or Meeting with Planning prior to /
C1 &WOR ❑SA.NTTARY SEWER DISTRICT
submittal of Building Permit application.
❑ LWIR MENTAL HEALTH
B1dgApp_2017.dac revised 06/21/71