11100027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11100027
CONSTRUCTION COMPANY
OWNER'S NAME: VILLA SERRA APARTMENTS LP ET AL 88 MONTEREY-SALINAS HWY STE A DATE ISSUED: 10/05/2011
C FR'S PHONE: 6509318400 SALINAS,CA 93908 PHONE NO:(831)601-2659
LICENSED CONTRACTOR'S DECLARATION r
n _ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# 'C��� �/ ;r �""
I MECH RESIDENTIAL COMMERCIAL
ContractorJ�� b 1 }-� L Q,<,�. Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 73,UNIT H,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:
1 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 WITHI AYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DA OM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section 77�n f
9.18. ! U /)
O / / Issued by: Date:
Signature ( �J` Date ( ` /
L 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:
I,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 r a*horized went:
forthwith comply with such provisions or this permit shall be deemed revoked. -
- 1 Date:
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
inlAmnify 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
6.—.ting 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
CITY OF CUPERTINO
7 ITEMS OF 28 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609072 . 00
DATE ISSUED. . . . . . . : 10/05/2011
RECEIPT #. . . . . . . . . BS000014949
REFERENCE ID # . . . : 11100027
SITE ADDRESS . . . . . : 20900 HOMESTEAD RD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER VILLA SERRA APARTMENTS LP ET A
ADDRESS 20900 HOMESTEAD RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RICHARD REGA
CONTRACTOR . . . . . . . : BEN REGA LIC # 32275
COMPANY MONTEREY CONSTRUCTION COMPANY
ADDRESS . . . . . . . . . . : 88 MONTEREY-SALINAS HWY STE A
CITY/STATE/ZIP . . . : SALINAS, CA 93908
TELEPHONE . . . . . . . . : (831) 601-2659
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1 .00 41. 00 0. 00 41. 00 0. 00
1BAPPLOTHE NO OF APPLIAN 2 . 00 130. 00 0. 00 130. 00 0. 00
1BCBSC VALUATION 20, 000.00 1. 00 0. 00 1 .00 0 . 00
1BSEISMICR VALUATION 20, 000 .00 2 . 00 0 . 00 2 .00 0. 00
1MPERMITFE FLAT RATE 1.00 44 . 00 0 . 00 44 . 00 0. 00
1REMRESKIT SQ FEET 50 . 00 588. 00 0. 00 588 . 00 0. 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 .00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 850. 00 0. 00 850 . 00 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 307 INSULATION
308 SHEETROCK 309 EXTERIOR LATH
310 INTERIOR LATH 311 SCRATCH COAT
313 ROOF NAIL 317 MECHANICL ABOVE CEILING
318 ELECTRICAL ABOVE CEILING 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
516 FINAL BUILDING
CITY OF CUPERTINO \
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd bldg73#H DATE: 10/05/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$20,000 —�
�'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1 R2REM
USE: 1 >3 Stories 0 Yes (j) No PERMIT TYPE:
WORK multi-family apt. complex remodel kitchen add new W/D hook-up.
SCOPE
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: 1 MPERMIT
Other Mech.Insp. 0.0 hrs $44.00 1 L
Li
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on therelirrina information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resohition 11-053 L f. Tl.%"11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $588.00 IREMRESKIT
PME Plan Check: $0.002 # Mechanical
Permit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip
Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00 0
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning,Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRAVDOC $44.00 1
Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $132.00 $718.00 TOTAL FEE: $850.00
Revised: 10/01/2011
10/04/2011 13 : 09 (FAX) P. 005/005
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION \ -'
10300:TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)7 77-3228• FAX(408)777-3333 •building(cr�,Cupertino.orcl `
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
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[application
y signature below,I certify to each oflIthe following: I am the property owner or authorized agent to act on the property owners behalf. I have read this
and the information I have ppi ed is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ances and slate laws relating t di g construction. I authorize representatives Of Cupertino to enter the abovepentifiedproperty for inspection purposes.
ture of Applicant/Agent: ; Date:
�U
SUPPLEMENTAL v�}7ORMATIO �N RE UIRED
"I t'ss{i �� i�E lt1NrG'{I[nC�iKt7i)'AG��1 Imo':�, t ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buildingNlER THS� YtE3LJ BG•11LANREIEW
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permit for new building,
Co , 1'�4�Y��1 3��t��i�lk�itS�It'I''Yui;�S'l�lr� sPL`ANIYINGPLANREYI&W
nunercial Bldgs: Provide a completed Hazardous Materials Disclosure IYaEJ� Pf ill�'�I �'} fig' 1 f Tf 1ri�1 f.
w,l,i} /\l AR1?t l 1 l+ s4 ❑ PUBLIGSWQItiCS`
form if any Hazardous Materials are being used as part of thisec
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Copy of Planning Approval Letter or Meeting with Planning prior to
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submittal of Building Permit application, s 1y1 s If rI ' jC t s5 P SANITARY SEWER DISTRICT.
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B1dgRpp_2011.doc revised 03/16/11
i
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
7 Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACT"",/ SUBCONTRACTOR LIST
JOB ADDRESS: i PERMIT# 11W Z•
OWNER'S NAME: r,? .L. 4, c� .c.. PHONE#
GENERAL CONTRACTOR: n t r4-V BUSINESS LICENSE#
ADDRESS.- F5 c 6 "n S 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 SUBCONTRACTOR HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. r'
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
Owner/Contractor Signature Date