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12070219
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRI?SS: 20800110MESTEAD RD CONTRACTOR:VILLA SERRA APTS PERMITNO: 12070219 ON'NISIt'S NADI lie VILLA SERRA APTS 1900 S NORFOLK STSIT ISO DA'I'S ISSl1EU.08/072012 ON)\ER'S 1'11ONE: 4086881581 SAN NIATEO.CA 94403 PI IONF,NO: �(7 I.IQENSED CONI'RAC`fOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.# r r r MEC& RESIDENTIALCOMMERCIAL Contractor I+ti6cn �Date 7/IF-- [ IZ1 hereby affirm that I nm licensed under the provisions of Cha parr') JOB DESCRIPTION: BUILDING 60-REMODEL UNIT A TKRU It(6,0000 SQFr) (commencing with Section 7000)of Division 3 of the Business S Professions (UNITTVI'E D) Code and that nn•license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain it certificate of consent to self-insure lar 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 die work for which this Sq.Ft Floor Area: Valuation;$120000 permit is issued. ,\I'PLIC\\I'CF;R'I'IFICA"TION APN Number:32609073.20800 Occupancy Type: I cenity 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 hays 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 E,' IRES IF WORK IS NOT STARTED indemnify and keep hamiless the City of Cupertino against liabilities,judgments, WITHIN O YS OF PERMIT ISSUANCE OR costs,and expenses which may accnm against said City in consequence of die granting of this permit. Additionally,llieapplicamt uriderstaads and will comply 180 DAY '- 'OM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. rj 7 Issued by: Date: Signature Date J ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law formic 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 nnv 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(Sce.7044, Business A`Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,13usiness&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BF;TEIR hereby affirm,under penalty of perjury one of the following three declarations: I have and will maintain a Cenifcate of Consent to self insure for Worker's I I,\%.\RDOIIS NLCI'ERI,U ti DISCLOSURE Compensation,as provided for by Section 3700 ofthe 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 S 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 0lunicipal Code,Chapter 9.12 and the I Iealth S 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 emil hazardous air permit is issued, contvminanrs as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work farwhich 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 S Safety Code.Sections 25505.25533,and 25534. Compensation laws ofCalifomia. If,after staking this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must O v�L"r reho agent: 7 ?� forthwith comply with such provisions or this permit shall be deemed rooked. Dare: CONSI'RIICI'ION I,IS\DING,\GI'.NC\' ,\I'I'LIG\\I'CFK'I'1IrIC,\'I'I(IN I certify that I have read this application and state that the above information is I hereby affirm that there is a construction leading agency for the performance of work's correct.I agree to comply with all city aid 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,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicam understands and will comply AKCI I I"1'FCT'S DECLARATIONwith 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildina(c)cuoertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERNDT- 12.030(ou? PROJECT ADDRESS APN 9 2—C O C O-7 OWNER NAME vo\ "" a\ PHONE MAn. V se-'c- I Liof-'(F£�!/S� ( I u/sI l�k �,rele.e..sre .co STREET ADDRESS CONTACT NAME AIt PHONE rG E- STRE E ADDRESS- I _(MTA Z FAX Arc , C{ - �/6(D3 Cosa -V1 - 7/ OWNER ❑ OWNER-BUILDER *WNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO C,TON e'n I LICI E NUtJ 2 I LICEN. E HUS.LICA 2-7 COMP-ANY NAt+ff /+ E-MAIL FAX c�'on CO . I (J2-+� FAX X-orvv 3 /- Ess- 9�G STREET AD��{5 - Inas I' /- ,t CITY S'[q �- Q31G Tj PHONE ((y� Wtz ff I n / O 3/—(0a .0 ARCHITER R NAME ry LICENSE NUtv®Et' p� I BUS.LIC A COMPANY NAME (� E-MAIL / Fyycc [?SS C� rSSar- -4 -- ,Cn, STREETADDRESS 0jn4 C77Y ATE, Ar'A y (�^ ,, - q//a-7b PF'ON`j6 DESCRIPTION_OFF WORK ` ` •\ Un1 \I /-r �e� s�S v Io} 0068 EXISTING USE PROP/nO7SED t ON1SrTR.T//��YPE O STOORREES USE TYPE OCC. SQFI. VALUATION($) k-2 F-2 J-!-] G. EXISTG NEW FLOOR DEMO TOTAL U N Z AIIEA AREA AREA NET.-ABA BATHROOM REMODE OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECWORCH AREA I GARAGE AREAL- DETACH ❑ATTACH A DWELLING UNITS: IS A SECOND UNIT OYES SECOND STORY ❑ -as BEMG ADDED? ONO ADDITION' ONO PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESzREf�IVEDi - TOTAL VALUATION: PLANNINGAPPLJ ONO PLANNINGAPPROVAL LETTER EICat.ER ROM' ONO T"' - ,. By my signature below,I 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 I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and sate laws rel ng building consm1 R0 authorize representatives of Cupertino to enter the above-identifiCtipra Cry far inspectionpurposes. Signature o(Applicant/AeenC Date:_�Z ( 112 SUPPLEMENTAL rNFORMA-FfON REQUIRED ;' z'$ CHEc�K;T,YPE � RotmNc;sulr` New SFD or Multifamily dwellings: Apply for demolition permit for 'N 70VER_7Hf.COUNTER." q H DING.PLA.v;REV7EW existing building(s). Demolition permit is required prior to issuance of building - aim vw�,.r• - permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure +©, srnNvnlcn - _ - yO PusuJ -woRRs f form if any Hazardous Materials are being used as pan of this project O.EtinacE >ti _ _MN _Copy of Planning Approval Letter or Meeting with Planning prior to - %t submittal of Building Permit application. t SADTTARYSEWERtDIS'I'RICT �-_ _. - ..I�f�:61'VIRON\fEN1'AL`.HEALTH BldgApp_2011.dec revised 06121/11 _ CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20800 Homestead Road DATE: 07/27/2012 REVIEWED BY': Sean APN: OP#: 'VALUATION: $120,000 *PERDIIT TYPE: Building Permit PLAN CIIECR TN'PE: Alteration/ Repair PRIMARY Multi-Family Dwelling Buildina is PENTAi111ATION 1R2REM USE: 3 Stories Yes 0 No PERMITTYPE: YY'ORI: Buildin 60 - Remodel units A thru H 6000 sq ft Unit Type D). SCOPE Mech. Plan Check 0.0 hrs $0.00 Phanh. Plan Cheek Elea Plan Check Mech. Permit Fee: 1 AIPERM17" Plumb.Permit Fre: Elec, Permit Fee: Other Mech. lisp. 0.0 hrs L$45.00 Other Plumb Insp. Li Other Eler.Insp. ,19ech.hup.Fee: Plumb. hup. Fee: Eler.Insp.Fee: NOTE: This estimate does trot include feev due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc.). These eev are baser/on the preflininan information available and are onh,air evdi ate. Contact the Dept for adds Y info. FEE ITEMS (Fce Rewhaion 11-053 EI! 7/1/1)) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 6,000 s.f. Remodel, Other Suppl. PC Fee: (F) Reg. 0 OT0.0 hrs $0.00 $7,629.00 IREMRES3 PME Plan Check: $0.00 F__87 # Mechanical Permit Fee: $0.00 $536.00 1BREA9AIR A/C Units (<=I OK cfm) SUppl. Insp. FeeQ Reg. 0 OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Pee: $45.00 7771 Cmtstraetiint Tax: Administrative Fee: IdDAIhv $42.00 0 Work Without Permit? 0 Yes 0 No $0.00 E) Advanced Planning Fcc: $0.00 Select a Non-Residential G Travel Documentation Fee: I7R/IVDOC $45.00 Building or Structure 0 A Stone Motion Fee: IBSEISAIICR $12.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $1149-.0-0-1$8,165.00 TOTAL FEE: $8,314.00 Revised: 07/01/2012