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11100025 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11100025 CONSTRUCTION COMPANY OWNER'S NAME: VILLA SERRA APARTMENTS LP ET AL 88 MONTEREY-SALINAS HWY STE A DATE ISSUED: 10/05/2011 ER'S PHONE: 6509318400 SALINAS,CA 93908 PHONE NO:(831)601-2659 C� LICENSED CONTRACTOR'S DECLARATION F r c� q BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (> Lic.# ��J�'' ` (� MECH RESIDENTIAL COMMERCIAL Contractor bate I hereby affirm that I am lic nsed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 73,UNIT E,MULTI-FAMILY APT COMPLEX, (commencing with Section 7000)of Division 3 of the Business&Professions REMODEL Code and that my license is in full force and effect. KITCHEN 50 SF,ADD NEW W/D HOOK-UP 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. 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:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:32609072.00 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 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 189 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 TDAOM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section9.18. Signature /Z ' Date/� � Issued byDate: c� �� OWNER-BUILDER DECLARATION RE-ROOFS: I 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 being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I 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: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS 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 Health&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& 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 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 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 certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or syQthor' ed agent: forthwith comply with such provisions or this permit shall be deemed revoked. + �1�., Date:Ir _ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 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 iv-'--unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the g,.aing of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with 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 10/04/2011 13 : 07 (FAX) P. 002/005 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 jTORRE AVENUE •CUPERTINO, CA 95014-3255 \\ (408)7 77-3228 • FAX(408)777-3333• bui(dingecupertino.orq CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITIONALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT it PROJECT ADDRESS l.}!v- APNN OWNER NAME PHONE E-MAIL —• for�Cr�hCJ�> 2rC'G�� ` �rc. e tT�y�P S,O �ti5\- 3` 1v0 i STREET ADDRESS j - CITY,STATE,ZIP FAX nc>0 S. 'C1c�� l\L Ste. 1��C� �c:,s� r`n �t CC CONTACT NAME PHONE E-MAIL �e Gti `t5ati Vl�r'7- �C\"J\ "•�\'lr=.,\t'.C.��.�.mC L�,;\:S�Uc:�F:U�.i_a.•.. STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGE•NT �CONTRACTOR ❑CONTRAGTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT f.ONTRACTOR NAME, �� LICENSE NUMBER LICEP7S 1'PE BUS.LIC b 'lam �t c=C�r.` CE> COMPANY NAME E-MAIL FAX -1 he-A k e-L m� c :.r i-c uc�c:✓.. t:> ( 3�� STREET ADDRESS I CITY,STATE,ZIP PHONE CSS �r54s Y`nt:�,r��el- -•S ,.6.s 1�.x . �. � G�c�lt_:..c�.5, C:.l� G•��—�;+^��S �1SS• �1c� ?�. ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC H COMPANY NAME - E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �— � —_•� •�-G�! 'f1� W c,�;:.�hc�s— Cis � <`j,� �Y��-hv�a� C�.<%��:'� 1 U s� ' �-�-� ' Y-15}G.\� T'lcAA7 C�� X�C.�i.U-st�l�'c��.'�f'� L.J�-��J+-- I�•C-'�.S-`c'�oC�E?Q E�X.��i-�Y"'�'r`r'I ��1•'�-�t'1� Sty�f .i�� \/Y:SLDG.,Q EXISTINGUSE PROPOSED USE CONSTR-TYPE #STORIES s,r�I.sK#1 4ii[ytlr {{{{s s'.}s'i l {s kit~lr,}ETFI t �.Y0�NLY .;,i.Irs}aL4r1sS rlt €�flsv zs,s Ei7s'.,ai scS._•�Sr hIBTI +''• S ..V. .T'ON IS). EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA i��t,qq f t#3 AI asst �C� '1`s '�,?'. 1..�^'.;; L�'�' .. BATHROOM KI`FCHFN OTHER sSgqsitg 11�I liii}t S'�l� {+ r t 7}ts s i;Iii S s s RF.MODELAREA REMODELAREA C,:—::� RMODELAREA AC::) PORCH AREA DECK AREA TOTAL DBCK/PORCH AREA GARAGE AREA: El DETACH - ❑ ATTACH '�I t i r! 'iS is 'l;3.?t'{i S N DWELUNO UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? NO ADU?TION7 r NO PRE-APPLICATION ❑ YES a'YES.PROVIDE COPYOF FI.ANNFJt'S NAI. : PLANNING APPLN NO PLANNDJO APPROVAL LETTER ❑ i I h 31{t1tY}fi'SS,l„{<+C•.iSt NSaE4t T. }f�.3....!:>~' 6_ By my signature below,I certify to each of the following: I 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 pryVj ed 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 relating construction. I authorize representatives of Cupertino to enter the abovi!lentified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFiORMATION REQUIRED i;a' RkgNsIte[c TPEI'I + t ROUTING'SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ;y'`i ISL' ,a _ ,� CHF GQUI{IPER ! BUtI,p►NG PLAtV REVIEW existing building(s). Demolition permit is required prior to issuance of building i, `r `s;lall� t iSa I, y 1 la f;EP ss x��l 111 P s t t 4. permit for new building. ''E�t+ p114xt1jy{}} a al t ,� tL!LA13I11GPIANRFVIEIV !E 111 111' lljl§ 3< ts+ h 141 _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I p 11 r� MRD;1 t ?�h "'I 11] PUr�IJtcwolllcs forrn if any Hazardous Materials are being used as part of this project. Iltt Ill�{'IS'A72 tuft!i t� i t}IFt I yl 1#lziS 1�Pi-iw Q -: .- e �:M 4 f I tt i t:)��"i 'It sttt t'i�.t• t I r 1`�r�At''il'T _Copy of Planning Approval Lettelj or Meeting with Planning prior to suttal of Building Permit application, bmiE{I}s �il'Iq Sgij €"f 7pI° 41ls tti z '€ �i €€+1 ANIT RX$EWER°DISTRIGI , Mt, 'ill Ils? , 1"� fiNit $R( ,r% SS.�S ��L��,� .. .,id,,,ENYIRONMI N�fAL'NDALTR: I BldgApp_201 1.doc revised 0311611 i Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O - Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ()a k1.5' 'rr_ PERMIT# OWNER'S NAME: ~ �, ,� i- r-V PHONE# GENERAL CONTRACTOR: n�jt�.� Y��_ L �' BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the c ty 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 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile F / Owner/Contractor Signature D to