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11070016 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11070016 CONSTRUCTION COMPANY OWNER'S NAME: PROMETHEUS REAL ESTATE GROUP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:07/14/2011 OWNER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO: (831)601-2659 L LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ BLDG 79-UNIT A;INSTALL NEW WASHER/DRYER AT EXISTING CLOSET(10SQFT)INSTALL NEW AIR License Class Lic.# !12 CONDITIONING UNIT,REMODEL EXISTING Contracto Date_ , � I hereby affirm that I a licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarat' Sq.Ft Floor Area: Valuation:$20000 1 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. APN Number:32609072.00 Occupancy Type: 2 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 permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that 1 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 180 DAYS FROM LAST CALLED INSPECTION. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued b Date: costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,t applicant understands and will comply with all non-point source repul ti�perpenicipal Code,Secti n 9.18. RE-ROOFS: Si nature �tiDate All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature.- installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: :by affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 1 1,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material. 1 1 have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality:Management District I will Compensation,as provided for by Section 3700 of the labor Code,for the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 2. 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 Ow r r th ` permit is issued. Date: 3 1 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 I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the =ing of this permit.Additionally,the applicant understands and will comply with )n-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date CITY OF CUPERTINO 7 ITEMS OF 21 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32609072 . 00 DATE ISSUED. . . . . . . : 07/14/2011 RECEIPT # . . . . . . . . . BS000014033 REFERENCE ID # . . . : 11070016 SITE ADDRESS 20900 HOMESTEAD RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PROMETHEUS REAL ESTATE GROUP ADDRESS 1900 S NORFOLD ST CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 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 1BREMAIRHA NO.UNITS 1 . 00 65 . 00 0 . 00 65 . 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 874 . 00 0 . 00 874 . 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 06/30/2011 17: 21 (FAX) l ��1 ( P. 004/004 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300',TORRE AVENUE •C:UPERTINO, CA 95014-3255 10 (408) GUPERTINO 777-3228 • FAX(408)777-3333•build ingacupertino.ora ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS `t -p nn (fl� "''J QNrl "LC�c1OO �-tC�^r\r �2C.C� `�LJt eAC�iI {t APNa �`�� I —_ OWNER NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX 1ca�t� S, (-1f�� ���Sf• #t 1�JC CA CONTACT NAME 7 PHONE E-MAIL 1`� C� 45�✓� LIS- "1�aa\ Jth�.\;c LrY,�. �•�-l+�crl;.y..ca-. STREET ADDRESS CITY,STATE, ZIP [ FAX �,ui\•k f,S .� _JG,Q�r\c.'S �-�t�+ '�•1 \."� �r- � C�Ga —\J t� roc_ C•• t c c• c` ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT rOM'ttACTORNAME 4TE-NIAEL ICENSE NUMBER ENSWE BUS.LICq � COMPANY NAME F FAX1 iii�.LSTREET ADDRESS Y,STATE,ZIP PFIONE C��r•�c:.�, ��� x-'13-ICJ'� �-iSS-..,�=i �` ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK CLQ-C� EXISTING USE PROPOSED USE {I# s�' Itl(ll+d "t>IFt it, "IF zl t t a�{t+�I�V CONSTR TYPE q STORIES y41 1 i 11" t{1 .li z;.,�{�s i114ziD RI CI Y z EXISTG ( tz VA T] NEW FLOOR .DEMO TOTAL N�isir1t1{P z Ii i$ AREA AREA AREA NET AREA #•?,t�!X331 uI c,„Sf 51 f.4, �: ;;,:ta Via, ,}iR t,,,13t'' z BATHROOM KITCHEN OTHER REMODEL AREA t}+ oI}!zs SE�zi3(;t; : 4oei REMODELAREA REMODELAREA z:� lrlt f PORCH AREA (01 DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA:❑DETACH +l t,.;i�dlp y�y}t f jj, Ft t (}z - i ;n°at ❑ATTACH izi tld'IfkHAi E>z'it�zr�€, u� sera i�it�l,+} i }it} $ �3 M DWELLING UNITS: IS A SECOND UNIT ❑YES 5ECOTiD STORY YES ❑ {tft�17�{'I ii F 3 i 1 wrt !1 t lit "lir,b f i,r 4 t1LING ADDED? NO ADDITIGNr NO j 1f11311i }i171'i�y5.-.lr fi, PRE-APPLICATION ❑ YES IF YES,PROVIDE COPYOF PLANNER'S NANW: 4 e t7.1"t$'1(3} 11'� i;p -�}t icier yr' it l� iyt s,i'ft , - �{` Y,t 411 r{t1 AsTOTAL VALUATION: PLANNING APPLN NO PLANNING APPROVAL LETTER ❑ By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read"t'his application and the information I have pr vi ed is correct. I have read the Description of Worlc and verify it is accurate. I agree to comply with all applicable focal ordinances and state laws relating t g construction. I authorize representatives of Cupertino to enter the above-identified operry for inspection purposes. Signature of Applicant/Agent: Date:—(.,0/ SUPPLEMENTAL INFORMATION REQUMD .,f:B tI .1�,411J$Gk{rlX>Ell t,`t t,., i ROUTIN_C'SLIP 1 "-i t1+ t•i, It je f't i s at New 5FD or Multifamily dwellings: Apply for demolition permit for I I,lt0�F11 C QUI$7iN3F4 ©, FIUH,DINC PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building tlIl&5Jl Wtti�l ltrl 1 ti fr 2t tis (t �i permit for new building, 1 l r,�3zI fA {s,{ y aR].ANNIIYGPLAN,RJ;VIEW _ } ltRl+rf�lil(l�l,'1 ii1h t h i i 1{ix z t d3 St n sS t i 1r ' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure i{(I '�({ ry�AI•i tR 1j+1�Wi��}i” form if any Hazardous Materials are being used as part of this project. }�Tl� to of Planning Approval Letter or Meeting with Planning i , —bmitta] „`sIi�+�P t{lU�AItuz,i lPVTG RKS; - of Building Permit application. �r i ;k Ql sANIT 'Rr DlsT $Ewrl3, Itl �1 cT +i�q�'ijl`� ti ��}3{lilr€!{rl s11 ;� ° T1:+ ; I 1 Sat+f}i3 s3 �3;tt lf.�J},kEN IRONMENTA&HC,ALTH BldgApp_2011.doc revised 03116111