11070011 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11070011
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS REAL ESTATE GROUP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED: 07/14/2011
V 'NER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO: (831)601-2659
❑ LICENSED CONTRACTOR'S DECLARA'T'ION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
BLDG 78,UNITJ-INSTALL NEW WASHER/DRYER AT
4 EXISTING NING UNI ,RE MODEL ALL NEW AIR
License Class Lic.# ® r'7� CONDITIONING UNIT,REMODEL EXISTING
Contract Date/ 1�1
I hereby affirm that am 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.
I hereby affirm under penalty of perjury one of the following two declarj� Sq.Ft Floor Area: Valuation:$20000
1. 1 have and will maintain a certificate of consent to self-insure for Worker
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 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 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 by: Date:
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply with
all non-point source regulations p the pert o Municipal Code,Section 9.18. RE-ROOFS:
`� Date ' 1/ All roofs shall be inspected prior to any rooting 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:
i,.creby affirm that 1 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. I,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&
I hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material.
t I 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
Compensation,as provided for by Section 3700 of the Labor Code,for the contaminants as defined by the Bay Area Air Quality Management District I will
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 Owner o auth rii gent-
permit is issued. ate:
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 1 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,
,osts,and expenses which may accrue against said City in consequence of the
nting of this permit.Additionally,the applicant understands and will comply with
non-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 # . . . : 11070011
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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 2, 622 . 00 VISA
---------------
TOTAL RECEIPT 2, 622 . 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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20900 homestead rd bldg.78#J DATE: 07/01/2011 REVIEWED BY: bobs.
APN: BP#: Ile ��� "VALUATION: $20,000
".PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1 R2REM
USE: 3 Stories 0 Yes 0 No PERMIT TYPE:
WORK
SCOPE
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: 1MPERMIT
Other Mech.Insp. El hrs $42
NOTE: These fiees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS (Fee Resolution 09-051 1f;ffff, 1.-'10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Re Itchen(<=300 sf)
Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 $570 1 T
PME Plan Check: $0.00 1 # Meth ical
Permit Fee: $0.00 $63 IBR IR A/C Units(<=10K cfm)
Suppl. Insp.Fee-E) Reg. 0 OT 0.0 hrs $0.00 2 # Mechanical
PME Unit Fee: $0.00 $1 O 1 BAPPLOT Other Appliance/Equip
PME Permit Fee: $42.00 +P
Acoustical Fee: 0 Yes E) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 E)
Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $42 Building or Structure
i
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg;Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $87.00 $759.00 TOTAL FEE: F $846.00
Revised: 04/29/2011
06/30/2011 17 : 20 (FAX) I 0 1 P. 003/004
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
103007ORRE AVENUE•C:UPERTINO,CA 95094-3255
CUPERTINO (408)777-3228• FAX (408)777-3333 • buildingftupertino.ora
❑NEW CONSTRUCTION ❑ ADDITION Q ALTERATION/T1 ❑ REVISIONS/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS . _.., APN#
OWNER NAMEI PHONE E-MAIL
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STREET ADDRESS r�� CITY, STATE,ZIP FAX
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CONTACT NAME n PHONE E-MAIL
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STREETy-ADDRESS CITY,STATE, Z[P FAX
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FOWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
ONTRACTOR NAME LICENSE NUMBER LICENSE
YPE HUS.LIC# _ �-•
COMPANY NAME E-MAIL FAX
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ARCHITECT/ENGrNEER NAME LICENSE NUMBER BUS.LIC#
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STREET ADDRESS CITY,STATE,ZIP PHONE
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REMODEL AREA REMODEL AREA .� t�!*' r ,,,.,�r;,• } ?.,Ir}+,41
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH -51,1st}"pigs t t�yt s�I s
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UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES 341 {i I I ,£$yt ££
BEING AOOEGN ♦ No
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ARE-APPLICATpN ❑ YES
ffY6s.PROVU)E COPYOFPLANNER'S NAI.ai: u4 is
PLANNING APPLN i It �rk� rla,{t{dy Y71E Sr s iTBTIiL VALIYAT[ON.
PLANNING APPROVAL I57TER [I
i 4s: SIPM1�,i£�i
By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have provijled 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 t I i g construction. I authorize representatives of Cupertino to enter the above-identified roperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for s u r �It,'tfu�tr£ IrsIt
'FR- FI ,CQUN Ft' t�3 BUILDING PLAN REViE)V
existing building(s). Demolition permit is required prior to issuance of building it11,,1 41{I �a�it�3t £, '
permit for new building. mi';`i.
[�
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Is$tt;I
lb sn#{isr s+s s
+ t For—in if any Hazardous Materials are being used as part of this project.
[AllCoPY of Planning Approval Lettex or Meeting with Planning Prior to Kip 5141.1 IN
sumttal of Building Permit application. 11'{ 11 (
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BldgApp_201I.doc revised 03/16/I1