12100010 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 208001iONISTEAD RD CONT'RACT'OR:MONTEREY PERJIIT'NO: 12100010
CONSTRUCTION COMPANY
OWNEWSNA\IE: PROMETHEUS 88,\IONTTSRF.YSALINAS IIN'1'SI'IsA DATE ISSUED: 10/052012
OWNER'S PI IONE: 6509313400 SAUNAS,CA 93908 t'DONF.NO:(831)601-2659
❑ LICENSED COnTRAC`VORR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB rl
License Class 3 Lic.N Vyl�3�-7 --
MECFI r RESIDENTIAL r COMMERCIAL rl
ConuactorMdh� 6115+ G° Date tO 2
hereby affirm That I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BUILDING 47 UNI'T'S A-H 660 SQ FT EACH TOTAL 5280 SQ
FT
(commencing with Section 7000)of Division 3 of the Business S Professions
Code and that my license is in fall 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 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 forwhich this Sq.FI Floor Area: Valuation:$160000
Permit is issued.
APPLICANT CISRT'IPIG\TION APN Number:32609056.LITTES Occupanc) 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 ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting ofthis 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
9.1&
/q/ �/ ,. 'L
Signaturez` Date 1610 Issued by: �C�{� /7rG Date: /Q -le, -
❑ OWNER-BUILDER DECLARATION
RI:ROOFS:
hereby affirm that I am enempt 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 ova reasons: installed without first obtaining an inspection,1 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). AL1,ROOF COVF-RINGS TO RIS CLASS"A"OR BET FEIR
I hereby affirm tinder penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIXLARDOUS MATERIALS IIISCLOSURIS
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&Safel•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 I Icalth&
Section 3700 of the Labor Code,for the performance of the work for which this Safely Code,Section 25532(a)should I store or handle hazardous material.
Addilionalh.should I use equipment or devices which emil hazardous air
permit is issued. contaminants as defined by the[lay Area Air Qualily Dlamagement 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 25505,25533,and 25534.
Compensation laws of California. If,after making this ceniticate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aul xized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. /� !'�hate:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and slate 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 cit and county ordinances mond state laws relating for which this permit is issued(Sec.3097,Cir 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 Cit of Cupertino against l iabililics,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 ARCIIITECI"S DECLARA'T'ION
with all non-point source regulations per the Cupertino Municipal Code,Sectio
n
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
09/27/2012 11: 1114tr-y Construction Co. (FAX)831 455 7986 P.003/003
. • ' ;. - /�/DSO/O
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3265
CUPERTINO (408)777-3228- FAX (408) 777.3333 •buildinG(dlcuoer inG oro
ggQ❑tt��CCNFW�CONSTRUCTION E) ADDIMON ALTERATION/TI ❑ REVISION/DEFERRPD ORIOINAL PimmrrN
omastead Road, Building #;", _, Units A -
Q iiha Serra Apartments PaOng B-MAIL
(850 931.3400
1 8BA90 orfDik Street, # 150 CtieratzipCA 94403 PAX
aYvAi T t P O8N5a0
931-3400
STREET ADDRESS Pmwrlght@prometheusreg,com
CITY,STATE, ZIP FAX
1900 So. Norfolk Street # 1550 San Mateo CA 94403
❑OWNER eA❑ OWNER-DUE-Da O OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCiaraCr ❑ENOIN9aR ❑ DBVELOPER ❑TENANT
t9IcheiC Ke Ao WCE�' �' e0. LICENSIFPE
own
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ontore onatrucllon Com any ben�la mryconstructlon.com (01) 455-7986
S TADDRESS CITY,STATE,ZIP 8 Onlere -S811nes Hwy„ Suite A PHONE
�allnat;. CA 9390§ 831 455-7931
ARCNITECTIENGINEER NAME LICENSE NUMBER
OUS,UC
COMPANY NAME EMAIL
FAX
STREET ADDASSS CITY,STATE,ZIP
PHONE
Amovte 8 re Gtaoe kitchen & bath cabinets. Replace electrical subpanel &subfeed, Install new W/O & hooku 9,
Run new hot& cold water lines for all existing fixtures.
�A'vd�Lr-N t 1 LDEXISTING USE PROPOSED SeY\S�
�hP'1�l CONSTR TYPE YSrORgS .:.:. :•
4/>7c 1/a a k
EAISTO NEW FLOOR Da.MO � TOTAL .{'�p �J �,/.T� •p
AREA AREA AW Nrr AREA -
BATHROOM
RITCMPN OTImR 2�^
0.EMODELAA
A ARM DEL AREA RE-MOD LARaASa� 1
PORCH AREA DECK AREA TOTALOECK/POACH AREA GAAAOe 1 y
AREA:❑ DETACH Y t
A ACX
•DW INQ VNRG: j� II AIL[ONp L'NR ❑10d ItCO.VO(rORY Y6l 1 -
(J/T BUND ADDtaf o AvoTONr �D r tl ' •
1 1Y."14 �1J <-Yns lie x .21 t - '�. . f 1111
PaeNKIGTI4N �YEI bYFd,1AOVpe�YDI ILANN91'd NAAp, 1RaCaDTUtBY 1 �` F�' ,t 11 j ITOT VA£VAlION ( 1 `1
IWIN:W MM' ❑
By my signature below,I certify to each of the N119 W Ing: Lamina property owner or authorized agent to act on the property t behalf. � fsi3 y
application and the Information I have provided i et. I have read the Description of Work and verify it Is aeeurala. I agree to comply with all Applicable lou,
ordinances and:tato laws rcleling to building e t horiEo rapt tadves of Cupertino to enter the above.i ontlaed roperty far inspection purpoece,
Slgnatuo of Applieant/Agent:
Date!
SUPPLEMENTALfNFORMATION REQUIRE 1 r
Li PLAY CHECK TYPO , I a kSROUTINC 9Lf1' ) -
NewSFDoiMultifamllydwellings: Apply for demolition pernllt for rti •,v' 1 : t - -
existing building(:), Demolition permit isrequired prior to Issumcc orb GVER 7TIE-...... ` ` � 'BU¢piNOPLANRRhtw '
permit for new building. AS + - :
1 ❑LESIpRE}9 .' ;•�:u•:.:•;.� '' (] PLANI_IMG PLAYAEVIEW
_Commercial,Bldgs: Provide a completed Hazardous Materials Disclosure
form irony Hazardous Materials are being used as pan ofthis project.
I :!�!i LARC6 .:+L';:,:-.:�:'..:: .,; 0i�itAEnEP.Ti:..:....,f:...'iI ••':;::.-,.
Copy of Planning Approval Lotter or Meeting with Planning prior to
submtnel of Building Perrnil application. s�y�;Nu`i0ii'rr`?•:•:.:,;;..�,:=•, ::' ' `�� "'''''-•''•�`'`� � -�
91dgJtpp 2011.doe revfsed03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:i
ADDRESS: 20800 Homestead Rd DATE: 09/28/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: 1$160,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTA,MATION 1R3SFDREM
USE: PERMIT TYPE:
\YORK BuiIding 47 Units A-H Master Plan 12030068 : Remodel units A thru H 5280 sq ft).
SCOPE
Mach. Plan Check Plumb, Platt Check Elec.Plan Check
:birch.Permit Fee: Phmrh. Permit Fee: Elec.Permit Fe
Orb.r btech,Insp. Other Plumb Insp. Other E/cc.bolt.
'ifech.Insp. Fee: Phonb.Insp. Fre: Dec.. btsp.Fee:
A'OTB:This estinmte does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District, etc.). These fees are based on the preliminarl information mailable and are onh•an estimate Contact the Det for adtln 7 info.
FEB ITEMS (Fee Resolution 11-053 EB 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 5,280 s.f. Remodel, Other
Suppl. PC Fee: Q Reg. 0 OT FO,0 hrs $0.00 $7,247.00 IRE,+-/RES3
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
A(Iministralive Fre: Q
Work Without Permit? O Yes (D No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Documentation Fees: Building or Structure t�
Strong Motion Fee: IBSE1SMICR $16.00 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC 1 $7.00
SUBTOTALS: 1 $23.001$7,247.001 'TOTAL FEE: $7,270.00
Revised: 07/01/2012