11040148 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 78 CONTRACTOR:MONTEREY PERMIT NO: 11040148
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:04/20/2011
VY" ER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Class Lic.# ?9 MECH F RESIDENTIAL COMMERCIAL F
Contractor 1Date L ��
I hereby affirm that I am;liesed under the provisio s of Ch pter 9 JOB DESCRIPTION:UNIT B-REMODEL KITCHEN(SOSQFT),NON
STRUCTURAL,&
(commencing with Section 7000)of Division 3 of the Business&Professions LIGHTS;ADD NEW WASHER/DRYER IN EXISTING
Code and that my license is in full force and effect. CLOSET(IOSQFT)&INSTALL NEW A/C UNIT
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
I certify that I have read this application and state that the above information is APN Number:32609065.78 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source re lations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
1 2—
Signature Date L Issued Date:
[ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
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:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
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.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Owne�,or a $horized agent: /
forthwith comply with such provisions or this permit shall be deemed revoked. L r,fi` Date•
OF
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby a
correct.I agree to comply with all city and county ordinances and state laws relating affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
C and expenses which may accrue against said City in consequence of the Lender's Address
g ig of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
9 FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd bldg 78 B DATE: 04/20/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $20,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1 R3S EM
USE: 3 Stories C) Yes Q No PERMIT TYPE:
WORK remodel kitchen non structural add new W/D at existing closet install new A/C unit.
SCOPE
Mech.Plan Check 0.0 hrs $0.00
Fmech.Permit Fee: IMPERMIT
Other Mech.Insp. LLJ hrs $42.00
NOTE. Thesefees are based on the preliminary information available and are onl an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Pee Resolution 09-051 I:ff.' .-!(� FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: G Reg. () OT 0.0 hrs $0.00 $570.00 IREMRESKIT
PME Plan Check: $0.00 = s.f. Remodel,Other
Permit Fee: $0.00 $380.00 IREMRESOTH
Suppl.Insp.Fee.e Reg. 0 OT 0.0 hrs $0.001= # Mechanical
PME Unit Fee: $0.00 $63.00 IBREMAIR A/C Units(<=I OK cfm)
PME Permit Fee: $42.00
Acoustical Fee: 0 Yes G No $0.00 0
Work Without Permit? 0 Yes E) No $0.00
Planning Fee: $0.00 Select a Non-Residential G
Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0
i
Strom Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bld>Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $87.001$1,013.001 TOTAL FEE: $1,100.00
Revised: 01/15/2011
CITY OF CUPERTINO
7 ITEMS OF 28 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609065 . 78
DATE ISSUED. . . . . . . : 04/20/2011
RECEIPT #. . . . . . . . . : BS000013244
REFERENCE ID # . . . : 11040148
SITE ADDRESS . . . . . : 20900 HOMESTEAD RD BLDG 78
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS
ADDRESS . . . . . . . . . . : 1900 SOUTH NORFOLK ST STE 150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
RECEIVED FROM . . . . : RICHARD B 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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 20, 000 .00 1. 00 0. 00 1.00 0. 00
1BREMAIRHA NO.UNITS 1 .00 63 . 00 0. 00 63 .00 0. 00
1BSEISMICR VALUATION 20, 000 .00 2 . 00 0. 00 2 .00 0. 00
1MPERMITFE FLAT RATE 1 . 00 42 . 00 0. 00 42 .00 0. 00
1REMRESKIT SQ FEET 50. 00 570.00 0. 00 570.00 0. 00
1REMRESOTH SQ FEET 10. 00 380. 00 0. 00 380.00 0. 00
1TRAVDOC FLAT RATE 1.00 42 .00 0. 00 42 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1100. 00 0. 00 1100 .00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 4,400. 00 VISA
---------------
TOTAL RECEIPT 4,400.00
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
Building Department
City Of Cupertino
La 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 2-09<nO h6m9Sr1V7RQ e-D PERMIT# 0
OWNER'S NAME r PHONE#
GENERAL CONTRACTOR: ,� u- A. BUSINESS LICENSE
ADDRESS: IkLQ CITY/ZIPCODE: �'AwAM Z
*Our municipal code requires all businesses working ' 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 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
Date
Owner/ o ctor Signature
04/20/2011 11 : 43 (FAX) f I \ ( / t( P. 017/021
CITY OF
CITY OF CUPERTINO
ADDITION/FXi MODEL
CUPERTINO FEE SCHEDULE
APN# , )/' r'�C / - Date:
Is a 2"d unit being added? Yes I No ® If yes, please fill out the permit application for 2"d unit.
Is this a 2n°story Addition? Yes ❑ No
Is this house an Eichler? Yes ❑ No ® If es, needs Planning approval,
Building Address:
20900 Homestead Road Building�_ Unit#
Mailing Address (if different from building address):
88 Monterey-Salinas Hwy.,Suite A, Salinas, CA 93908;
Owner's Name: Phone#
Prometheus Real Estate Group 650)931-3400
Contractor: Phone#: (831)455-7931
Monterey Construction Company Fax/e-mai I:(831) 455-7986/thalia@mryconstructii)n.com
Cupertino Business License: State Contractor License#:
32275 885297
Contact: Phone#:(831)455-7931
Thalia Tardivet/Ben RegaFax/e-mai 1:(831)455-7986
__[Landscape Ordinance Compliance:
Landscape:urea in sq. ft. (includes all irrigated!areas):
If 2,500 sq. ft. or less,compliance with the Landscape Yater-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Pertnit Info: Bldg. Elect. Plumbing Mechanical Hillside El
Project Size: Counter ❑ Express ❑ Standard ❑ Large [] Major ❑
Job Description:
Addition-What is being added?(Be Specific):Install new washer/dryer at existing closet(10sq ft); install
new air conditioning unit
What is being remodeled (not including add itl6n)?Remodel existing kitchen (50 sq ft) cabinets,lights
Remodel Includes Re-Roof: Yes ❑ No ;® If yes list number of squares
Remodel Includes Structural: Yes ❑ No I
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of yourplanniri approval letter. Planners carne:
Square Footage:
Addition: Porch: Deck: Garage:Detached Attached
Remodel: Kitchen 50 Bath Other 10
Type of Construction (Usage Class): Occupancy Type:
1-A, l-B II/III/V-A ❑ IUlIIB, IV-HT, V-B Valuation:$ 2.0 e)a,,)
Please complete relevant portion of the Green Building-
Checklist.& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.