11070012 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11070012
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS REAL ESTATE GROUP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:07/14/2011
O"'NER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659
CJ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
BLDG 78-UNIT I-INSTALL NEW WASHER/DRYER AT
EXISTING CLOSET(I0SQFT)JNSTALL NEW AIR
License Class Lie.# CONDITIONING UNIT,REMODEL EXISTING
Contractor77-14(
Date
I hereby affirm that I am lie sed 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.
1 hereby affirm under penalty of perjury one of the following two declar Sq.Ft Floor Area: Valuation:$20000
t 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 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 �7 /
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:
_ �T-
costs,and expenses which may accrue ag st said City in consequence of the
granting of this permit. Additionally, applicant understands and will comply with
all non-point source repul tions pe e C perti o Municipal Code,Section 9.18. RE-ROOFS:
Date 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.
I-' OWNER-BUILDER DECLARATION Signature of Applicant: Date:
1.. .eby 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:
t. 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 I,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 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
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 or aurtl rize
permit is issued. Date: ,�j
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 ofthe Labor Code,1 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
ng 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 # . . . : 11070012
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd bldg. 78#1 DATE: 07/01/2011 REVIEWED BY: bobs.
APN: (�Q 07BP#: D "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 E) No PERMIT TYPE:
WORK
SCOPE
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $4 . F-1 Lj
NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee.Resolution 09-051 f;f'. 7;'I,-10) FEE QTY/FEE / MISC ITEMS
Plan Check Fee: $0.00 = s.f. ` odel,Kitchen(<=300 sf)
000,
Suppl.PC Fee: G Reg. 0 OT0.0 hrs $0.00 $57 . 0 IREMRESKIT
PME Plan Check: $0.00 = # h�ical
Permit Fee: $0.00 $601 IBR IR I A/C Units(<=10K cfm)
Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 # Mechanical
PME Unit Fee: $0.00 $12 . 0 1BAPPLOT Other Appliance/Equip
PME Permit Fee: $42.00
Acoustical Fee: 0 Yes E) No $0.00 0
Work Without Permit? 0 Yes (D No $0.00 E)
Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRA VDOC $ 0 Building or Structure
i
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $87.00 $759.00 TOTAL FEE: $846.00
Revised: 04/29/2011
06/30/2011 17: 19 (FAX) P- 002/004
07 12-
CONSTRUCTION
ZCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300',TORRE AVENUE •C:UPERTINO,CA 95014-3255 1B
CVIPERTINQ (408)777-3228• FAX(408)777-3333 • bUlldingncupertinO.OTq
❑NEW CONSTRUCTION ❑iADDITION EI ALTERATION/TI ❑ REVISION/DEFERRED ORIGIN,ALL(PERMIT it
PROIECTADDRESS UYI�F� APN M I 40n
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY STATE,ZIP
noo S, �u� \�L Si. -a I��CU Sc,s� �rN FAX
CONTACT NAME �7 PHONE E-MAIL
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STREET AADDRESS` CITY,STATE, ZIP FAX
Ca ' Y-.�s r_-c..a G:ter;o� • 3� Ya«�- .1�iSS1v
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
rONTRACTOR NAME LICENSE NUMBER LICENS YPE BUS.LIC H
'cs� ��� 4S`ti5 a 2�=Y`1 1 Z-1 S
COMPANY NAME E-MAIL FAX( 3'•)
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STREET ADDRESS CITY,STATE,ZIP PHONE C`si:5`
r�c� `IY�Or�Yr-2j- •.� r�s:.5 1-lL.. V! � ScJL:.s�c;.�, �-�1 �3�=;c���6" �-1��5• `1�,?�'\
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC H
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
I
DESCRIPTION OF WORK
h���-c.\` til c�_a_,� c_v c,��h ter— d l.f� 2f" c,,.� �x\�•�-:r C..lo'��k' � 1 U s� ._
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EXLSTING USE R"281101 "11—f,
{� { t k- (` } �Hjl+til li t �tt( +'!tE I� t3;,��.}
PROPOSED USE Co s"TYPE 0 STORIES R"2 I.STFa s 11—f a
1P��7�,ys`!ft�ylit {({t�t C¢j•RSII S uI
`4u to 5e+}�[_ MI UATION
EXISTG NEW FLOOR DEMO TOTAL Ali I' fl
14
AREA NET AREA 1
AREn AREA G
BATHROOM KITCHEN OTHER yy----��� t•[I '1�37it2illtfi+ I}}lt I N t! ``( t ti tic+1 I,; , f r s.>,;
REMODEL AREA REMODEL AREA - REMODELAREA 1tJ }..i({I
PORCH AREA DECK AREA TOTAL OECK/PORCH AREA GARAGE AREA: ❑DETACH ;t:i)}
❑ ATTACH
N DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES
BEING ADDED? ' QNOADDITION?NO Itttl1`j3,{.il!ii fI'Ifi1111� l ILISI}{{ ViESyt=ttt jII"I"Xf<1
..1
PRE-APPLICATION ❑ YES i3,'}ljl!amt S il�� 4 3
IF ,PROVIDE COPYOF LANN
ER'SNAIa: t �Psl4l ;lkS.�r'•IESS�;`l,: t ftIt<E•! ft
Lt
ATIQN:'
PLANNING APDL NO PLANNING APPROVAL LETTER
By my signature below,I certify to each of the following: Jam the property owner or authorized agent to act on the property owner's behalf. I h ve red ad this
application and the information I have prP vi 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 to g construction. I authorize representatives of Cupertino to enter the above-identified operty for inspection purposes.
Signature of Applicant/Agent: Date:_C.D„�z3
SUPPLEMENTAL INFORMATION REQUIRED
ORO, It r R4uTlvc sLrP
Q 11i
_New SFD or Multifamily dwellings: Apply for demolition permit for
O c iar� Ul�iiL�{' k BUIIAINC PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of buildingJI v�
permit for new building, hjl;L
irth12 I�,. x4j{ HLAIQIJItf( ELAN REVIEN,
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ''Isi �TIti ij
is D.1 l+'[i{: iQd}PUFIL10WORKS'.
Form if any Hazardous Materials are being used as part of this project. {(y��3 ti ala ate s`"�)I}it
_
Copy of Planning Approval Lettei or Meeting with Planning Prior to
submittal of Building Permit application.
e i ti 1 ! f r AN.►T �2Ye SEWER DlSTJt(CT
�t! r�{{I1+ _ i e
Sa :AQld�)N1ttIROIYMENTAbHFA'I:TFf
i
BIdgApp_2011.doc revised 03116111