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12070220
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRIiSS: 20800 HOMESTEAD RD CONTRAC'I'OR:VILLA SERRA APTS PERMI I'NO: 12070220 OWNER'S NANI Ii: VILLA SERRA APTS 1900 S NORFOLK S'1'S"19? 150 DATE ISSUED:08/072012 ON'i' . 'S PHONE,: 4086881581 SAN DL\TEO,CA 94403 1'IIONE NO: LICENSED CONTRA(-TOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUNIB I— License Class tom• Lic.k O5 2-0 ,,,, h1ECll r RESIDENTIAL r COAItr1ERCL\L en�� r Contractor I o,)TCAf _4� C061 Date 7 /� - I hereby affirm that I am licensed under the prnyisions of Chapter 9 ,JOB DESCRIPTION: BUILDING 18-REMODEL UNITS A THRU H(6,000 SQIrr) (commencing with Section 7000)of Di%isinn 3 of the Business S Professions (UNIT'I'YPE B) Code and that my license is in full force and effect. 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 workfor which this permit is issued. I have and gill maintain Worker's Compensation Insurance•as provided for by Section 3700 of the Labor Code,for the performance of Ute work for which this Sq.Fl Floor Area: Valuation:$120000 permit is issued. APPLICANT CERTIFICA'T'ION APN Number:32609073.20800 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 constmetion,and herebyauthorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORKjIS NOT STARTED indemnify and keep hamtless the City of Cupertino against liabilities,judgments, WITHIN I8O DAYS OF PE IT ISSUANCE OR costs,and expenses which may accrue agsiasf said City in consequence of the granting ofthis permit. Additionally,thrapplicam understands and will comply 180 DAYS FROM LAST C I ED INSPECTION. with all non-point source regulations per the Cupertiiho Municipal Code,Section 101-711—Z- Issued by: Dale: Signature r Date ❑ OWNER-BUILDER DECLARATION RP;ROOFS: 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 beitg 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 comM1nsation, 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(Sce.7044,Business&Professions Code). AL1,ROOF COVERINGS•1'O BE CLASS"A"OR BE FFR hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's IIA%ARDOUS DIATF.RIAI S DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the pedbrmanee of the work for which this permit is issued. California I Iealth S 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 S Section 3700 of the Labor Code,for the performance of the work for which this Safety Code.Section 25532(1)should I store or handle hamrdous material. Additionally,should 1 use equipment or devices which emit hazardous air permit is issued, contaminants as defined by the Bay Area Air Quality Management District 1 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 I Iealth S Safety Code.Sections 2550.5.25533,and 2.5534. Compensation laws of California. If,alter making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code.1 must Owner or aulh tzed h ant: p � Forthwith comply with such provisions or this permit shall be deemed reeked. 1' Date' U CON9I12LIC11ON LENDING AGENCY APPIACANT CF,RTI FICATION 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 perfomtance of work's correct.I agree to comply with all city and county ordinances mid 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,mid expenses which may acerae against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ,\NCI I I'I'FCI"S DECLARATION all non-point source regulations per the Cupenum Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20800 Homestead Road DATE: 07/27/2012 REVIEWED BY: Sean \ APN: BP#: 'VALUATION: $120,000 'PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Buildina is PENTAMATION Multi-FamilyDwelling 1R2REM USE: 3 Stories 0 Yes E) No I PERt�11TT1'PE: � WORK Buildin 18 - Remodel units A thru H 6000 sq H Unit Type 13). SCOPE Mech. PlanCheck 0.0 hrs $0.00 Plumb. Plan Check Elee. Plan Check Mech. Permit Fee: IMPERMIT Plumb. Po"a Fee: Ekc. Permit Fed: Other Mech. Insp. 0.0 hrs $45.00 OrinrPlumhlnsp. El Other Elee.Insp. El Mech.Insp.Fee: Plumb. hep. Fee: Elce.Insp.Fee: NOTE: This estivate does not include fees due to other Deparnnenrs(i.e. Planning, Public Works, Eire,Sanitary Server District,Schoo! District,etc.). There ees are baser/an the reliminan information available and are only(at estivate. Contact the Dept or adtln'I in a. FEE ITEMS (Fee Kesohrtlon I!-053 EB: 7/!/!U FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 6,000 s.f. Remodel, Other Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $7,629.00 IREAIRES3 PME Plan Check: $0.00 8 # Mechanical Pennit Fee: $0.00 $536.00 IBREMAIR A/C Units (<=10K cfm) Suppl. Insp. FeeQ Reg. 0 OT 0,0 hrs $0.00 PNIE Unit Fee: $0.00 PME Permit Fee: $45.00 Conswuction Tar: Administrative Fee: MWIIN $42.00 0 Work Without Permit? 0 Yes (F) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential Q Travel Documentation Fee: ITRA VDOC $45.00 Building or Structure 0 Stone Motion Fee: IBSE/S,141CR $12.00 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $149.001$8,165.001 TOTAL FEE: $8,314.00 Revised: 07/01/2012 CONSTRUCTION PERMIT APPLICATION Z U-7 Z C> COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 3 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildinor8cuoertino.oro ❑ NEW CONSTRUCTION ❑ ADDfrioN F2!] ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL PERWTEO 30rU I'D>,' PROJECT ADDRESS 2 AIN' -0KI l loT 2,0 X 0 /f .CV OWNERNAME C-C" PHONE Lt STREET ADDRESSICT STATE \Gco SUISV 6-731 - 35 CONTACT NAM PHONE EIL� J ,v\' o f? .CD. STREET ADDRESS Iso CTA ZIe //D3 FAX -931-35 7l OWNER ❑ OWNER-BUILDER *OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT c" CITO N LIC"2A 7 LICENS E BUS.LIC p Z7 — COMPANY.NAME 1 E-MAIL `� 1 FAX LCI . LJe-+• on -CUCrSNon.CaM 131- Yss 7y�� STREET ADDRESS /t /- CITY STATE,ZIP Gr37O ly PHONE / Hol Wit / O 3 ARCHITECT NAME /y �� I LICENSE NUMAEL_ �r n3 BUS.LIC M COMPANY NAME (� E-MAIL ` G I %1 ILS e � rSSar � �eclL�r�•can (s So- ?6 -a/� STREET ADDRESS a1l11r.>'" Era , cJYO PHOSS DESCRIPTION OF WORK 2X 1 4-o 2x2 Coc��ecs:o•� U n:�S n EXLSTING USE PROPOSED ONSIA TYPE 4STORIES USE TYPE OCC. $Q.F7. VALUATION(S) 2_2 2-Z J-3 Z =G NEW FLOOR DEED TOTAL U N P--2- BATHROOM AREA AREA AREA I NET TOTAL BATHROOM KITCHEN OTHER REMODELAREA • REMODEL AREA REMODEL AREA FibOD PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: Lj DETACH ❑ATTACH M DWELLING UNITS: 15ASECONDUNIT ❑YES SECOND STORY ❑YES BELNGADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES T YES.PROVIDE COPYOF IS THE BLDG AN C]YES PRECE[VEDI "F TOTAL VALUATION: PLANNDJGAPPLM []NO PLANNING APPROVAL LETTER EICHLER ROME? [3 NO �''^'- 'P'+`? ` _ /� �10 By my signature below,1 certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided 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 rel ting to buildin cons= tW authorize representatives of Cupertino to enter the ab-ov7cidrntifiedproperty for inspection purposes. Sigmnureof ApplicanUAgen1 Date: SUPPLENE ITAL INFORM] ON REQUIRED %€ ��`�� Q P1iAN.GHECKT1'PE a ROUTINGISIi1P New SFD or Multifamily dwellings: Apply for demolition permit for b� - ONiR.TII�COUN7ER ff DL\ RENEW- existing building(s). Demolition permit is required prior to issuance of building ( •, �. - y permit for new building. ®?eArReEss '�� ta vicetav RENEw:,, _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure bO $TA\DARD � W211 C WOR's • Tom if any Hazardous Materials are being used as pan of this project :. EPTjsT. _Copy of Planning Approval Letter or Meeting with Planning prior to ©, 31AJOR` d0 'SANITARI;SEWEA Ii15TRICT R submittal of Building Permit application. I E,�'Y [EYT U:HEAI:TH Bldg 1pp_201 Ldoc revised 06121111 _