13020043 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD. CONTRACTOR:MONTEREY PERMIT NO:13020043 '
. . CONSTRUCTION COMPANY -
OWNER'S NAME: VILLA SERRA APTS 88 MONTEREY-SALINAS HWY STEA DATE ISSUED:02/082013
OWNER'S PHONE: 4086881581 - SALINAS,CA 93908 PHONE NO:(831)601-2659
LI ENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
IJ
License Class Lie # REMODEL BLDG 38(UNITS A-H,6000SF)REFER TO
�orMASTER PLAN SET(PERMIT#12030068)
Contractor M(S✓1 w� (6:4 : 'Date Z `13
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division-.of the Business&Professions
Code and that my license is in full force and effect.
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. Sq.Ft Floor Area: Valuation:$120000
1 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 I PN Number:32609073.20800 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating W ITIHN 180 D RMIT ISSUANCE OR
construction,building consction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree m save 180 D OM CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City inconsequence of the ssued b ' Z g
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source re ulations per the Cupertino Municipal Code,Section
9.18. 3
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
' Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or.my employees withwages as their sole compensation,
will do the work,and the stnlctumis not httended or offered for sale(Sec.7044,
Business&-Professions Code) '
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE ..
concoct the (Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this Perrin is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255�0�5,�2�J55-3�3,end 25534. �f
Section 3700 of the Labor Code,for the Performance of the work for which this /L' ;�--Date:
Owner or authorized agent:
permit is issued:
I certify that in the performance of the work for which this permit is.issued,I shall
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. if,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTMCATION Lender's Address
1 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments, - -
costs,and expenses which may accme against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit:Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
00
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �O V
CUPERTINO (408)777-3228•FAX(408)777-3333•buildine(Wcuoertino.orcl \
❑NEW CONSTRUCTION ❑ ADDITION N ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS CA APN
OWNERNAME PHO
L/I
STREETADDRESS CITY,STATE F C
1
CONTACT N P NE
STREET DRESS ( ,+. CCIY, TATE,ffi F
❑ OWNER ❑ OWNER-Bm,,ER ❑ OwNm AGENT ❑ CONTRACrOR ❑CONTRACTORAGENT ❑ ARCNITECr ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRA R QP� LICENSE NUMB LICENSETYP BUS.LIC
COMPANY NMAIL NA e" ,�V F
S ADD S S CRY ST ,ZIP �( N P O
L4 1
14 1
ARCHIr'ECT/ENGINEER A1]CENSENUMB („� G� BUS.LIC M
COMPANY NAME &PAIL, F
5
STREETADDRES , CITY,ST TE, PHO _
_VDI hjkllAt�+ '5+1
DESCRIPTION OF WORK I LI
EKISTING PROP SID CONSTR TYPE M STQI S
1171_ USE TYPE ( OCC. //rSQ.FT. VALUATION(S)
EXISTAREA NEW AREA FLOOR DEMO AREA N T ( ➢ lC 1 00 IS( uA'1�
BATHROOM KITCHEN OTHER v�
REMODEL AREA REMODEL AREA REMODELAREA
PORCH AREA DECK AREA TOTALDECKNORCH AREA I GARAGEAREA: Ll DETACH
❑ATTACH
#DWELLING UNITS: ISASECONDUNrr OYES SECOND STORY OYES
BEING ADDED? ONO ADDITION? ONO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ISTHEBLDGAN ❑YES4vm*it
IQTAL VALUAV9k:
PLANNINGAPPLM ONO PLANNN`GAPPROVALLEITER EICHLERHOME? 0NO /O/ICn/
ov
By my signature below,i certify to each of the following: I am the prpoperty owner or authowner's behalf. 1 bave read this
application and the information I have provided is correct I have read the Description of agree to comply with all applicable local
ordinances and state laws relating to building eo tion. I ' o � representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agenb Date:9
SUPPLEMENTAL INFORMATION REQUIRED wixQ siTP` M
_New SFD or Multifamily dwellings: Apply for demolition permit for ..a ER- J• °, "� "'�°'
t( `BUILLD `•P REVaEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. s q3¢.'G REn�t3.
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
fo {'+� sr 'D .•tyo
rm if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. srlue -
EldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20800 HOMESTEAD RD DATE: 02/0812013 REVIEWED BY: MELISSA
APN: 32609073.20800. BP#: *VALUATION: $120,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Building is PENTAMATION 1R2REM
USE: Multi-Family Dwelling >3 Stories O Yes (D No I PERMIT TYPE:
WORKREMODEL BLDG 38 UNITS A- H REFER TO MASTER PLAN SET PERMIT# 12030068
SCOPE
PIT 4MI
F `« .49t
Mech.Plan Check 0.0 his $0.00 Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plumb.Permir Fee' flee. Permit Fee:
Other Mech.Insp. 0.0 his $45.00 Ocher Plumb Insp. Other Glee.Insp.
;blech.Insp. Feer Plumb. htsp. Pee: Mee.Insp.Fee.'
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff• 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 6,000 s.f. Remodel,Other
Suppl.PC Fee: Q Reg. O OT 0.0 his $0.00 $7,629.00 IREMRES3
PME Plan Check: $0.00 8 # Mechanical
Permit Fee: $0.00 $536.00 IBREMMR A/C Units(<=10K cfm)
Suppl. Insp.FeelD Reg. OOT 0.0 his $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction Tar:
Administrative Fee: IADWN $42.00 O
Work Without Permit? O Yes Q No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure O
Travel Documentation Fee: 1T2ZAVDOC $45.00
Strong Motion Fee: IBSEISMICR $12.00 Select an Administrative Item
Bldg Std s Commission Fee: IBCBSC $5.00
Timt T$ . $ , . 'TOT $8,314.00
� ' Revised: 01/0112013
Building Department
City Of Cupertino
y, f 10300ToreAnuc
Cupertino, CA 95014-3255
Y Tolcphonc: 408-777-3228
Fax: 40B-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: ZC 00:,, wed' =gd PERMIT# 13 OZ-00
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR-.- p BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires'all°businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.`
I am not using any subcontractors:
Signature Date
Please check applicablesubcontractors,and complete the following information:
V SUBCONTRACTOR-I'll. BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwork:
Cement Finishing,, ;
Electrical
Excavation
Fencing
Flooring/Carpeting:
Linoleum/Wood
Glass /Glazing,
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
r Lo
047er/Contractor Signature Date